HQ/HRD/Job Application Form/001

PT I LINK AGE INTERNATIONAL INDONESIA

Employment Information
Please read these instructions carefully.
1) This form is to be completed before an interview session.
2) Do not leave any item blank. If it is not applicable to you, please indicate "N/A".
3) Please attach a copy of your National ID or passport showing all relevant details duly marked across for "interview Only".
4) Please attach photocopy of all educational certificate(s) and present the original certificate(s) during interview.

Position Applied For : Date:

Personal Particulars

Name ( As Per National ID ) Alias (If Any) :

National ID

Nationality Race :

Sex Age : Marital Status :

Date of Birth Place of Birth : Religion :

Handphone No.: House No.: Email Address:

Permanent Address

Post Code :

Present Address

Post Code :

Language / Dialects
Please indicate competency in language (B - Basic ; I - Intermediate ; F - Fluent)
Language / Dialects Spoken Read Written

Family Particulars
A. Spouse Details

1 Spouse Name (As per National ID )

Employer :
2 Occupation Tel. No. (Office) :

B. Children
No. Name Sex Age Occupation

EMERGENCY CONTACT

No. Name Relatioship Mobile No. Address

 HQ/HRD/Job Application Form/001

Education & Qualification

Primary & Secondary School Education

Year Attended
Type of School Name of School Qualification Obtain
From To

Professional Body Affiliations & Other Affiliations (active only)

Membership Title/
No. Name of Prof. Body/Society Membership Type Membership since
Position Held

Other Skills
Please Describe the skills that you :-
1) have obtained throughout your working experience. 2) have learned by self study without going through a course of study.

No. Description of Skill Acquired Since

Employment Status
Please attach with comprehensive resume which MUST be duly updated.

Additional Particulars

Have you worked in PT I Link Age International Indonesia before? Yes No

If yes, please fill up the following.

Company Name Nature of Work From To Reason For Leaving

Name of Relatives or Friends working in

PT I Link Age International Indonesia

Have you been found guilty in any court of law or detained under written laws?
Yes No
If yes, please give details:

Have you ever been declared Bankruptcy or declared under Bankruptcy Act?
Yes No
If yes, please clarify.

Have you ever been hospitalised or diagnosed or treated for any illness or undergone any medical treatment over
the last 12 months? Yes No
If yes, please clarify.

Professional Referral

No. Name Position Relationship Tel. No. Company Name

Expected Salary :

Estimated Commencement Date : Notice Period:

I declare that the above information are true and complete and I am liable to diciplinary action conducted against me for falsifying or not declaring any of the above information
required.False or inaccurate information given will render any subsequent employment contract null & void.

Name Signature of Applicant Date

This Employment Information must be attached with all relevant certificate(s), National ID or Passport, 3 months updated payslip duly certified and updated comprehensive
resume.