QF.HC.03.Rev.

UDDERS INDONESIA
QF.HC.01.Rev.0

EMPLOYMENT APPLICATION FORM

release doc : 12.20

CONFIDENTIAL
I. GENERAL INFORMATION
COMPLETE / FULL NAME SEX
Antonius Jonathan Juniardi Male
NICK NAME PLACE OF BIRTH DATE OF BIRTH COUNTRY OF BIRTH
Anton mataram 07-June-1995 Indonesia
RELIGION ID NUMBER NATIONALITY
Catholic 7,201,040,706,950,000 Indonesia
MARITAL STATUS DRIVING LICENCE NUMBER CELLULAR PHONE NUMBER
Single 950,624,240,117 (+62) 85240106240
NO. OF CHILD DRIVING LICENCE VEHICLE TELEPHONE NUMBER
0 Motorcycle
CURRENT ADDRESS OTHER ADDRESS
jl. Kh. Moh. Mansyur no 63 krendang kec.tambora. Jakarta Barat. DKI BTN permata sentral blok A no 06. luwuk kab. Banggai sulawesi t

II. FAMILY BACKGROUND

COMPLETE NAME RELATIONSHIP AGE SEX LAST EDUCATION OCCUPATION
Halim Father 59 Male SMU wiraswasta
Koo Mei Lan Mother 52 Female SMU housewife
Ervandra Fajar Pranata Halim Brother 31 Male S1 wiraswasta
Fabian M Halim Brother 29 Male SMU wiraswasta
Satria Ignatius Nahor Halim Brother 26 Male S1 wiraswasta
Antonius Jonathan Juniardi Brother 25 Male SMU student
maria monica angle halim Sister 19 Female SMU student

III. EDUCATION BACKGROUND

FORMAL
NAME OF SCHOOL LEVEL MAJOR FIELD OF STUDY FROM TO GPA

akademmi pariwisata paramitha Associate Hospitality 2018 now

Saint Joseph Hisgh School Highschool science 2011 2013
 QF.HC.03.Rev.1

TRAINING / COURSE
TRAINING SUBJECT PROVIDER DURATION PERIOD

Bread Making BBC Certificate 1days 2018

Cake Making BBC Certificate 3days 2018
Floral cake Certificate 1days 2018
Coffe class Santika bekasi Certificate 1days 2018

IV. SKILLS
LANGUAGE COMPUTER
LANGUAGE SPOKEN WRITTEN PROGRAM / SOFTWARE SKILL

V. ACTIVITIES
ORGANIZATION ACTIVITIES POSITION PERIOD

VI. HOBBIES
HOBBIES

VII. JOB EXPERIENCES

COMPANY NAME CORE BUSINESS WORK LOCATION SERVICE PERIOD

LAST POSITION LAST SALARY REASON OF LEAVE

RESPONSIBILITY

COMPANY NAME CORE BUSINESS WORK LOCATION SERVICE PERIOD

LAST POSITION LAST SALARY REASON OF LEAVE

RESPONSIBILITY

COMPANY NAME CORE BUSINESS WORK LOCATION SERVICE PERIOD

LAST POSITION LAST SALARY REASON OF LEAVE

RESPONSIBILITY
 QF.HC.03.Rev.1

COMPANY NAME CORE BUSINESS WORK LOCATION SERVICE PERIOD

LAST POSITION LAST SALARY REASON OF LEAVE

RESPONSIBILITY

VIII. COMPENSATION & BENEFITS

CURRENT BASIC SALARY DESIRED BASIC SALARY

CURRENT BONUS / INCENTIVES DESIRED BONUS / INCENTIVES

CURRENT BENEFITS DESIRED BENEFITS

BENEFIT VALUE / AMOUNT BENEFIT VALUE / AMOUNT

IX. OTHERS
Do you have any side jobs? If yes, please explain.

Do you mind if we confirm your previous employer for a reference ? If no, please mention the address and phone number.

Please give three (3) personal references, but NOT relatives, former employers or teachers.

Do you have relatives and/or friends who have worked in our company ? If yes, please mention the name(s) and relationship(s).

Do you ever take a psychological evaluation ? If yes, please mention the time and place.

Do you mind if we do medical exam, including but not limited to HIV-AIDS and Psychotropics / Drugs usage?* If yes, please explain

* = HIV-AIDS test will not use for selection process.

* = Applicant agree that the medical records are belongs to company.

I hereby certify that all the information given above are true and if under circumstances any omission or misrepresentation

Signature :

Name :
Date : 1/22/2021