APPLICATION FOR EMPLOYMENT

PT. Crystal Anugerah Abadi

Green Sedayu Bizpark DM9 no. 031
Jl.Daan Mogot km 18
Jakarta 11840 Indonesia
Tel.: +62 21 22952523
Fax: +62 21 29725467

Application for Employment

 As an equal opportunity employer, the policy of

PT. Crystal Anugerah Abadi is to employ applicants strictly
on the basis of an individual’s qualification. Selections are
made without regard to race, color, religious belief, sex,
marital status, national origin, or non-disqualifying disability.
 A condition of employment is the execution of an employment
which includes restrictions on post employment competitive
activities.


Application is active for 6 months.
Nothing herein will constitute a commitment of indefinite or
Photo 4 X 6
permanent employment
 All offers of employment are contingent upon satisfying certain
pre employment requirement including receiving a negative test
result on drug screen.

I. Personal Data

Name : M/F
ID & NPWP:
Permanent Address :

Place & Date of Birth

Home Phone : Mobile Phone :
Email Address :
Temporary Address :

Marital Status :
Name of Spouse :
Occupation of Spouse:
No. of Children :
Name of Children / Age :
Sex : Age :
Age :

Parent & Family Education Occupation Marital Status

Date Issued : 01/08/2017

II. Career Objective

Position Applied :

What is your ultimate

career goal :
Expected Gross Salary
(Before Tax) :
Available to begin work :

III. Education
Formal and informal with the sequence of the year starting from the most recent period.
 
Name of School Date Attended Date Graduated Major

Note: Please attach transcript(s)

Date Issued : 01/08/2017

IV. Employment
Start with your present job. List all job. Use another sheet if necessary. Applicants with professional
experience should supplement this application with a resume or detailed description of work
experience

Employer:
Address & Phone :

Date of Employment: From to

Job title &
Responsibilities:
Immediate supervisor: May we contact? Y/N
Salary; Beginning Rp Last Drawn Rp
Reason for Leaving:

Employer:
Address & Phone :

Date of Employment: From to

Job title &
Responsibilities:
Immediate supervisor: May we contact? Y/N
Salary; Beginning Rp Last Drawn Rp
Reason for Leaving:

Employer:
Address & Phone :

Date of Employment: From to

Job title &
Responsibilities:
Immediate supervisor: May we contact? Y/N
Salary; Beginning Rp Last Drawn Rp
Reason for Leaving:

Employer:
Address & Phone :

Date of Employment: From to

Job title &
Responsibilities:
Immediate supervisor: May we contact? Y/N
Salary; Beginning Rp Last Drawn Rp
Reason for Leaving:

Date Issued : 01/08/2017

V. Skill

Languages spoken & 1. Poor / Fair / Excellent

written : 2. Poor / Fair / Excellent
3. Poor / Fair / Excellent
4. Poor / Fair / Excellent
Computer literacy 1. Poor / Fair / Excellent
2. Poor / Fair / Excellent
3. Poor / Fair / Excellent
4. Poor / Fair / Excellent
5. Poor / Fair / Excellent
Other/ special Skills 1.
2.
3.
4.

VI. Others

Achievement 1.
(academic, honor, scholarships,
publication, award, etc.) 2.

3.

4.

5.

6.

7.

What is your hobby?

What is your strength? Please explain

What is your weakness? Please explain

Have you ever got a serious ill? Please Explain.

How many days of sickness you have in the past 12 months

Date Issued : 01/08/2017

Are you willing to travel? What present of the time?

Are you able and confirm to be placed all over in Indonesia? Please Explain

Have You previously applied to PT. CAA? Yes/No If yes, when?

Have you ever been convicted of a criminal act (other than a misdemeanor) by
civilian court or military court-material? Yes / No If yes, please explain

Are you currently bond by an employment agreement with your present

employer(s)? Yes/No, If yes, please explain

Are you now applied to any scholarship at any institution or waiting for another
job?(Please describe)

Please give any information on your non-academic accomplishment which you

think would assist us in evaluating your qualification (i.e. extracurricular,
community, business or personal development activities)

VII. Reference
Please list persons we may contact who know your qualifications. We prefer present or former
supervisor, former business client, teacher, etc., who have personal knowledge of your experience
and abilities.

Name Address & Phone Occupation Years known

1.

2.

3.

4.

Date Issued : 01/08/2017

‘I understand that PT Crystal Anugerah Abadi may request an investigation of my
reputation and character in connection with my prospective employment. I
understand that mis representation or omission of acts called for in this
application is cause for possible cancellation of this application or, if employed,
separation from the company.

It is the policy of PT. Crystal Anugerah Abadi to maintain a drug and alcohol free
workplace and as part of our standard pre-employment requirement, all
applicants will be subject to substance use/abuse testing, and I agree to comply
with such requirement

Signature of applicant / date

Date Issued : 01/08/2017

VIII. Interview Remark
For official use only

1st Interviewer (Name …………………) 2nd Interviewer (Name……………)

Accept/Considered/Reject Accept/Considered/Reject

Date Issued : 01/08/2017