Confidential

Rahasia v5.0

BIODATA
This form will be use for further employee master data
Please fill this form by using a type NOT hand writing (Mohon untuk mengisi form ini dengan diketik, TIDAK menggunakan tulisan tangan)
*Filled by HR Division
1. Personal Data Data Pribadi
Employee No.* Commencing Date*
NIK* Tgl Masuk D D - M M - Y Y Y Y
==============================================================================================================================

Title* ✔ Mr Mrs Ms Marital Status* ✔ Single Married Divorced Widower

Gelar Status

Name (as in ID)* Employee Name Date of Marital

Nama (sesuai KTP) Tanggal pernikahan D D - M M - Y Y Y Y

Date of birth* 01-01-1900 Religion - Please Select -

Tanggal Lahir D D - M M- Y Y Y Y Agama

Place & Country of Birth Birth Place Height/ Weight cm kg

Tempat Lahir Tinggi/ Berat badan

Nationality - Please Select - Blood Type

Warga Negara
- Please Select -
Golongan Darah

Ethnic Group - Please Select - Social Media

Suku
Media Sosial

NPWP Number Payee Name Sinarmas

No NPWP (No Pajak) Nama sesuai rekening Bank Sinarmas
BPJS Number Account Number Sinarmas
No Jamsostek(BPJS Ketenagakerjaan) Nomer rekening Bank Sinarmas

2. Contact Details Detail Kontak

Email Address
Alamat Email
Permanent Address (as in ID) Alamat Tetap (sesuai KTP)
Street & House No. Region/ Province
Jalan & Nomor Rumah Wilayah/ Propinsi - Please Select

2nd Line Address City

Alamat Baris ke-2 Kota/Kabupaten
Country Districts
Negara - Please Select - Kecamatan
Postal Code 99999 Sub - Districts
Negara Kelurahan
62
Telephone No.
No. Telephone
Current Address* Alamat Sekarang
*To be filled should current address is different from address stated in ID (Diisi jika alamat sekarang berbeda dengan alamat di KTP)
Street & House No. - Please Select
Jalan & Nomor Rumah Region/ Province
Wilayah/ Propinsi
2nd Line Address
Alamat Baris ke-2 City
Kota/Kabupaten
Country
Negara - Please Select - Districts
Kecamatan
Postal Code 99999
Negara Sub - Districts
62 Kelurahan
Telephone No.
No. Telephone

Emergency Address Alamat Darurat

Street & House No.
Jalan & Nomor Rumah Region/ Province - Please Select
Wilayah/ Propinsi
2nd Line Address
Alamat Baris ke-2 City
Kota/Kabupaten
Country
Negara - Please Select - Districts
Kecamatan
Postal Code 99999
Sub - Districts
Negara Kelurahan
62
Telephone No. Contact Person
No. Telephone

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BIODATA FORM

3. ID Data Data Identitas

Place & Country of
Items Number Issue Date of Issue Valid to
Jenis Nomor Dikeluarkam di Tanggal Dikeluarkan Berlaku sampai dengan

ID Card
1 - Pleas e Select -
. (No KTP)
D D - M M - Y Y Y Y D D - M M - Y Y Y Y

2
. Passport
(Passport) Indone sia

D D - M M - Y Y Y Y D D - M M - Y Y Y Y

3
Driving License Type A
(Jenis Surat Izin Mengemudi) Indone si
a
D D - M M - Y Y Y Y D D - M M - Y Y Y Y
4
Driving License Type
(Jenis Surat Izin Mengemudi) A Indone sia

D D - M M - Y Y Y Y D D - M M - Y Y Y Y

4. Family Data Data Keluarga

Relationship Full Name Place of Birth Date of Birth Occupation Nationality
Hubungan Nama Lengkap Tempat Lahir Tanggal Lahir (dd/mm/yyyy) Pekerjaan Warga Negara

1 Father (Ayah) 01-01-1900 - Please Select -

.

2 Mother (Ibu) 01-01-1900 - Please Select -

.

Father-in-law
3 (Ayah Mertua) 01-01-1900 - Please Select -
.

Mother-in-law
4
(Ibu Mertua) 01-01-1900 - Please Select -
.

Spouse
5
(Istri/ suami) 01-01-1900 - Please Select -

6 Son 01-01-1900 - Please Select -

7 Son 01-01-1900 - Please Select -

8 Son 01-01-1900 - Please Select -

9 Brother 01-01-1900 - Please Select -

Tax Exemption Status

(Jumlah Tanggungan Penghasilan Tidak Kena Pajak PPh 21) No Kartu Keluarga
Tidak Ada Tanggungan

Please use this space for additional information for your family members
(Silahkan pergunakan tempat kosong di bawah untuk informasi tambahan anggota keluarga
anda)

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BIODATA FORM
5. Previous Employers Riwayat Pekerjaan

Company Name From To Type Industry Job/Position City Country

Nama Perusahaan Awal
(dd-mm-yyyy) Akhir Tipe Industry Pekerjaan Kota Negara
(dd-mm-yyyy) please choose one type industry

- Please Select - - Please Select - Indonesia

1.

- Please Select - - Please Select - Indonesia

2.

- Please Select - - Please Select - Indonesia

3.

- Please Select - - Please Select - Indonesia

4.

Job Description at last position

(Tanggung jawan pekerjaan di posisi terakhir)

6. Last Education Pendidikan Terakhir

School/College/University Country Education Level Branch of Study GPA From - To (date)
Nama Sekolah Negara Level Pendidikan Jurusan Nilai Mulai dari / sampai dengan

Indonesia - Please Select - - Please Select -

Indonesia - Please Select - - Please Select -

7. Training Pelatihan
Course Name Institution From - To (date)
Nama Pelatihan Penyelenggara Mulai dari / sampai dengan

1.

2.

3.

8. Skills Keterampilan
Languages (Bahasa)

Computer / Program (Komputer / Program)

Others (Lain-lain)

9. Other Associations/Organizations Asosiasi/Organisasi Lainnya

Association/Organization Name From - To (date) Position Country
Nama Asosiasi / Organisasi Mulai dari / sampai dengan Posisi Negara
1.

2.

3.
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BIODATA FORM
10. Others Lain-lain

1. Are you willing to be relocated Ye No

s
Bersediakah anda untuk di relokasi?
If yes, please state your prefered location (Jika ya, tuliskan lokasi yang dikehendaki)

2. Are you willing working on shifts? Ye No

Bersediakah Anda untuk bekerja dalam shifts? s
* For certain area and locations Please state reason (alasan)

3. Do you own any vehicle? Ye No

Apakah Anda memiliki kendaraan pribadi? s
If yes, please state type and year (jika ya, tulisan tipe dan tahun)

4. Have you ever suffered any serious

illness/ have acccident history ?
Apakah Anda pernah menderita penyakit berat/ Ye No
s
memiliki riwayat kecelakaan?
If yes, please state what and when (jika ya, tuliskan penyakit dan kapan diderita)

*5. Do you have family/ relatives at

Company Group?
Apakah Anda mempunyai keluarga/ kerabat di Grup Perusahaan ini?
Ye No
s
*6. Do you own or are part of ownership/ shareholder of If yes, please state detail : employee name, company and dept (Jika ya, sebutkan nama, karyawan
perusahaan, dan dept)
any companies or hold directorship or other external/ part
time employment of other than your current company
discussed during recruitment process?
Apakah anda memiliki / menjadi bagian dari kepemilikan perusahaan Ye No
atau memiliki jabatan directorship atau menjalani pekerjaan diluar/ s
paruh waktu diluar pekerjaan anda saat ini? If yes, please state % of ownership or directorship or employment position and name of the
company (Jika ya, sebutkan % kepemilikan atau jabatan directorship atau pekerjaan lainnya serta
nama perusahaan)

*Note : If candidate state Yes on point 5 or 6, please consult with CRI

Division
7. Have you ever followed the recruitment process in
Ye No
Company Group in the past? s
Apakah Anda pernah mengikuti process di Grup Perusahaan ini? If yes, please state when and what company (Jika ya sebutkan kapan dan
perusahaan)
8. How do you know about this Company?
Darimana Anda mengetahui mengenai Grup Perusahaan ini?

9. Have you completed your COVID 19 Vaccination? - Please Select - - Please Select -
Ye No
s
Apakah anda sudah melakukan vaksinasi COVID 19?
If yes, please state type and date of vaccination (1st and 2nd dose) - Please Select - - Please Select -

10. Do you have any concern on COVID - Please Select - - Please Select -
19 Vaccination ?
Apakah anda memiliki kekhawatiran terhadap vaksinasi Ye If yes, please please choose one of the reason below :
No
s

-Please Select-
Covid 19 ?

11. References Refer en i

Name s Company Phone Number Job/Position Relationship
Nama referensi Nama Perusahaan Nomor Telepon Pekerjaan Hubungan

1.

2.

3.

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BIODATA
12. Closing Penutup
I hereby certify the information provided above is true. I understand that any misleading information provided in biodata form may result in
rejected application / termination of my employment.

Date
Tanggal
D D - M M - Y Y Y Y Signature and Full Name
(Tanda Tangan dan Nama Lengkap)

Note:
For applicants; no salary, compensation or benefit is to be discussed during the interview. This process will be done by Compensation and
Benefit team of CHR. Thank you.

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