EMPLOYEE APPLICATION FORM
Date
Position Applied
Availability
Personal Information
Full Name
No KTP
Phone Number Personal Email
Current Address
Place of Birth Date of Birth
Gender Blood type
Marital Status Religion
Call in case emergency
1st Contact 2nd Contact
Name
Address
Phone Number
Relationship
Formal Education and Professional Certification
Name of Institution Place Year Faculty / Major GPA
Working Experience
Name of Company Position Period Reason of Resignation
Skills and Abilities
Languages Level of Proficiency Computer Literate / Other skills Level of Proficiency
OTHERS
What kind of information you would like to inform us? Please specify e.g. awards, acknowledgement.
Current Salary Expected Salary
Would you mind if we contact your previous company?
If yes, why?
Have you ever been convicted of a crime?
If yes, why?
Would you mind to work from the office?
If yes, why?
Reference Contact Name
Company/position
Have you had any serious disease or physical or mental disorder?
Please Describe
I hereby declare that the information provided us is true and correct. I also understand that any willfull dishonesty may impact to immediate
termination of the employment
I authorize PT Cerdas Digital Nusantara to keep this information in my personal file and disclose n a confidential
manner of any information supplied in this form to the parties namely the People & Culture staff, concerning
department head or above for and assessment.
I also understand that it is mandatory to update the above information, if any.
Date
Full name
Signature