HC-201.

01B

JOB APPLICATION FORM

Job Applied {Pekerjaan yang dilamar] Administration Head Trainee

Location / Base [Lokasi] Kalimantan Selatan

Part 1 – Personal Data [Data Pribadi]

1 Name [Nama] : Muhammad Nabil

2 Place, Date of Birth [Tempat Tgl Lahir] : Bireuen,17 April 1996
3 Permanent Address [Alamat Tetap] : Dusun Tgk Mustafa Bireuen Meunasah Blang Kota
juang Kab Bireuen

Phone [Telpon] :
Mobile [HP] : 08982249206
4 Citizenship [Kewarganegaraan] : Indonesia
5 Religion [Agama] : Islam
6 Status : Single
Spouse Name [Nama Isteri / Suami] :
Place, Date of Birth [Tempat Tgl Lahir] :
Job [Pekerjaan] :
Name of Children [Nama Anak] Place, Date of Birth [Tempat Tgl Lahir]

Part 2 – Education [Pendidikan]

School / University / College [Sekolah / Year [Tahun Major GPA Qualification

Universitas] [Jurusan] [IP] [Ijazah]
From To
Universitas Islam Kebangsaan 2015 2019 Ekonomi 3.11 S1
Indonesia dan Bisnis

Language Mastery [Penguasaan Bahasa] Oral [Lisan] Written [Tulisan]

Good Av. Poor Good Av. Poor
Indonesian [Bahasa Indonesia]
English [Bahasa Inggris]
Others [Bahasa Lain]:Aceh
Part 3 – Work Experience [Pengalaman Kerja]

Company Position Month – Year Reason for

[Perusahaan] [Jabatan] [Bulan Tahun] Leaving
[Alasan Keluar]
From To

PT Admika Jaya Utama Tim compro 2018 2019 Akhir Kontrak

References [Referensi]
Name [Nama] Company [Perusahaan] Position [Jabatan] Contact #

Part 4 – Others

1. Have you ever suffered from diabetes or heart disease? [Apakah No

anda pernah menderita diabetes atau sakit jantung?]

2. Have you ever had an accident that caused brain or mental

exhaustion? [Apakah anda pernah mengalami kecelakaan yang No
menyebabkan gangguan otak / mental?]
3. Do you have any relatives employed by this Company? [Apakah No
ada saudara yang bekerja dengan Perusahaan ini?]

4. Have you ever worked with Rajawali Group of Companies before? No

[Apakah sebelumnya anda pernah bekerja di Rajawali Group?]
If yes, in what company? [Jika pernah sebutkan nama Perusahaan]
Period [Periode]
Position Title [Jabatan]
5. Other information that you think would be good to mention [Informasi lain yang perlu anda
tambahkan]
Keterangan yang saya isikan dalam formulir ini adalah benar dan sah, jika ada data yang saya
palsukan, saya menyatakan bersedia di berhentikan dari perusahaan tanpa syarat apapun walau
saya sudah diterima bekerja. All information stated in this form is true and valid, if found falsified, I will
bear all the responsibility for all causes and willing to unconditionally discharged although, I am
already hired.

Name of Applicant & Signature Date

[Nama dan Tanda Tangan] [Tanggal]