APPLICATION FORM

(Write in Capital Letters)

Position Applied For EXPECTED SALARY Available Starting Date

General Admin 2.700.000 As soon

A. PERSONAL INFORMATION
PERSONAL DATA
Full name : Revika Pratama Manrafi  Male  Female
Place / Date of Birth : Bandar Lampung, 22 Mei 1996
Temporary Address : Jl. Teluk Pandan 2 No. 07 Kel. Kota Karang Kec. Telukbetung Timur

City : Lampung Post code : 25231 Telephone : 0895396311945

Permanent Address : Jl. Teluk Pandan 2 No. 07 Kel. Kota Karang Kec. Telukbetung Timur

City : Lampung Post code : 25231 Telephone : 0895396311945

I.D. Card Number : Date of Expiry :
Marital Status : Single Number of Children : -
Religion : ISLAM Blood Group :-
Height / Weight : 167cm / 52 Hobby : Badminton
Distinguishing Marks :

FAMILY RECORD

Father Name Mappiasse Date of Birth 01–01-1966 Address Jl. Teluk Pandan 2
Mother Name Nuraini No. 07 Kel.
Date of Birth 12-02-1968 Address Kota Karang
Jl. Teluk PandanKec.
2
Husband/Wife Name Date of Birth No. 07 Kel. Kota Karang Kec.
Address
Children Name 1 _Date of Birth
2 Date of Birth
3 Date of Birth
Brother/Sister Name Hikmah Ananta Manrafi Address/Phone. 081377888347
Contact person in case of emergencies Ibu _ Address/Phone. 082257180005

B. EDUCATION

Name and address of school,

From To Major Course
University or other Training Degree or Certificate
(MM/YY) (MM/YY) or
Institutions.
Stud
Universitas Teknokrat Indonesia 22/09/2014 22/09/2020 Sistem Informasi S1
C. RECORD OF PREVIOUS EMPLOYMENT

1. Company Name : LP2KP Telephone : 081315068999

Address : Jl. Tl Pandan 4, Bandar Lampung _ Position : Staff
Duties : Staff marketing social media,
membuat postingan – postingan di web,
mengedit surat undangan bimtek

Nature of Business : Event Organizer

Employment dates : from 2015 to 2020 Supervisor’s Name: Hj. Khadaria
Salary : _2.000.000
Reason for leaving : Ingin menyelesaikan kuliah yang sedang di tahap sidang skripsi di tahun 2020

2. Company Name :PT. PLN Persero Telephone :

Address : Tj. Karang Pusat Position :PKL
Duties : Mahasiswa PKL

Nature of Business :BUMN

Employment dates : from 2017 to 2018 Supervisor’s Name:Iradona
Salary : _
Reason for leaving : Habis masa PKL

3. Company Name :BAWASLU Telephone :

Address :Bandar Lampung Position :PANWASLU
Duties :Panitia Pengawas Pemilu

Nature of Business :Pemilihan Walikota

Employment dates : from 2020 to 2020 Supervisor’s Name:Ismail Marzuki
Salary : 1.500.000 _
Reason for leaving : Habis masa kontrak

4. Company Name :SD N 2 Sukamaju Telephone :

Address :Lempasing Position :Staff TU
Duties : Melakukan adminstrasi

Nature of Business :Pendidikan

Employment dates : from 2022 to 2022 Supervisor’s Name:Rosidah
Salary : _1.000.000
Reason for leaving : Staff TU sebelumnya yang cuti melahirkan masuk kembali

REFERENCES (Non – Relatives)

1. Name : Phone/Mobile: Company : _

E-Mail : _ Years Known : _

2. Name : Phone/Mobile: Company : _

E-Mail : _ Years Known : _

3. Name : Phone/Mobile: Company :

E-Mail : Years Known : _
Other Activities

Name of Organisation From date To date Status

D. GENERAL INFORMATION
Have you ever applied to any of OHMManagement properties? Yes  No

Which property? _ When

Are you presently employed? Yes  No

Have you ever been discharged from employment? If yes, please explain

Have you any objection to our contacting your previous employers? Yes  No

Have you had any serious illnesses, injuries or operations within the last five (5) years? If so, please describe
No

Do you have any immediate family members, i.e. husband, wife, parents, child, brother, sister, working within
OHM Management Group? Yes No

If yes, who and in which property?

(1)
(2)
(3)

Excellent Good Average Not Good

Language Proficiency

English
Other

Computer

Word
Excel
Other

Serious Illness

Lungs Veneral Disease HeartHypertension

Ayan Di betes Cance Other

The Positive in Yourself

STRENGTH WEAKNESS
- Senang belajar hal baru - Karakter pendiem, jadi lebih pemalu pada
- Cepat belajar tentang sebuah tugas kerja momen pertama seperti berkenalan dengan
- Teliti teman baru

I certify that all statements made on this application are true and complete to the best of my knowledge. I
understand that misrepresentation or omission when discovered, will subject me to discharge and I hereby
authorize any investigation relating to my work experience, education, or reputation for the purpose of my
application for employment.

Signature
 INTERVIEW SHEET

PERSONNEL HOD GM
DATE OF INTERVIEW

INTERVIEWED BY

OBSERVATION

APPEARANCE 3
PERSONALITY 3
INITIATIVE LEADER ABILITY 2

COMMUNICATION SKILL 3

MOTIVATION 3
STABILITY 3
TECHNICAL SKILL 3
COOPERATIVE ATTITUDE 3
EXPERIENCE BACKGROUND 3
4 = Excellent 3 = Good 2 = Average 1 = Not Good

REMARKS

HRD :

HOD :

GM :

Recommended ( ) Yes ( ) No
Reference check required ( ) Yes ( ) No
Site Inspection ( ) Yes ( ) No
Hired ( ) Yes ( ) No ( ) Put on Hold

ACCEPTED / NOT ACCEPTED

If accepted, Approved by,

Position

Starting of date _

Salary Confirmed Rp. _

Others Benefit Director