CANDIDATE FORM

Personal data

Full Name

If you change your full name,

please indicate the previous
and the reason

Date and

place of birth

Last 2 places of labor activity: (information must be indicated in full, reductions are not allowed)

Start date: Company name: Tel:

Company field: Company address:

End date:

Your position: Reason for leaving:

Start date: Company name: Tel:

Company field: Company address:

End date:

Your position: Reason for leaving:

Marital status _____________________________________________________

Details of relatives (wife / husband):

Relation Full Name DOB

degree

Position for which you are

applying

Do you have relatives or

friends who work for the
company?

I do not object to the verification of the information I have provided and the rejection of my candidacy if they
are unreliable.

1
 I do not mind checking additional information about me and holding a conversation with recommenders,
sending requests to other organizations, including those from my previous jobs, to clarify or obtain additional
information about me as an applicant.
My personal data is any information relating to me as an individual (subject of personal data) specified in
this questionnaire.
I express my consent to the implementation by the user of any actions in relation to my personal data that
are necessary or desirable to achieve the specified goals, also, I agree to the processing without limitation of my
personal data, including the collection, recording, systematization, accumulation, storage, clarification (updating ,
modification), extraction, use, transfer (provision, access) to third parties (legal entities in whose interests the user
acts under the relevant agreement), depersonalization, blocking, deletion, destruction of personal data performed
using automation tools or without using such tools .
This consent to the processing of personal data is valid from the moment it is provided for the period when
the user makes a decision on employment or refusal of employment, or until the withdrawal of this consent.
I am aware that in the event of a denial of employment, the information provided by me will be destroyed by
the user within 30 days.
This consent may be revoked by me upon submission to the user of an application in a simple written form
in accordance with the requirements of the legislation of Indonesia.
About the responsibility for the accuracy and completeness of the provided personal information I was
warned prior.

___________________________________________________________ / _________________ / ____________

Full Name Signature Date