PRIVATE & CONFIDENTIAL

JOB APPLICATION FORM

Date : __________________________________
Apply as : __________________________________
PHOTO

A. Personal Details:

*Full name : ___________________________________________________________

Gender : _________________________________ *Blood Type : ______________
*Date of Birth : _______________________*Place of birth : ______________________
*Domicile Address : ___________________________________________________________
___________________________________________________________
*Phone number : _________________________
*Whatsapp Number : _________________________
*Home number : ___________________*Linked-In :______________________________
*E-mails : ___________________________________________________________
*Identity Card Num : ___________________________________________________________
*Marital Status : ___________________________________________________________
*Religion : ___________________________________________________________
Race : _________________________ Nationality: _______________________
Description about you:

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 B. *Emergency Contact :

Name Mobile Phone Number Relations

C. Education :

College or University Major Qualifications and Year of Graduated

School Subjects Qualifications and Year of Graduated

D. Professional, Technical and Management Qualification :

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 Please give details:
Language Knowledge
Technical Knowledge
Management (Beginner,Intermediate, Expert)
Skills Database Networking Speaking Writting
Programming

E. Training and Development :

Please give details of any training and development courses or non-qualifications courses
which support your application. Include any on the job training as well as formal courses.
Title of Training Programme or Course Duration of Course

F. Please explain a project you have done or complish.

G. Employment History
(Start from PRESENT employer)

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 Company’s name

__________________________________________________________________________________

Company’s address

__________________________________________________________________________________

Period

__________________________________________________________________________________

Title

Job’s Descriptions and Project Specifications

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Current Salary

Basic Salary (net) : IDR. __________________________ x ____ times

Allowances :
:
:
Draw your organization’s structure

Reason of living :

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 Company’s name

__________________________________________________________________________________

Company’s address

__________________________________________________________________________________

Period

__________________________________________________________________________________

Title

Job’s Descriptions and Project Specifications

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Current Salary

Basic Salary (net) : IDR. __________________________ x ____ times

Allowances :
:
:

Draw your organization’s structure

Reason of Leaving :

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Company’s name

_________________________________________________________________________________

Company’s address

_________________________________________________________________________________

Period

_________________________________________________________________________________

Title

Job’s Descriptions and Project Specifications

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Current Salary

Basic Salary (net) : IDR. __________________________ x ____ times

Allowances :
:
:

Draw your organization’s structure

Reason of Living :

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 H. Other information

1. Have you ever been discharged from any previous employment due to misconduct?
(Give a brief statement and reason)
________________________________________________________________________
________________________________________________________________________
2. Have you ever been arrested for any violation of any law/ conviction of any crime?
(Give a brief story, year, nature of violation)
________________________________________________________________________
________________________________________________________________________
3. Have you had any illness or injury? (give a brief explanation)
________________________________________________________________________
________________________________________________________________________
4. Would you be willing to perform overtime or shift duties should be need arises? If No,
give a brief explanation.
________________________________________________________________________
________________________________________________________________________
5. Do you mind if your data will be use for Background Verification or Screening? (Yes/No)
________________________________________________________________________
6. Reference
1. Name : _____________________________________________________ 2. Company
Name& Address
_____________________________________________________________________
3. Relations : _____________________________________________________
4. Phone Num : _____________________________________________________
5. Emails : _____________________________________________________

1. Name : _____________________________________________________ 2. Company

Name& Address
_____________________________________________________________________
3. Relations : _____________________________________________________
4. Phone Num : _____________________________________________________
5. Emails : _____________________________________________________

I. Statement Declare

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 I hereby declare that:

a. I have not been convicted of criminal offence or been declare bankrupt in any country
b. The particulars in this application form and document attached hereto are true in every
aspect.
c. I have not willfully suppressed any material fact.

I understand if any particulars supplied by me in this form are proved untrue, I am liable to be
summarily dismissed.

Jakarta,

(Name& Signature)

REQUESTED SALARY : ________________________________ (Take Home Pay/All In)

Do you have these documents :

NPWP
BPJS/Jamsostek Card
Rekening Tabungan BCA

OFFICE USE ONLY