PT.

FIBERHOME TECHNOLOGIES INDONESIA

PRIVATE & CONFIDENTIAL

Applicant’s Form

Identity
Position Applied For : OM Engineer
Full Name : Agus Purna Irawan
Nick Name : Agus
Place & Date of Birth :Palangkaraya, 26 August 1978
Nationality : Indonesia
Ethnic Origin : Dayaknese
Sex : Male Female
X

Marital Status : Single Married Widow Divorce

X

Identity Card No. : 6304052608790001

Valid Until : Lifetime
Home address : Jalan AMD Komplek Borneo Lestari Blok 2 No.40

Fix & Mobile Phone No. :08565368361

Relatives to be Contacted : 085648885888
(in case of emergency)
 PT. FIBERHOME TECHNOLOGIES INDONESIA

Family Information
Member Name Sex Age Date of Birth Education Occupation
Spouse Mega Waty F 41 May, 11, 1981 Bachelor Acoounting
Degree
Child 1 Anindya Bawi Lintar F 9 October, 25, Elementary Student
Lovato 2013 School
Child 2
Child 3

Education (start from most recent)

Institute Name & Location From To Certificate
University of Palangkaraya, Palangkaraya, Central 2004 2011 Number :
Kalimantan 1190.H24.4.31.2011

Course-Training (related to the current job)

Subject Organizer Place/City Year Sponsored By
 PT. FIBERHOME TECHNOLOGIES INDONESIA

Language Proficiency (filled by : poor, fair, good, excellent)

No Language Speaking Writing Listening
.
1 Indonesia Native Native Native
2 English poor fair fair
3 Mandarin poor poor porr

Job Experiences (start from most recent)

From To Company Name Position Salary Reason for
Resign
2012 2021 Sinaralam corp Sr. Network IDR Looking for
rngineer 16.800.000 another
challenge
2010 2012 PT. Aplikanusa Technical IDR. 9.500.000 marry
Lintasarta Engineer

2008 2010 UPT. Puskom Technician IDR. 1.600.000 Contract ends

Universitas
Palangkaraya
 PT. FIBERHOME TECHNOLOGIES INDONESIA

Please Explain Your Last Job Description/Task List


 Designing and Implementing Network data Communication Platform for
Sinaralam Corp including configuration administration and maintenance for mail
server,VoIP server and ERP Server.
 Network Integration between Head Office and remote Office with microwave
radio technologies.
 Desktop application support.
 Lead MIS Department Team

Expecting Salary : IDR. 23.000.000 (gross)

I shall be fully responsible for any incorrect information above.

Date : January, 3, 2013

Applicant Signature