Employee Application Form

NO: _______________________
The following information will help us to assess your employment opportunity with FAVE
HOTEL ZAINUL ARIFIN (hereinafter called the Employer). All portions of this application
pertaining to you must be completed. We appreciate the time you spend completing this
application form.
Position applied for
Other position (s) you would like to be considered for
Salary Expectation
Date Available to start

Recent Photograph
4X6 cm

: CHEF
: SOUS CHEF
: Rp. 6.000.000
: Based on Company Need

PERSONAL DATA
Full Name : RESTU ANGGESTI
Date of Birth : 8 10 1969
Address : Jl. Raya Warung Borong RT 03/02 (Belakang Kecamatan)
Ciampea
City : Bogor
Telephone : (Residence) 081385248739
Telephone : (Office)
I.D Card Number
: S.997729
Marital Status : Married
Height / Weight : 175 / 84
Distinguishing Marks
EDUCATION AND TRAINING
Name and address of school,
University or other training
institution
SMA GANESA

Post Code : 16620

From Date

Date of Expiry : Hobby : Cooking

Blood Group : A

To Date

Major Course or
Study

Decree of Certificate

TH 1989

Study

Certificate

RECORD OF PREVIOUS EMPLOYMENT

1. Company Name
Position
Period
Address
Telephone
Nature of Business
HR/Application Form/001

: Serela Hotel
: Sous Chef
: From Maret 2013
To October 2013
: Jl. Kartini No 65 Jakarta
: 021 6000500
: Hotel
Supervisors Name : Restu Anggesti
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Employee Application Form

Duties
Last salary
Reason for leaving

: _______________________________________________________________
: Rp 4.500.000,: Change Management

2. Company Name
Position
Period
Address
Telephone
Nature of Business
Duties
Last salary
Reason for leaving

: Singapore Embassy
: Chef
: From ______________________ To _________________________________
: Menteng
: _______________________________________________________________
: Embassy
Supervisors Name : Mr. Kang
: _______________________________________________________________
: Rp 6.000.000
: Change Embassy Finish Contract

3. Company Name
Position
Period
Address
Telephone
Nature of Business
Duties
Last salary
Reason for leaving

: Laras Restaurant, Term 3 Bandara Soekarno Hatta

: Chef
: From ______________________ To _________________________________
: Term. 3 Bandara oekarno Hatta
: _______________________________________________________________
: _____________________ Supervisors Name : Royke
: _______________________________________________________________
: Rp 6.000.000
: Dinish Contract

REFERENCES (Non Relatives)

1. Name
Occupation
Address

: Royke
: HRD
: Term. 3 Soekarno Hatta

2. Name
Occupation
Address

: ________________
Telephone Number : __________________
: ________________
Years known : _______________________
: _______________________________________________________________

3. Name
Occupation
Address

: ________________
Telephone Number : __________________
: ________________
Years known : _______________________
: _______________________________________________________________

LANGUAGE PROFICIENCY
Language Skill ( Language Spoken)
Language
Speaking
English
Poor Good Excellent
Mandarin
Poor Good Excellent
Others
Poor Good Excellent
HR/Application Form/001

Telephone Number : 081

Years known : _______________________

Reading
Poor Good Excellent
Poor Good Excellent
Poor Good Excellent

Writing
Poor Good Excellent
Poor Good Excellent
Poor Good Excellent
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Employee Application Form

FAMILY RECORD
Fathers Name : RA Sudjani (Alm)
Age : _______ Occupation : ________________________
Mothers Name : Sukriah (Almh)
Age : _______ Occupation : ________________________
Permanent Address :
_____________________________________________________________________________________________
______________________________________
City : __________ Telephone : ________________________
Husband / Wifes Name : Chandra Kurniawati
Birth of Date : 26-09-1976 Occupation : _______________
Children :
1. Name : Tristandi Reuch
Birth of Date : 05-11-99 Male
Female _____
2. Name : Reindra Cahya Afif
Birth of Date : 31-05-04 Male
Female _____
3. Name : Annisa Restiviandra
Birth of Date : 21-06-10 Male ______ Female
GENERAL INFORMATION
Are you presently employed? ______________
Yes ______________
No _________________________
Have you ever been discharged from employment? If yes, Please explain _________________________________
Have you any objection to our contacting your previous employers ? _________ Yes ______ No _______________
Have you had any serious illnesses, injuries or operations within the last (5) years? If so, please describe
Have you ever suffered from any of the following illnesses?
Tuberculosis
Yes ___ No
Heart Disease
Hypertension
Yes ___ No
Diabetes
Venereal Disease
Yes ___ No
Epilepsy
Hepatitis
Yes ___ No
HIV / AIDS Virus

Yes ___
Yes ___
Yes ___
Yes ___

No
No
No
No

Do you have any immediate family members, i.e. husband, wife, parents, child, brother, sister, working within the
company?
Yes ___ No
If yes, who?
(1) __________________________________________________________________________________________
(2) __________________________________________________________________________________________
(3) __________________________________________________________________________________________
DECLARATION
I certify that all statements made on this application are true and complete to the best of my knowledge. I
understand that misrepresentation or omission when discovered, will subject me to discharge and I hereby
authorize any investigation relating to my work experience, education or reputation for the purpose of my
application for employment.
Applicants Signature
CODE : 1. Excellent
Subject

________________________
Date ___________________________________
INTERVIEW ASSESSMENT
2. Very Good
3. Good
4. Need Improvement
5. Poor
1st
Interview

Comment

2nd
Interview

Comment

3rd
Interview

Comment

Appearance
Verbal Skill
HR/Application Form/001

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Employee Application Form

Language Skill
Interpersonal Skills
Technical Skills
Professional Skills
Initiative Leader Ability
Motivation
Stability
Co-Operative Attitude
Reliability
Interviewers Name
Date
Overall Comment

Position
Starting Date
Level
Basic Salary
Transportation Allowance
Service Charge
Service Charge Point
Housing Allowance
Others
Gross Salary

For Human Resources Department Only

: __________________________________
: __________________________________
: __________________________________
: __________________________________
: __________________________________
: __________________________________
: __________________________________
: __________________________________
: __________________________________
: __________________________________

REFERENCE CHECKING
1. Name / Company : ___________________________

Date : _______ Comment : ___________

2. Name / Company : ___________________________

Date : _______ Comment : ___________

APPROVED FOR HIRE

Department Head

Date: ____________________________________________

Human Resources Manager

Date: ____________________________________________

Hotel Manager

Date : ____________________________________________

HR/Application Form/001

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