APPLICATION FORM

Position Applied For (Posisi yang dilamar) :

A. Personal Information (Informasi Pribadi)

Full Name
(Nama Lengkap)
Alias
(Nama Panggilan)

Permanent Address
(Alamat Sekarang)

Mobile Email Address

(Handphone) (Alamat Email)
Gender
Male/Female
(Jenis
Date of Birth (Laki-laki/Wanita)
Kelamin)
(Tgl & thn Lahir)
Marital Status No. of
(DD/MM/YYYY)
(Status Children
Pernikahan) (Jumlah Anak)
Country / State of
Parents Address
Birth
(Alamat Tinggal
(Negara/Tempat
Orang Tua)
Lahir)
Identity Card Nationality
(Kartu Identitas) (Kebangsaan)
Religion Blood Type
(Agama) (Golongan Darah)

B. Education Background (Please attach copies of certificates/testimonial)

(Latar belakang Pendidikan - Harap dilampirkan salinan sertifikat/Ijazah)

Year Highest Level

Academic
Name of Institution (Tahun) Achieved
Level
(Nama Institusi) From To (Tingkat
(Tingkat Akademik)
(Sejak) (Sampai) Tertinggi)
Primary
(Ke-1)
Secondary
(Ke-2)
Pre-U/College
(Perguruan Tingi)
Vocational
(Kejuruan)
(e.g. ITE)
Diploma
(Diploma)
Tertiary
(Pendidikan
Lanjutan)
Other
(Lain-lain)

C. Language Skill (Keterampilan Bahasa)

Oral Reading Written

Language
(Berbicara) (Membaca) (Menulis)
(Jenis Bahasa)
(Limited/Average/Good) (Limited/Average/Good) (Limited/Average/Good)

D. Work Experience (Pengalaman Pekerjaan)

(Pls. begin with the three most current job, and attach a copy of detailed resume if all employment history could not be completed in this
form – Dimulai dari tiga pengalaman kerja terakhir)

Current Employer Date Basic Monthly

(Pekerjaan saat ini) [MM/YYYY] Salary
Start
Position Start
(Jabatan/Posisi) /
Report To Last Drawn
(Lapor ke) Left
(Position) /
(Posisi)
Nature of Business
(Bidang Bisnis)
Reason(s) for
Leaving
(Alasan berhenti)
Did you receive any other remuneration / Allowance? [ ] Yes [ ] No
(Apakah ada tunjangan lain)
If yes, please specify :
(Jika ya, harap sebutkan)

Previous Employer
Date Basic Monthly
(Pekerjaan
[MM/YYYY] Salary
sebelumnya)
Position Start Start
(Jabatan/Posisi) /
Report To Last Drawn
(Lapor ke) Left
(Position) /
(Posisi)
Nature of Business
(Bidang Bisnis)
Reason(s) for
Leaving
(Alasan berhenti)
Did you receive any other remuneration / Allowance? [ ] Yes [ ] No
(Apakah ada tunjangan lain)
If yes, please specify :
(Jika ya, harap sebutkan)

Previous Employer
Date Basic Monthly
(Pekerjaan
[MM/YYYY] Salary
sebelumnya)
Position Start Start
(Jabatan/Posisi) /
Nature of Business Left Last Drawn
(Bidang Bisnis) /
Reason(s) for
Leaving
(Alasan berhenti)
Did you receive any other remuneration / Allowance? [ ] Yes [ ] No
(Apakah ada tunjangan lain)
If yes, please specify :
(Jika ya, harap sebutkan)

Last Drawn
Previous Employer
Salary
(Pekerjaan sebelumnya) Start Left Position Reason(s) for Leaving
Amount
(Continue from above) (Mulai) (Akhir) (Jabatan/Posisi) (Alasan berhenti)
(Gaji
(Lanjutan dari atas)
terakhir)

