APPLICATION FORM

F.HRD.002.rev 0

POSITION APPLIED FOR : CHIEF ENGINEERING

Please Complete This Form Properly

Personal Data
Full Name (same with ID Card) : ACHMAD RADIUS
Nick Name : RADIUS
Place of Birth : JAKARTA
State : INDONESIAN
Country : MALANG EAST JAVA
Date of Birth : 1 6 0 7 70
Gender : ● Male Female Blood Type o
Status : Single ● Married Divorce
Religion : ISLAM
Ethnic : JAKARTA Photo
Citizenship : ● Indonesia Others
Height / Weight : 1 6 5 Cm / 6 2 Kg
E-mail Address : achmadradius16@gmail.com

Skype ID : Achmad Radius

Hobby : SPORT & FISHING
ID Card Number : 3 2 7 6 0 5 1 6 0 7 7 0 0 0 0 5 Expired Date
Passport Number : Expired Date
License Number : A
B1
C "700712212488

NPWP Name : ACHMAD RADIUS NPWP Number 49.240.883.6-412.000

NPWP Address : JL.RADEN SALEH STUDIO ALAM TVRI NO.9 SUKMAJAYA DEPOK

Address (Original and Residential)

Original Address : PERUM GRIYA NAGARI BLOK F-22 (number & street)
(Same with ID Card) RT : 0 6 RW: 1 6
Kelurahan : Zip Code
WATUGEDE 6 5 1 5 3
Kecamatan : City
SINGGOSARI KABUPATEN MALANG
Province Country
EAST JAVA INDONESIA
Phone Number :
Handphone Number 1 : 0821-1037-7206
Handphone Number 2 : 0878-8233-6512

Residential Address : JL.RADEN SALEH STUDIO ALAM TVRI NO.19 (number & street)
(Current Address)
RT : 0 4 RW: 0 7
Kelurahan : Zip Code
SUKMAJAYA 1 6 4 1 2
Kecamatan : City
SUKMAJAYA DEPOK
Province Country
WEST JAVA INDONESIAN
Phone Number :
Handphone Number 1 : 0821-1037-7206
Handphone Number 2 : 0878-8233-6512

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Family Members & Emergency Contact
Family Members
Date of Birth
Relation Name Place of Birth M/F Address Occupation
(dd/mm/yy)
Husband /
PUJI DWI ASTUTIK BLITAR 29-Mar-76 F PERUM GRIYA NAGARI BLOK F-22 PNS
Wife
Children

1 MUHAMAD RAFLY YUSUF JAKARTA 19-Nov-00 M STUDENT

2 REZA NURZAINI CHANDRA JAKARTA 09-Jun-03 M STUDENT

3 ADISTY FARELLYAN TIORY MALANG 15-Mar-04 F STUDENT

Parents

Father ALM. IDRIS YUSUF JAKARTA 02-Jan-45 F SUKMAJAYA DEPOK

Mother ROZANI JAKARTA 26-Dec-65 M SUKMAJAYA DEPOK

Siblings (Including yourself)

1 DEWI INDRIANTI JAKARTA F DEPOK MOTHER HOME

2 ACHMAD RADIUS JAKARTA M MALANG

3 ALM.ACHMAD RIZAL JAKARTA M BEKASI

4 IDA HANDAYANI JAKARTA F PAMULANG SWASTA

5 INDRIYANI JAKARTA F DEPOK MOTHER HOME

6

Emergency Contacts
Full Name : NYARINING TYASIH
Date of Birth : 0 1 0 6 8 0 Gender Male ● Female
dd mm yy
Place of Birth : MALANG
Relation : ● Sibling Parents Others
Address : JLN.MT HARYONO NO.71

RT : 0 7 RW: 0 6
Kelurahan : Zip Code
LOWOKWARU 6 5 1 4 1
Kecamatan : City
LOWOKWARU MALANG
Province Country
EAST JAVA INDONESIAN
Phone Number :
Handphone Number : 0812-3276-4234

Company Name : MOTHER HOME

City :
Position :

Educational Background
1. College Name : THE NATIONAL INSTITUTE OF TECHNOLOGY MALANG
Educational Degree : Diploma ● Bachelor Master Doctor Others
Major : INDUSTRIAL TECHNOLOGY
City : MALANG
Years of Completed : 0 1 9 4 until 1 4 0 3 GPA : 2 , 7 3
mm yy mm yy

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2. College Name : TECHNOLOGY HIGH SCHOOL
Educational Degree : Diploma Bachelor Master Doktor ● Other TECHNIC SCHOOL
Major : ELECTRICITY
City : JAKARTA
Years of Completed : 1 5 0 6 until 0 1 0 5 GPA :
mm yy mm yy

Courses / Training

Subject Institution Period

FIRST AID TRAINING PMI KOTA MALANG 18 - 19 NOVEMBER 2013
FIRE BRIGADE PMK KOTA MALANG 25-26 NOVEMBER 2013
ELECTRICITY SAFETY K3 DISNAKERTRANS EAST JAVA 01 - 02 & 08 - 09 DECEMBER 2015

Languages

Language Read Write Speak Listen

ENGLISH GOOD GOOD GOOD GOOD

Organizations

Organization Name Position Period

ASSOCIATION OF INDONESIAN CHIEF ENGINEER COMMITTEE 2018 - 2020

Special Achievements (Local / National / International)

Year
EMPLOYEE OF THE MONTH IN CROWNE PLAZA HOTEL JAKARTA 2005
PROMOTION FROM DUTY ENGINEER TO CHIEF ENGINEER IN IBIS STYLES MALANG 2013

Working Experiences (Start from your latest experience)

