Human Resources Department

JOB APPLICATION FORM

I. POSITION APPLIED

Position :

II. PERSONAL DATA

Full Name :
(Male / Female *)
Sex :
(striketrough the unnecessary)
Date of Birth : Place :

Religion Nation :

Senior High School / Academy / University / Post Graduate *)

Last Education :
(striketrough the unnecessary)

ID Card Number :
NPWP Number :
C / A / B I / B II
Driving Lisence
(striketrough the unnecessary) Driving Lisence No :
Current Address :

Telephone : Home: Phone :

E-Mail Address :

In case of emergency, family, address, phone number that can be contacted:

:
Name
Family Relation :
Phone Number :
Address :

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 Human Resources Department

III. EDUCATION
Year
Education Level School / Institution Major
Start Graduate

IV. WORKING EXPERIENCE

Duration of Work
Company Name Last Position Last Salary Reason for Leaving
From Untill

V. LANGUAGE SKILLS (Beginner, Intermediate, Advanced)

Language Reading Writing Speaking
English

VI. FAMILY DATA

Relation Name Date of Birth Education Occupation
Spouse
Children 1
Children 2
Children 3
Father
Mother
Sibling 1
Sibling 2
Sibling 3

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 Human Resources Department

VII. STRENGTH AND WEAKNESS

STRENGTH WEAKNESS

Yes / No *)
1. Are you still working? :
(striketrough the unnecessary)

2. Wage package expected (gross) :

3. When is your availability to work? :

Yes / No *)
4. Do you able to be placed in our store? :
(striketrough the unnecessary)
Yes / No *)
5. Do you have relatives who works here? :
(striketrough the unnecessary)
Name :

I declare that the particular in these applications, are true in every respect. I understand that if any of the particulars supplied by me are
proved untrue, I am liable to be summarily dismissed. I am not willfully suppressed any meterial fact.

Jakarta, ___________________

__________________________
Applicant’s Name and Signature

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