EMPLOYMENT APPLICATION FORM

DOKUMEN DATA DIRI KANDIDAT

(WAJIB DILAMPIRKAN)
NO DOKUMEN KETERANGAN

Formulir aplikasi diisi dengan “TULIS TANGAN” wajib di tanda Scan berwarna
1
tangan

2 CV terbaru Scan berwarna

3 Ijazah & transkrip nilai terakhir sudah legalizir Scan berwarna

4 Semua Sertifikat Workshop Scan berwarna

Surat keterangan kerja /paklaring dari semua Perusahaan yang Scan berwarna
5
telah lampau

6 Kartu Tanda Penduduk (KTP) Scan berwarna

7 Kartu Keluarga (KK) Scan berwarna

8 Nomor Pokok Wajib Pajak (NPWP) Scan berwarna

9 BPJS Ketenegakerjaan Scan berwarna

10 Slip gaji bulan terakhir Scan berwarna

11 Pas Foto 4x6 berwarna – Background bebas Digital

Buku tabungan LEMBAR AWAL SAJA yang terdapat nama & nomor Scan berwarna
12
rekening

-oOo-

Page i of 9
 EMPLOYMENT APPLICATION FORM

USE CAPITAL LETTERS

Position Applied for

Vacancy Information from

I. PERSONAL DATA

Full Name: Sex:

Blood Type:

Place Of Birth: Date of Birth: Religion:

Ethnic:

Correspondence Address: Marital Status :

Post Code:
Permanent Address: ID Number / Passport #:

Post Code:
Home Phone Number: Cell Phone Number 1:

Email Address: Cell Phone Number 2:

Jamsostek Number:

Driving License Number: Driving License Type:

Nationality:

A. Personal Details

Page ii of 9
B. Family Details
(Spouse and Children)
Name M/F Age Education Occupation Company
Spouse
Child 1

Child 2
Child 3

Child 4

C. Family Details
(Father, Mother, Brothers/Sisters, Including You)
Name M/F Age Education Occupation Company
Father
Mother
Bro./Sis. 1
Bro./Sis. 2
Bro./Sis. 3
Bro./Sis. 4
Bro./Sis. 5
Bro./Sis. 6
Bro./Sis. 7

II. EDUCATION AND SKILLS

A. Formal Education
Education School Name Major From Until GPA
High School
Diploma
Graduate - (S1)
Master - (S2)
Doctorate - (S3)

B. Non Formal Education: Course/Training/Seminar

Field/Kind Held By Level Year/Period Paid By

Page iii of 9
 1. Scientific Publication Including Thesis

2. Extra Curricular/Social/Teaching Activities

Name of Activities/ Organization Position Year/Period
1.
2.

C. Language (Proficiency)
Listening Speaking Writing
Fluent Fair Slight Fluent Fair Slight Fluent Fair Slight
1. English
2. Bahasa
3.

D. Hobbies/Sport

E. List any other education, training, special kills, or certificate/licenses that you posses related to this job

F. Scholarship/Award/Prize Received
Year Award Specification Remark

III. REFERENCE

Please mention two persons that we can get information about you (not your family)
Name Relationship Home/Company Address Telephone

Please mention employee of PT TOBA SEJAHTRA who know you very well
Name Relationship Department Extension

Page iv of 9
 IV. WORK EXPERIENCES

(There latest experience, please begin with the most recent)

1. Month Year Name/Address/Phone of Company Position
From First:
To Last:
Type Of Business: Total Employees: Last Drawn Salary:

(GROSS / NETT)*
Name of Supervisor: Name of Director:

Major Tasks And Responsibilities:

Major Achievement:

No. Of Employees Supervised, Directly: Indirectly:

Major Reason For Leaving:
Minor Reason For Leaving:

2. Month Year Name/Address/Phone of Company Position

From First:
To Last:
Type Of Business: Total Employees: Last Drawn Salary:

(GROSS / NETT)*
Name of Supervisor: Name of Director:

Major Tasks And Responsibilities:

Major Achievement:

No. Of Employees Supervised, Directly: Indirectly:

Major Reason For Leaving:
Minor Reason For Leaving:

3. Month Year Name/Address/Phone of Company Position

Page v of 9
From First:
To Last:
Type Of Business: Total Employees: Last Drawn Salary:

(GROSS / NETT)*
Name of Supervisor: Name of Director:

Major Tasks And Responsibilities:

Major Achievement:

No. Of Employees Supervised, Directly: Indirectly:

Major Reason For Leaving:
Minor Reason For Leaving:

V. CURRENT OR LAST WORK CONDITION – SALARY AND BENEFITS

Monthly Salary Company Car /Make / CC
(GROSS / NETT)*
THR House (Value / Month)
BONUS Medical-Inpatient 1.
COMMISSION 2.
ALLOWANCE 1. Medical -Outpatient 1.
2. 2.
3. Other 1.
2.

