Recent

Passport
Photo

(Non-Returnable)

APPLICATION FORM
PT. MITSUBISHI ELECTRIC INDONESIA
1. The following details provided are solely for information requirements and will not be used as a selection criterion.
2. We will use your personal information purely for recruitment purposes & will not proceed with any other use without your consent.
3. We will take great care in maintaining the security of your personal information and in preventing unauthorized access to it

POSITION APPLIED FOR :

I. PERSONAL PARTICULARS
Full Name Nick Name :
Age : Gender : (M / F)
Place/ Date of Birth
Race : Nationality :

Permanent Address

Current Address

Email Address Religion :

(Home) (Mobile)
Telephone Number
(Emergency)
ID Number NPWP :
Martial Status Number of Children :
Driving Licence A / B1 / B2 / C Own Vechicle : (Car / Motorcycle / None)
Use Glasses Yes / No Height : Weight :

II. EDUCATION, SEMINAR & ABILITY

Education (From The Last Education)
Periods Degree* Graduate
School/ College/ Istitute Major (Bachelor / Diploma /
From To High School) (Y / N)

Training/ Seminar
Certificate*
Name of Training/ Seminar Organization / Place Periods (Brevet A & B, TOEFL, TOEIC, Japanese
Proficiency Test, Etc)

Language Ability Computer Ability

Language Level of Proficency Computer Skills Level of Proficency
(Out of a Rating 10) (Out of a Rating 10)
Indonesian
English
Japanese
Etc ....

1
PT Mitubishi Electric Indonesia
FM/MEIN/HRA-PS-APP/I/17; Rev:01; 20/01/17
III. WORKING EXPERIENCE
(Fill in the following form based on the number of jobs changes you’ve had, starting with your current or most recent job)
Company Name
Company Address
Industry Company Catagory Local / PMA / Joint Venture
Employment Status Permanent / Contract Company Origin
From (Mth/ Yr) To (Mth / Yr) Position(s) Held Reporting to No. of Subordinates

Describe your duties and responsibilities (Last Position)

Your organization structure

Allowance
Reason for leaving (Please indicate the
type of allowances)

Salary Variable bonus

(If any)

Company Name
Company Address
Industry Company Catagory Local / PMA / Joint Venture
Employment Status Permanent / Contract Company Origin
From (Mth/ Yr) To (Mth / Yr) Position(s) Held Reporting to No. of Subordinates

Describe your duties and responsibilities (Last Position)

Reason for leaving Allowance

Salary Variable bonus

Company Name
Company Address
Industry Company Catagory Local / PMA / Joint Venture
Employment Status Permanent / Contract Company Origin
From (Mth/ Yr) To (Mth / Yr) Position(s) Held Reporting to No. of Subordinates

Describe your duties and responsibilities (Last Position)

Reason for leaving Allowance

Salary Variable bonus
2
PT Mitubishi Electric Indonesia
FM/MEIN/HRA-PS-APP/I/17; Rev:01; 20/01/17
IV. LIST OF REFERENCES (Your professional contact references for recommendation)
Name of Referee Relationship Occupation Phone

V. FAMILY PARTICULARS
Name Relationship Age Occupation Company

Is your spouse or any of your relative(s) presently working in this Company? Yes / No
If yes, please provide details below :
Name Position Held Department Relationship

VI. GENERAL
(a) Have you ever been prosecuted or convicted of any offence? If so, give details
Yes / No*

(b) Do you suffer from any disability during the past 5 years? If so, give details
Yes / No*

(c) Do you have any interest or share in any company or business? If so, give details
Yes / No*

(d) Are you financially indebted at the moment? If so, give details
Yes / No*

(e) Do you have any problem if the Company ask you to do overtime? If so, give details
Yes / No*

(f) Do you have any problem if the Company ask you to move to other city ? If so, give details
Yes / No*

(g) What is your whises/ expectation/ notes towards your new job?

(h) What is your notice period required/ earliest available date?

(i) What is your minimum expected salary?

VII. DECLARATION
I declare that all the information given to me in this application is true and correct. I understand that misrepresentation or
omission of any material fact is cause for dismissal without notification.

_________________________ ____________________
Signature of Applicant Date

3
PT Mitubishi Electric Indonesia
FM/MEIN/HRA-PS-APP/I/17; Rev:01; 20/01/17
4
PT Mitubishi Electric Indonesia
FM/MEIN/HRA-PS-APP/I/17; Rev:01; 20/01/17