Kedoya Elok Plaza Date : ____ / ____ / _____

Blok DD NO. 64 Interviewed by : __________________

Jl. Panjang, Jakarta Barat 11520 Score : __________________

APPLICATION FOR EMPLOYMENT

Position Applied for : ____________________________________________________________________

Personal Particulars

Full Name (Mr/Miss/Mdm) : ____________________________________________________________________

Address : ____________________________________________________________________

____________________________________________________________________

ID No. : ____________________________________________________________________

Place / Birth date : ____________________________________________________________________

Religion : ____________________________________________________________________

Tel Nos (Residental) : ____________________________________________________________________

Handphone : ____________________________________________________________________

E-mail Address : ____________________________________________________________________

Marital Status : (Single / Attached / Married / Divorced / Widowed / Separated)

Married with _______ children

Language Ability (In order to Strength)

Spoken : ___________________________________________________________________

Written : ___________________________________________________________________

Dialects Spoken Only : ___________________________________________________________________

1
FAMILY BACKGROUND (Inclusive of Spouse, Children, Parents, Siblings including yourself)

Relationship Name Occupation Age Handphone

__________________ _____________________ __________________ _____ ________________
__________________ _____________________ __________________ _____ ________________
__________________ _____________________ __________________ _____ ________________
__________________ _____________________ __________________ _____ ________________
__________________ _____________________ __________________ _____ ________________
__________________ _____________________ __________________ _____ ________________

EDUCATIONAL QUALIFICATIONS

Year Institution Qualification

_____________________ _____________________ __________________
_____________________ _____________________ __________________
_____________________ _____________________ __________________

ASSIGNMENT

Do you mind to be assigned to work outside city/country for some period of time ? Yes / No

Do you mind to be assigned to work after office hour or beyond office hour ? Yes / No

SUSPENSION

Have you ever been suspended or asked to resign from any position? Where & Why?

Have you ever been convicted by a Court of Law & any other authority?
NO / YES reasons ______________________________________________________________________________

Professional Training / Course / Seminar attended

Year & Duration Type of Training / Course / Seminar Organized by

_______________________ ____________________________________ ___________________
_______________________ ____________________________________ ___________________
_______________________ ____________________________________ ___________________
_______________________ ____________________________________ ___________________

Professional Membership (if any)

Professional Organization Year Membership Type

____________________________________ ________________ __________________________
____________________________________ ________________ __________________________
____________________________________ ________________ __________________________

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JOB EXPERIENCE

Start from the latest

Duration
Company’s Name
Position
Job Description

Reason of Leaving
Salary

JOB EXPERIENCE

Duration
Company’s Name
Position
Job Description

Reason of Leaving
Salary

Duration
Company’s Name
Position
Job Description

Reason of Leaving
Salary

3
ABOUT THE JOB APPLIED FOR

State briefly the reasons why you feel qualified for the job applied
_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Expected Salary : ____________________

When can you commence work (if appointed): _______________________________________________________

Declaration

I declare that the information contained in this application, is correct to the best of my knowledge. I understand that any
inaccurate or false information will contribute it the dismissal of my employment with the company.

Signature of Applicant : _______________