Employee Application Form

Recent Photograph
4X6 cm

NO: _______________________
The following information will help us to assess your employment opportunity with PANDANARAN HOTEL
SEMARANG (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
Expected Salary
Date Available to start
PERSONAL DATA
Full Name :
Address :

: _________________________________________________
: _________________________________________________
: _________________________________________________
: _________________________________________________
Date of Birth :

City :
Post Code :
Mobile Phone:
House Phone:
I.D Card Number
:
Date of Expiry :
Marital Status :
Hobby :
Height / Weight :
Blood Group :
Email:
Have you ever been working with Pandanaran Hospitality?(N) / (Y) Where:
Have you ever got interview with Pandanaran Hospitality? (N)/ (Y) Where:
EDUCATION AND TRAINING
Name and address of school,
University or other training
institution

From Date

PHS-HR- Application form Page 1

To Date

Major Course or
Study

When:
When:
Decree of Certificate

Employee Application Form

RECORD OF PREVIOUS EMPLOYMENT
1. Company Name
: _______________________________________________________________
Position
: _______________________________________________________________
Period
: From ______________________ To ________________________________
Address
: _______________________________________________________________
Telephone
: _______________________________________________________________
Nature of Business
: _____________________ Supervisors Name : _________________________
Duties
: _______________________________________________________________
Last salary
: Rp ____________________________________________________________
Reason for leaving
: _______________________________________________________________
2. Company Name
Position
Period
Address
Telephone
Nature of Business
Duties
Last salary
Reason for leaving

: _______________________________________________________________
: _______________________________________________________________
: From ______________________ To _________________________________
: _______________________________________________________________
: _______________________________________________________________
: _____________________ Supervisors Name : _________________________
: _______________________________________________________________
: Rp ____________________________________________________________
: _______________________________________________________________

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

: _______________________________________________________________
: _______________________________________________________________
: From ______________________ To _________________________________
: _______________________________________________________________
: _______________________________________________________________
: _____________________ Supervisors Name : _________________________
: _______________________________________________________________
: Rp ____________________________________________________________
: _______________________________________________________________

REFERENCES (Non Relatives)

1. Name
: ________________
Telephone Number : __________________
Occupation
: ________________
Years known : _______________________
Address
: _______________________________________________________________
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
PHS-HR- Application form Page 2

Reading
Poor Good Excellent
Poor Good Excellent
Poor Good Excellent

Writing
Poor Good Excellent
Poor Good Excellent
Poor Good Excellent

Employee Application Form

FAMILY RECORD
Fathers Name : _______________________
Age : _______ Occupation : ________________________
Mothers Name : _______________________
Age : _______ Occupation : ________________________
Permanent Address :
_____________________________________________________________________________________________
______________________________________
City : __________ Telephone : ________________________
Husband / Wifes Name : _______________
Birth of Date : ____________Occupation : _______________
Children :
1. Name : _______________________
Birth of Date : _______
Male ______ Female _____
2. Name : _______________________
Birth of Date : _______
Male ______ Female _____
3. Name : _______________________
Birth of Date : _______
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 ___ No ___

Yes ___ No ___
Yes ___ No ___
Yes ___ 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

________________________

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Date ___________________________________

Employee Application Form

CODE : 1. Excellent
Subject

2. Very Good
1st
Interview

Appearance
Verbal Skill
Language Skill
Interpersonal Skills

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

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INTERVIEW ASSESSMENT
3. Good
4. Need Improvement
Comment

2nd
Interview

Comment

5. Poor
3rd
Interview

Comment

Employee Application Form

For Human Resources Department Only
Position
Starting Date
Level
Basic Salary
Phone Allowance
Transportation Allowance
Service Charge
Housing Allowance
Other Allowance

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

REFERENCE CHECKING
1. Name / Company : ___________________________
Mobile Phone:
Email:
2. Name / Company : ___________________________
Mobile Phone:
Email:

Date : _______ Comment : ___________

Date : _______ Comment : ___________

APPROVED FOR HIRE

Department Head

Date : ____________________________________________

Human Resources Manager

Date : ____________________________________________

Hotel Manager

Date : ____________________________________________

General Manager

Date : ____________________________________________

PHS-HR- Application form Page 5