EMPLOYMENT APPLICATION FORM

III. PERSONAL IDENTITY

Full Name Choose initial ABRAHAM BILL KANTER

Place/Date of Birth
TOMOHON / 20 - 12 - 1995 Sex Male Female
(dd-mm-yyyy)
ID Number
7102102012950002 NPWP 93.659.963.8-015.000
(please attach a copy)
Permanent Address (based on ID) Current Address (if different from ID)
JL. MASJID I NO.25 KEBON BARU TEBET      

Zip Code : Zip Code :

Privately Owned Contract/ Rent Parents Owned Privately Owned Contract/ Rent Parents Owned

Phone 1 085256658998 Office abraham.kanter@sbiindo.com

Mobile Phone
E-Mail
(ex. 62-81-2xxxx)
Phone 2       Personal kanterbill95@gmail.com

Dependant No
Marital Status Single Married Divorced
(children) Yes:       (ex. 2 kids)

IV. WORKING EXPERIENCE

Employment History Current Employer Previous Employer
Company name PT. State Bank of India Indonesia      
Industry/type of business
Financial Services      
(ex. manufacturing, banking, etc.)
Address Graha Mandiri Imam Bonjol      

Phone 021-39838747      

Service period  From: November 2019 To: Present  From:       To:      
Last position Junior Staff      
Status Full-time Part-time Full-time Part-time
Monthly salary 5.500.000      
Reason for leaving Salary      
Job summary Financial and Accounting Reporting      

Line Manager 1* – Name Chaerudin      

Line Manager 1 – Position Head Finance Division      
Line Manager 1 – Phone 021-39838747      
Line Manager 2** – Name            
Line Manager 2 – Position            
Line Manager 2 – Phone            
*)
Line Manager 1 is your direct manager
**)
Line Manager 2 is the manager of Line Manager 1

Please fill in the form correctly. The form will be sent to Bank’s authorized agency to verify/validate the contents.
 EMPLOYMENT APPLICATION FORM
Formal Activity
Membership of professional, social or political organisation and/or other employment (ex: lecturer, teacher, entrepreneur, etc.)

Year
No. Activity/Organization Position
From To
1.                              

2.                        

3.                        

I. ACADEMIC AND PROFESSIONAL BACKGROUND

Formal Education
Year
No. Degree Name of Institution Major
From To

1. Diploma                        

Undergraduate Christian University Of Indonesia

2. 2013 2017 Financial Management
(ex. bachelor) Jakarta
Graduate
3.                        
(ex. magister)

Banking and/or Professional Certification and/or Training/Workshop

No. Type of Certification Publish Date Expired Date
1. Wakil Agen Penjual Efek Reksa Dana (WAPERD)            
2. Asosiasi Asuransi Jiwa Indonesia (AAJI)            
3. Sertifikasi Manajemen Risiko (BSMR/LSPP)
Level 1 Level 3 Level 5            
Level 2 Level 4

Courses/Training Completed (within last 12 months )

No. Courses/Training Date Sponsored by Certified
1.                   Yes No

2.                   Yes No

3.                   Yes No

Foreign Language Proficiency

Foreign Languages Speaking Writing
English Poor Fair Good Excellent Poor Fair Good Excellent
Mandarin/Hokkien      Poor Fair Good Excellent Poor Fair Good Excellent

II. FAMILY TREE

  Spouse Father Mother

Full name Choose initial       Arthur Bob Kanter Astrid Massie

Place/Date of Birth       /       -       -       Palembang / 14 - Januari - 1952 Jakarta / 31 - 03 - 1958
Occupation       entrepreneur      entrepreneur
Phone       081356191820      
Is this your Emergency
Yes No Yes No Yes No
Contact?

Please fill in the form correctly. The form will be sent to Bank’s authorized agency to verify/validate the contents.
 EMPLOYMENT APPLICATION FORM
Children
  I II III IV
Full name                        

Place/Date of Birth                        

Sex Male Female Male Female Male Female Male Female
SD SLTP SD SLTP SD SLTP SD SLTP
Education/occupation
SLTA S1 SLTA S1 SLTA S1 SLTA S1

Siblings
1 2 3
Full name                  
Place/Date of Birth       /       -       -             /       -       -             /       -       -      
Occupation                  
Mobile numbers                  
Sex Male Female Male Female Male Female
Is this your Emergency
Yes No Yes No Yes No
Contact?