E. Family Member (Anggota Keluarga)

Relationship Name Male/Female Place, Date of Birth Education Occupation

(Hubungan) (Nama) (Laki/Perempuan) (Tempat,Tgl Lahir) (Pendidikan) (Pekerjaan)
Spouse
(Suami/Istri)
Children no.1
(Anak ke-1)
Children no.2
(Anak ke-2)
Children no.3
(Anak ke-3)
Children no.4
(Anak ke-4)
Children no.5
(Anak ke-5)

F. General Information (Informasi Umum)

 Character Reference (please provide ex-employee’s contact)
(Referensi Karakter, berikan kontak teman karyawan di Perusahaan sebelumnya)

Name Name
(Nama) (Nama)
Contact Contact
No. Relationship No. Relationship
(Nomor (Hubungan) (Nomor (Hubungan)
kontak) kontak)
[ ] Newspaper Advertisement [ ] Agency [ ] Unsolicited/Walk-in
(Surat kabar) (Agensi) (Tidak sengaja)
How are you referred to ARA
[ ] Executive Search [ ] E-recruitment (Internet)
Shoes Indonesia
(Pencarian Execuitve) (Internet)
(Bagaimana anda
[ ] Employee Referral (pls. provide name : )
mengetahui tentang ARA
(Referensi Karyawan(Mohon sebutkan nama)
Shoes Indonesia)
[ ] Other (pls. Specify : )
(Lainnya(harap sebutkan)
Do you have any [ ] Yes [ ] No
friends/relative working in
ARA Shoes Indonesia If yes, please state name / relationship : )
(Apakah anda mempunyai (Jika ya, harap sebutkan nama/hubungan)
teman yang bekerja di ARA
Shoes Indonesia )
[ ] Yes pls. state class license (e.g. 2A,2B, etc)
Are you holding a driving
license (including forklift)
[ ] No
(Apakah anda mempunyai
SIM, termasuk Forklift)
Have you been convicted for [ ] Yes [ ] No
any criminal offence in any
country? If yes, please give details :
(Apakah Anda pernah (Jika ya, tolong berikan detailnya)
dihukum karena
pelanggaran pidana di
negara mana pun?)
[ ] Yes [ ] No
Do you have known illness?
(Apakah anda menderita If yes, please give details :
penyakit lain) (Jika ya, tolong berikan detailnya)
[ ] Yes pls. state which year it was diagnosed:
Do you have color blind? (Tahun diagnosis)
(Apakah anda buta warna) [ ] No

Notice Period Expected Basic Salary Amount :

(Waktu siap Bekerja) (Gaji yang diharapkan) (Angka)

G. Declaration (Pernyataan)

I declare that the particulars given in this application are true and accurate to the best of my knowledge.
(Saya menyatakan bahwa keterangan yang diberikan dalam aplikasi ini adalah benar dan akurat).
I understand that any omissions or false statement made by me on this application will give sufficient grounds for
immediate termination.
(Saya mengerti bahwa apabila dikemudian hari ditemukan kelalaian atau pernyataan tidak benar/palsu yang saya buat
pada aplikasi ini akan memberikan alasan yang cukup untuk pemberhentian hubungan kerja saya).

Date Applicant Signature

(Tanggal) (Tanda tangan Pemohon)

FOR OFFICIAL USE ONLY

 Interview Assessment

Interview(s) Comments Signature & Date

Name :

Date & Time : Assessment :

[ ] 1st Interview [ ] Potential-Proceed to 2nd interview
[ ] 2nd Interview
[ ] 3rd Interview [ ] Reject

Name :

Date & Time : Assessment :

[ ] 1st Interview [ ] Hire
[ ] 2nd Interview
[ ] 3rd Interview [ ] Reject

Name :
Assessment :
Date & Time :
[ ] Hire
[ ] 1st Interview
[ ] 2nd Interview
[ ] Reject
[ ] 3rd Interview

Final Application Status [ ] Hire [ ] Reject

Other Comments :