VI. SALARY AND COMMENCEMENT OF EMPLOYEE

Desired monthly salary (GROSS / NETT)*

Earliest date able to commence employment

Page vi of 9
 VII. OTHERS

Do you mind doing business trip and/or

following training overseas?
If No, please describe

Do you mind working over time?

If No, please describe

Please provide you reason why you apply

to this company?

Please specify type of position you like to

keep based on your ability or
specialization

Do you ever be captive or involved in any

criminal act? If yes, please describe

Do you currently have any debt with any

institution/ company or person?
If yes, please describe

Have you had a rather severe Month:

illness/accident?
If yes. please describe Year:

Does it have a side effect presently?

If yes, please describe

Please read carefully before signing. If you have any question regarding the following statement, please ask for
assistance.

I certify that, to be of my knowledge of belief, the answer given by me to foregoing question and statement made by
me in this application are correct and complete. I understand that any false information contained in this application
may result in my termination at any time and without any liability to me for any continuation of salary, wages, or
employment related benefits)

I authorize you to communicate with all my former employers, school officials and person named and references. I
hereby release all employers’ school and individuals from any liability for any damage whatsoever resulting from
giving such information.

Jakarta, ……………......, 20………….

(……………………………………………)

Page vii of 9
INTERVIEW RATING (Filled by Interviewer)

1. PHYSICAL QUALIFICATIONS 6. INTEREST & INITIATIVE

Statute & Appearance for position Interest work for His/her being considered – Soundness of
reasons for seeking job – Effectiveness in presenting His/her case
Poor Bellow Meets Above Exceeds Poor Bellow Meets Above Exceeds
Expectation Expectation Expectation Expectation Expectation Expectation Expectation Expectation
Comment: Comment:

2. EXPRESSIONS 7. ATTITUDE
Clearness of grammar – Vocabulary - Enthusiasm Reason for leaving previous job – Relation with other employee
Poor Bellow Meets Above Exceeds Poor Bellow Meets Above Exceeds
Expectation Expectation Expectation Expectation Expectation Expectation Expectation Expectation
Comment: Comment:

3. MENTAL GRASP 8. POTENTIAL

Sense of Endurance for position Seeking ability to advance to higher job
Poor Bellow Meets Above Exceeds Poor Bellow Meets Above Exceeds
Expectation Expectation Expectation Expectation Expectation Expectation Expectation Expectation
Comment: Comment:

4. EXPERIENCE & WORK HISTORY 9. ADAPTABILITY

Previous job held & applicability to position applied for Personality such as His/her can adapt to condition of the job
Poor Bellow Meets Above Exceeds Poor Bellow Meets Above Exceeds
Expectation Expectation Expectation Expectation Expectation Expectation Expectation Expectation
Comment: Comment:

5. EDUCATION INTERVIWER 1 INTERVIWER 2 INTERVIWER 3

Meets requirements for the job
Poor Bellow Meets Above Exceeds
Expectation Expectation Expectation Expectation
Comment:

Signature & Date Signature & Date Signature & Date

General Comments (Strength / Weakness / Other)

______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

To Indicate Your Recommendation, please give check mark on appropriate circle:

HIRE DO NOT HIRE NEED OTHER CONSIDERATION HOLD FOR FUTURE NEED

FINAL RATING 1 2 3 4 5 Suggested Salary Reporting To:

(Circle One)
Low High

ACCEPTANCE APPROVAL
Page viii of 9
 (Filled by Authorized Personnel)

Name: Employment Status

PKWTT PKWT Daily / Internship

Department Job Title Grade

Required Join Date Man Power Planning Count

Current Vacant Pipe Line Approved
MPP

Approval Director / Division Head: Approval Human Resources:

Approval COO: Approval CEO:

-oOo-

Page ix of 9