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Application Form
Name AJ

I.C. No.

Home Address
Sex:
Do you live in :

Own House
Rented House
With Parents
Others

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Date of Birth :

Place of Birth:

Marital Status :

Nationality:

Driving License :

Do you own a car :

Tel. No. (Off)

(Res)
(H/P)
(E-mail)
Working Starting Date:
Race:
Yes

Religion:

No

EDUCATION & PROFESSIONAL QUALIFICATION

FROM TO

NAME OF SCHOOL, COLLEGE

(STATE DATE)

STATE LEVEL ATTAINED MAJOR COURSE OR SUBJECT

MEMBERSHIP OF PROFESSIONAL & OTHER SOCIETIES (state dates and position held)

Computer proficient

Yes

No

Type:

Program/Languages:

Position applied for:

Are you interested in any other position:
Current Salary :

Salary Expected:

Details of current remuneration package:

When are you available for work:

Notice Period:

EMPLOYEMENT HISTORY
(Commence with current or last employment)

Date of Employment

Date Employment Ended:

Name of Employer:
Address of Employer:

State nature of employers business:

Position Held:
Name & designation of immediate supervisor:
Total number of employees in company:

Number of staff supervised by you:

Give detailed description of duties/responsibilities:

How did you get employed in this company

(Through Advertisement, Recommendation, etc.)
Reason for Leaving:
Last Drawn Salary:

Date of Employment

Date Employment Ended:

Name of Employer:
Address of Employer:

State nature of employers business:

Position Held:
Name & designation of immediate supervisor:
Total number of employees in company:
Give detailed description of duties/responsibilities:

How did you get employed in this company

(Through Advertisement, Recommendation, etc.)
Reason for Leaving:
Last Drawn Salary:

Number of staff supervised by you:

Date of Employment

Date Employment Ended:

Name of Employer:
Address of Employer:

State nature of employers business:

Position Held:
Name & designation of immediate supervisor:
Total number of employees in company:

Number of staff supervised by you:

Give detailed description of duties/responsibilities:

How did you get employed in this company

(Through Advertisement, Recommendation, etc.)
Reason for Leaving:
Last Drawn Salary:

Date of Employment

Date Employment Ended:

Name of Employer:
Address of Employer:

State nature of employers business:

Position Held:
Name & designation of immediate supervisor:
Total number of employees in company:
Give detailed description of duties/responsibilities:

How did you get employed in this company

(Through Advertisement, Recommendation, etc.)
Reason for Leaving:
Last Drawn Salary:

Number of staff supervised by you:

FAMILY DETAILS
RELATIONSHIP

NAME

AGE

OCCUPATION
PRESENT/PAST

ADDRESS

NAME OF
EMPLOYER

Father
Mother

Brother/
Sister

Spouse

Children

MEDICAL DETAILS
Are you in good health?
Yes
No
If no, why?
Please state with dates, any serious illness, allergies, operations, disabilities or accidents, you had.

Have you been refused insurance coverage?

Do you take alcohol/drugs?

Yes

Yes
No

Have you ever been convicted in a court of law?

If so, give details:

No

To what extent?
Yes

No

Are you involved in any administrative, civil or criminal case?

Are you in debt?

Yes

No

If so, to whom, to what extent & for what reason?

Have you been dismissed or suspended from any position?
If so, state details:
Are you interested or engaged in any business?

Yes

Yes

No

No

What type of Business?

Do you have any other sources of income?

(Please specify)

LANGUAGES

Yes

No

INDONESIA
ENGLISH
CHINESE (SPECIFY)
SPOKEN
( )
( )
( )
WRITTEN
( )
( )
( )
(please specify with scale 1-10, 10 is the highest score)
Hobbies, game & other interests

...
(
(

...
)
)

(
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)

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ADDITIONAL INFORMATION Give any additional information which you consider may be of interest to a prospective employer, if
possible state why you believe you are suitable for the position you are applying

ORGANISATION CHART OF COMPANY MOST RELEVANT TO POSITION APPLIED FOR.

(PREVIOUS OR CURRENT EMPLOYER)

State companys name, indicate where you fit in within the organization.

EMPLOYEMENT REFERENCES
From past and present employment

Name:

Name :

Position:

Position:

Company Name:

Company Name:

Company Address:

Company Address:

Tel: (Office)

(Res)

Tel: (Office)

(Res)

PERSONAL REFERENCES
Give names or person of responsibility who have known you for at least 3 years

Name:

Name :

Position:

Position:

Company Name:

Company Name:

Company Address:

Company Address:

Tel: (Office)

(Res)

Tel: (Office)

Years of Acquaintance

(Res)

Years of Acquaintance

Name of companies with which you have pending application for employment.
(Give dates of application)
1.
2.
3.

Have you applied with this office before?

Yes

No

State Date:

I HEREBY CONFIRM ALL THE ABOVE DETAILS TO BE TRUE AND CORRECT. I AUTHORIZE WALL STREET ENGLISH INDONESIA TO CARRY OUT
REFERENCE CHECKS WITH PAST EMPLOYERS AND REFEREES IN CONNECTION WITH THIS APPLICATION.
I UNDERSTAND THAT ANY MISREPRESENTATION OR OMISSION OF INFORMATION WILL BE SUFFICIENT REASON FOR WITHDRAWAL OF AN OFFER
OR SUBSEQUENT DISMISSAL, IF EMPLOYED.

Date

Signature: