PT.

SETIA ANUGRAH MEDIKA Page 1

Mitra Sunter Boulevard Blok B No. 39 - Jl. Yos Sudarso Kav. 89 - Jakarta
Phone : 62-21-65305921, 65304719; Fax : 62-21-65304719

APPLICATION FORM

HRGA Staff
WHAT JOB DO YOU APPLY FOR?
NAME (in block letter) FAHMI NUR’AFIF
FIRST NAME (in block letter) FAHMI
ADDRESS CLUSER NATA GARDEN BLOK C6
PHOTO
SUMUR BATU BANTAR GEBANG BEKASI
PLACE & DATE OF BIRTH CILACAP, 22 JULI 199r
LOKAL PHONE NO HANDPHONE 0811220796
NATIONALITY INDONESIA RELIGION MOSLEM
MARRIED/SINGLE/WIDOWER/WIDOW? MARRIED NUMBER OF CHILDREN 3

KNOWLEDGE OF LANGUAGES WRITING READING SPEAKING

*) Indonesian PROFICIENT PROFICIENT PROFICIENT
*) English BEGINNER ELEMENTARY BEGINNER
*) German
*) Others

SCHOOL / INSTITUTE DIPLOMA PLACE FROM TO

MAN 3 CILACAP CILACAP 2011 - 2014
PANCA SAKTI UNIVERSITY BEKASI 2021 – ON GOING
EDUCATION

1. 6.
2. 7.
3. 8.
COURSES
4. 9.
5. 10.

PREVIOUS COMPANY TOWN FUNCTION/JOB TITLE FROM TO REASON OF LEAVING

JANGKI JAYA SANTANA DEPOK HUMAN RESOURCES SEPT 2022 PRESENT SO FAR
AMAZON PET INDO BEKASI HR SPECIALIST FEB 2021 FEB 2022 END CONTRACT
SAESAR PRATAMA SAKTI BEKASI HRD LEGAL JAN 2019 AUG 2020 HEALTH REASONS
MANAGER
APL LOGISTICS JAKARTA HR RECRUITMENT FEB 2018 DEC 2018 TEMPORARY
SUPPORT
MITRA DINAMIKA BERLIAN TANGSEL HR RECRUITMENT JUL 2016 JAN 2017 END CONTRACT
Further details of your jobs experiences I HAVE EXPERIENCE RECRUITMENT AND SELECTION,
LEADERSHIP AND MANAGEMENT SKILLS, MICROSOFT OFFICE,
ADOBE PHOTOSHOP, SALES MARKETING SKILLS.TRAINING AND
DEVELOPMENT, COMMUNICATION, PAYROLL PROCESSING, HRIS,
BPJS EDABU & SIPP. PSYCHOLOGICAL TEST ADMINISTRATION,
ETC.
What experience gained in your previous jobs is BE A MAJOR PART OF COMPANY'S SUCCESS, ESPECIALLY IN
most important to you? TERMS OF TRAINING AND DEVELOPMENT.
 Page 2

NO
Have you any objection if we contact your lates
employer?
PLAYING MUSIC, SINGING & FOOTBALL
What is your hobby?

Are you a member of a YES

club or an organization?

Have you had any NEVER

serious illness during
the past 2 years?
NEVER
Have you had any
major surgery?
NEVER
Have you had any
physical disability?
If you are married, is NO
your wife/husband
working?
IDR. 8.500.000,-
Your latest salary per
month
IDR. 8.500.000,-
Your expected salary
per month
Prior to engagement, YES
are you prepared to
under go physical
Do you have any YES
family member,
relatives who is
-
What is your father’s
accupation?
Whom shall we MY WIFE
contact for your
references
Can you explain the I WANT TO GAIN GREATER EXPERIENCE AND BE ABLE TO CONTRIBUTE
reason why you wish to
work for PT. Setia
1 MONTH NOTICE
When are you be able to
join our company?

…………..,……………………………

1 2 3 4
Attitude
General Impression
Appearance
Skill/Capacity
Interviewer’s (………………………………….)
Signature Signature