V. DISCLAIMER

Have you ever been dismissed or asked to resign from any position? YES NO

If Yes, please explain:      

Are you are aware of any positions, relationships or any other matters that could give rise to real or apparent conflicts of interest if
you obtain the position you have applied for?
YES NO
If YES, Please provide details of any conflicts of interest that may arise if you obtain the position you have applied for:
     

Do you have any relatives or associates that have any prior or present association with any organization particularly in PT. Bank ICBC
Indonesia or individual that could be considered a real or apparent conflict of interest if you are successful in obtaining the position
you have applied for?
YES NO
If YES, Please provide details of any prior or presents associations of any relatives or associates with any organization or individual that
could be considered a real or apparent conflict of interest, if you are successful in obtaining the position you have applied for
Employee’s Name Position Department/Unit Location Relationship
                             

Have you ever been arrested, acting as witness summoned by court or convicted of a criminal offense (other than a traffic violation)?
YES NO
If yes, please describe what charges, where and when:      

VI. OTHER REFERENCES (MANDATORY)

List at least three persons not family related to you, whom we may contact immediately, have known you for at least two years, and
are familiar with your character and qualifications (ex: lecturer, supervisor, Subordinate, etc).

Full Name Relationship Company Occupation Phone/Email

                             
                             
Saya yang bertandatangan di bawah ini membenarkan bahwa pernyataan I, the undersigned, certify that the statements made by me on the
yang telah saya buat di Personal Data form yang disediakan adalah lengkap Personal History form are complete and true to the best of my

Please fill in the form correctly. The form will be sent to Bank’s authorized agency to verify/validate the contents.
 EMPLOYMENT APPLICATION FORM
dan benar sesuai pengetahuan dan keyakinan saya. Saya mengerti bahwa
segala bentuk kesengajaan dalam memberikan pernyataan yang salah dan
tidak benar dapat menyebabkan didiskualifikasikannya saya dari kesempatan
bekerja di PT. Bank ICBC Indonesia, dan pendiskualifikasikan tersebut dapat
menimbulkan pemecatan jika saya sudah bekerja pada PT. Bank ICBC
Indonesia. Saya juga mengerti bahwa PT. Bank ICBC Indonesia akan
melakukan penyelidikan atas data-data pendidikan, pekerjaan, catatan
kriminal, dan referensi lainnya atas nama saya sebelum tawaran pekerjaan
yang resmi dapat diberikan kepada saya.
Saya memberikan kuasa kepada penyelidik, agen, ataupun perwakilan yang
diakui oleh PT. Bank ICBC Indonesia, untuk melakukan penyelidikan latar
belakang dan memperoleh segala bentuk informasi terkait kegiatan saya dari
individu, lembaga pendidikan, manajemen pemukiman tempat saya tinggal,
perusahaan tempat saya sedang/pernah bekerja, aparat penegak hukum,
maupun sumber-sumber informasi lainnya. Informasi yang dimaksud dapat
berupa, namun tidak terbatas pada: informasi akademik, tempat tinggal,
prestasi, kinerja, kedisiplinan, absensi, riwayat pekerjaan, riwayat catatan
kriminal, riwayat penuntutan perdata, dan afiliasi professional. Saya memberi
kuasa kepada penyelidik, agen, ataupun perwakilan yang diakui oleh PT. Bank
ICBC Indonesia yang melakukan penyelidikan latar belakang atas diri saya
untuk memberikan catatan hasil penyelidikan tersebut kepada PT. Bank ICBC
Indonesia guna menentukan kelayakan saya selaku calon karyawan.
Saya memberikan kuasa kepada pemegang catatan atau sumber informasi
lainnya terkait dengan diri saya untuk memberikan informasi tersebut kepada
penyelidik, agen, ataupun perwakilan yang diakui oleh PT. Bank ICBC
Indonesia yang memintanya, terlepas perjanjian apapun yang saya telah buat
sebelumnya yang tidak memungkinkan diberikannya informasi tersebut.
Saya mengerti bahwa informasi yang diberikan oleh pemegang catatan atau
sumber informasi lainnya adalah untuk dipergunakan oleh PT. Bank ICBC
Indonesia hanya untuk tujuan sebagaimana yang disebutkan sebelumnya, dan
bahwa informasi tersebut dapat diungkapkan kembali oleh PT. Bank ICBC
Indonesia pada kesempatan lainnya.
Saya membebaskan PT. Bank ICBC Indonesia beserta manajemen, direktur,
agen, maupun karyawan-karyawannya dari tanggungjawab atas kerusakan
dalam bentuk apapun yang dapat muncul akibat atau berkaitan dengan:
laporan konsumen/investigasi ataupun informasi latar belakang diri saya yang
diminta, didapatkan, ataupun digunakan oleh PT. Bank ICBC Indonesia;
dan/atau akses, perolehan, dan penggunaan oleh PT. Bank ICBC Indonesia
atas segala informasi atas diri saya yang dapat dikumpulkan atau digunakan
oleh agen maupun perwakilannya dalam menentukan pencalonan saya
ataupun dalam tindakan personil lainnya dalam rangka memperkerjakan saya
di PT. Bank ICBC Indonesia.
Salinan dari surat kuasa yang menunjukkan tanda tangan saya ini adalah
sama sahnya dengan dokumen aslinya yang telah saya tandatangani. Surat
kuasa ini berlaku satu tahun sejak tanggal ditandatanganinya, ataupun di
akhir masa kerja saya dengan PT. Bank ICBC Indonesia.
Full name/Nama Lengkap
     