1
Company Name : APLINES HOTEL BATU MALANG BY ARTOTEL
Latest Position : CHIEF ENGINEERING ( PREOPENING TEAM )
Period : 2 8 0 5 1 8 until
dd mm yy dd mm yy
Reason for Leaving : FINANCIAL PROBLEM , BECAUSE MY BENEFIT STILL LATE
Basic Salary : 15,000,000 nett/gross
Benefit : Car ● BPJS ● Medical Insurance ● Communication Allowance

● Meal Transport ● THR Bonus

● Placement Allowance Positional Allowance ● Others

Company Address : JLN.TRUNOJOYO SONGGOKERTO NO.09 BATU MALANG

City : BATU EAST JAVA
Company Type : ● Public Company Private Company
State Own Company Others
Industry Type : HOSPITALITY 4 STAR HOTEL LOCAL
Division :
Superior Name : RICHARD TURPYN
Superior Position : GENERAL MANAGER

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2
Company Name : BANDARA INTERNATIONAL HOTEL BY ACCOR HOTELS
Latest Position : CHIEF ENGINEERING
Period : 2 0 0 4 1 7 until 1 0 0 8 1 8
dd mm yy dd mm yy
Reason for Leaving : MOVE TO ALPINES HOTEL BATU MALANG
Basic Salary : 18,000,000 nett/gross
Company Address : COMPLEX BANDARA INTERNATIONAL SOEKARNO - HATTA TANGERANG BANTEN
City : TANGERANG
Company Type : ● Public Company Private Company
State Own Company Others
Industry Type : HOSPITALITY 5 STAR INTERNATIONAL HOTEL
Division :
Superior Name : PASCALL BELON
Superior Position : GENERAL MANAGER

3
Company Name : MELIA HOTEL MAKASSAR
Latest Position : CHIEF ENGINEERING ( PREOPENING TEAM )
Period : 0 1 0 5 1 6 until 3 1 0 1 1 7
dd mm yy dd mm yy
Reason for Leaving : UPGRADE TO CHIEF ENGINEERING 5 STAR INTERNATIONAL HOTEL
Basic Salary : 13,000,000 nett/gross
Company Address : JLN.ANDI MAPPANYUKI NO.17 KUNJUNGMAE MAKASSAR
City : MAKASSAR SOUTH SULAWESI
Company Type : ● Public Company Private Company
State Own Company Others
Industry Type : 5 STAR HOTEL INTERNATIONAL
Division :

Superior Name : MUHAMAD YUSLAN

Superior Position : GENERAL MANAGER
Job Descriptions (Latest Position)
01. PREPARATION FOR OPENING HOTEL
PREPARATION GOVERNMENT LICENCES FROM MEP EQUIPMENT
02.

03. CHECK MEP AND TESCOM WITH CONTRACTOR FOR OPENING HOTEL , THE SAFETY EQUIPMENT MUST BE DONE AND RAEDY
DIRECT REPORT TO GM
04.

05.

Organization Chart (Latest Position)

GMGM

FC - HRD - DOS - CE - FOM - FBM - EHK - EXEC CHEF

SEC - SM - ENG SPV

Professional References (Must be filled)

Name Company Name Position Contact Number Relation
RICHARD TURPYN ALPINES HOTEL BATU GENERAL MANAGER 0818-515-345 NOW MY GM
GREATTA RILLASARI ALPINES HOTEL BATU HRD 0818-0506-9796 NOW MY HRM
EKSI AYUNINGTYAS MERCURE IBIS GENERAL MANAGER 0813-8930-1660 EX MY GM
MUHAMAD YUSLAN ROOM INC GENERAL MANAGER 0813-1804-2089 EX MY GM

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Medical History

Last Medical Check-Up : 17

dd mm yy
Medical Check-Up Type : ● Regular Check-Up Sickness
General Check up Others
Place : ● Hospital MAKASSAR
Clinic
Others
Allergic : Yes
● No
Do you have any serious illness / surgeries / accidents ? Yes
● No
Have you ever been hospitalized within the last 2 (two) years? Yes
● No

Smoking : ● Yes No
Eyes Condition : Silinder Minus ● Plus Others
Others
Strength Weakness
ELECTRICITY ELECTRONIC
MANAGEMENT INDUSTRIAL
MEP
Expected Monthly Salary 18,000,000
Expected Benefits SERVICE CHARGE , COMMUNICATION

Expected Facilities BPJS,INSURANCE , TRANSPORTATION, MESS , ACOMODATION TIKET MEDAN SBY 3 MONTH

Availability ● 1 month notice Others ________________

dd mm yy
I'm willing to have psychological test & medical check-up ● Yes No

Have you ever been involved in criminal case ? Yes ● No

If you have, when is it?

What is the biggest failure in your life? NO

What is the biggest success in your life? PROMOTION TO CHIEF ENGINEERING , SUCCESSFUL ENERGY SAVING
What kind of trouble usually made you stressed? How do you manage it?

Have you ever been through any process of recruitment in PT. Lippo Karawaci Tbk and subsidiaries?
If you have, when is it? NO
Do you have any family or friend who is working within PT. Lippo Karawaci Tbk and subsidiaries?
If you have, please provide us with the details! (Name, Occupation, Relation, and PT) NO
Do you agree to be located anywhere in Indonesia ? ● Yes No
If yes, please mention the preferred cities of region ? JAKARTA
Where do you get the information of the job opportunities of this company? MR.BASRI YOUR CHIEF ENGINEERING

Declaration
I hereby certify that the facts in the above employment application are true and complete to the best of my knowledge and authorize.
I understand that if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient
basis for dismissal.

Signature
.........................., .................................

__________________________

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