Form No.

: POS – 003
Date : 23 Nov 2022

APPLICATION FORM Please attach

Production & Operation Supervisor your latest
photo.

I. PERSONAL INFORMATION

1. Full Name :
2. Address :

3. Email Address :
4. Telephone No. : [Home] [Mobile]
5. Place & Date of Birth :
6. Identification [KTP] No. :

II. EDUCATIONAL QUALIFICATION

Formal Education

YEAR DEGREE SCHOOL / UNIVERSITY MAJOR GRADE

Informal Education / Training

CERTIFICATE
YEAR EDUCATION / TRAINING HELD BY
YES NO

III. LANGUAGE PROFICIENCY

Please write: Excellent / Good / Fair

LANGUAGE SPEAKING LISTENING READING WRITING

IV. EMPLOYMENT HISTORY

Company : Position :
Address : Main Duties :
[in brief]

Telephone No. : Reason for Resigning :

Field :
No. of Employees : Last Salary :
Director’s Name : Working Period :

Company : Position :
Address : Main Duties :
[in brief]

Telephone No. : Reason for Resigning :

Field :
No. of Employees : Last Salary :
Director’s Name : Working Period :

Company : Position :
Address : Main Duties :
[in brief]

Telephone No. : Reason for Resigning :

Field :
No. of Employees : Salary :
Director’s Name : Working Period :

DESCRIBE AND ELABORATE YOUR RESPONSIBILITIES OF YOUR LATEST POSITION [IN ENGLISH]

V. OTHERS

Referees : Name : Position :

Company : Telephone :
 Address : Relation :

VI. QUESTIONS

Do you mind if we contact your referees

directly?
Do you have any friends or relatives who work
in this company?
Have you ever had a serious illness, surgery, or
been hospitalized?
Have you ever had any criminal records with the
Government or Security Department?
If you are accepted, how much is your expected
salary?
When will you be able to start working in this
company?

I hereby declare that all of the above statements are true and correct. I fully understand that any
information if proved incorrect or false will render me liable to be rejected or terminated.

Jakarta,

Full Name

To be Filled-in by HRD

This data has been input in the Database This data has been checked
:
Date : Date
:
By : By

Signature Signature :