Signature below/Tanda tangan
Please fill in the form correctly. The form will be sent to Bank’s authorized agency to verify/validate the contents.
knowledge and belief. I understand that any willful misstatement
may lead to disqualification for employment at PT. Bank ICBC
Indonesia, and that the disqualification could lead to dismissal, if
employed. I also understand that PT. Bank ICBC Indonesia will check
my education, employment, criminal history, and references before
a firm employment offer will be made.
I authorize any investigator, agent or other duly accredited
representative of PT. Bank ICBC Indonesia conducting my
background investigation and to obtain any information relating to
my activities from individuals, schools, residential management
agencies, employers, criminal justice agencies, or other sources of
information. This information may include, but is not limited to, my
academic, residential, achievement, performance, attendance,
disciplinary, employment history, criminal history record, civil
litigation actions, and professional affiliations. I authorize the
investigator, agent, or duly accredited representative conducting
my background investigation to disclose the record of the
investigation to PT. Bank ICBC Indonesia for the purpose of making
a determination of suitability for employment.
I authorize custodians of records and other sources of information
pertaining to me to release such information upon request of the
investigator, agent, or other duly authorized representative of PT.
Bank ICBC Indonesia regardless of any previous agreement to the
contrary.
I understand the information released by records custodians and
sources of information is for use by PT. Bank ICBC Indonesia only for
the purposes provided and that it may be redisclosed by PT. Bank
ICBC Indonesia.
I release PT. Bank ICBC Indonesia and its officers, directors, agents,
and employees from any and all liability for damages of whatever
kind that may arise from or relate to: any consumer report and/or
investigative report or other background information requested,
obtained or used by PT. Bank ICBC Indonesia; and/or PT. Bank ICBC
Indonesia’s access to, acquisition of or use of the information that it,
or its agents or representatives, may gather or use for the purpose
of deciding upon my candidacy or in any subsequent personnel
action for employment at PT. Bank ICBC Indonesia.
Copies of this authorization that show my signature are as valid as
the original release signed by me. This authorization is valid for one
year from the date signed or upon termination of my affiliation with
PT. Bank ICBC Indonesia, whichever is sooner.
Date of Birth/Tanggal Lahir
      -       -