APPLICATION FORM Doc. FRM.REC.

01
(Please fill in details below for our reference) Date

JOB APPLICATION FORM

Vacancy title:

Please tell us how you heard about this vacancy:

Have you ever applied to the Company before? If yes, list the date (s) and job title (s)

Have you ever been employed with the Company before? If yes, list the date (s) and job title (s)

Are you acquainted with or related to any employee of the Company? If yes, identify by name and relationship

Your Social Media Profile

LinkedIn : ___________________________ Github : ___________________________
Facebook : ___________________________ Medium : ___________________________
Twitter : ___________________________
Instagram : ___________________________

1. Personal details

Full name: Nick name:

Date of Birth

Domiciled Address:

(Present Address)

Address
(based on ID):

Mobile Phone Phone: E-mail address:

Identity Card No.

NPWP No.

Marital Status Married Single Divorced

 2. Family Details

Spouse and Children

Name M/F Age Education Job Company
Spouse

Child 1

Child 2

Child 3

Family Details (Father, mother, brothers/sisters including you)

Name M/F Age Education Job Company
Father

Mother

Bro./Sis. 1

Bro./Sis. 2

Bro./Sis. 3

3. Health History

1. Have you had a rather severe illness/accident? Date obtained

If yes, please describe

2. Does it have a side effect presently? Date obtained

If yes, please describe

4. Education/Qualifications

Formal Education

Education School’s Name Major Year Attended: From/To Degree Received

High School

Academy

University

Non-Formal Education: Course/Training/Seminar

No Course Details Provider Year/Period Paid by
Training Course
(Nature of training)
Extracurricular / Social / Teaching Activities

No Name of Activities Position Organization Year/Period Paid by

A scientific publication including thesis

Language Skills

Listening Speaking Writing

Language
No Fluent Fair Slight Fluent Fair Slight Fluent Fair Slight

Hobbies

Scholarship/awards/prizes received:

5. Employment history

Previous employment: Please include any previous experience (paid or unpaid), starting with the most recent first.

A current or most recent employer

Name of employer:

Address:

Postcode:

Position held: Grade:

No. of total employees:

No. of employees supervised:

Direct Supervisor’s name:

Date started: Leaving date:

Reason for leaving:

Salary:

Allowances (*transport, meal, etc.):

Bonus/Commission:

Benefit (*medical, etc.):

Brief description of duties:

Company Structure:

Achievement:

Previous employer

Name of employer:

Address:

Postcode:

Position held: Grade:

No. of total employees:

No. of employees supervised:

Direct Supervisor’s name:

Date started: Leaving date:

Reason for leaving:

Salary:

Allowances (*transport, meal, etc.):

Bonus/Commission:

Benefit (*medical, etc.):

Brief description of duties:

Company Structure:

Achievement:

Previous employer

Name of employer:

Address:

Postcode:

Position held: Grade:

No. of total employees:

No. of employees supervised:

Direct Supervisor’s name:

Date started: Leaving date:

Reason for leaving

Salary

Allowances (*transport, meal, etc.):

Bonus/Commission:

Benefit (*medical, etc.):

Brief description of duties:

Company Structure:

Achievement:
Expected monthly salary

Earliest date able to commence employment?

References
Please give the detail of two references

Name of referee and relationship to you:

Address:

Postcode:
Email: Phone:

Name of referee and relationship to you:

Address:

Postcode:
Email: Phone:

Declaration

Statement to be signed by the applicant

Please complete the following declaration and sign it in the appropriate place below. If this declaration is not completed and signed, your application will not be
considered.
I confirm that all the information given by me on this form is correct and accurate and I understand that if any of the information I have provided is later found to
be false or misleading, any offer of employment may be withdrawn or employment terminated.

Signed: Date: