CONFIDENTIAL

APPLICATION FORM
PT. PARAMITA BANGUN PERSADA

BY HRD
 I. PERSONAL DETAILS / DATA PRIBADI

POSITION APPLIED FOR/

NAME / NAMA POSISI YANG DI INGINKAN

PLACE & DATE OF BIRT H /

TEMPAT &TANGGAL LAHIR

PERMANENT ADDRESS /
ALAMAT TETAP :

Telephone & Mobile Phone :

EMERGENCY ADDRESS :

MARITAL STATUS/ STATUS

GENDER / JENIS KELAMIN

RELIGION / AGAMA

RACE / SUKU

NATIONALITY /
KEWARGANEGARAAN

ID CARD / NO.IDENTITAS :
 KTP :

 PASSPORT :

NO. NPWP :

II. FAMILY MEMBERS / SUSUNAN KELUARGA

1. Family ( including the employee )

Susunan Keluarga sekandung ( termasuk diri sendiri )

NAME/NAMA AGE/ USIA EDUCATION / PENDIDIKAN OCCUPATION/ PEKERJAAN

FATHER
Ayah

MOTHER
Ibu

1st Child
Saudara 1

2nd Child
Saudara 2

3rd Child
Saudara 3

4th Child
Saudara 4

5th Child
Saudara 5
 2. If you are married, please fill in this table
Bila telah menikah, lengkapilah data berikut ini

NAME AGE M //F EDUCATION OCCUPATION PEKERJAAN

NAMA USIA L/P PENDIDIKAN
Husband/ Wife
Suami / Istri
1st Child
Anak 1
2nd Child
Anak 2
3rd Child
Anak 3

III. EDUCATIONAL BACKGROUND / PENDIDIKAN

1. Formal

EDUCATION NAME & PLACE OF EDUCATION MAJORING YEAR FROM - TO

PENDIDIKAN NAMA & TEMPAT SEKOLAH JURUSAN DARI TAHUN
MASTER
PASCA SARJANA
BACHELOR
SARJANA
ACADEMY
AKADEMI / DIPLOMA
SENIOR HIGH SCHOOL
SLTA
JUNIOR HIGH SCHOOL
SLTP
ELEMENTARY
SD

2. Non Formal

SUBJECT NAME OF COURSE DURATION YEAR SPONSORED BY

SUBYEK NAMA KURSUS LAMA KURSUS TAHUN DIBIAYAI OLEH

Language Ability
Kemampuan Berbahasa

LANGUAGE SPEAKING READ WRITING

BAHASA BICARA MEMBACA MENULIS

Indonesia Limited / Good / Fluent Limited / Good / Fluent Limited / Good / Fluent

English Limited / Good / Fluent Limited / Good / Fluent Limited / Good / Fluent

Others Limited / Good / Fluent Limited / Good / Fluent Limited / Good / Fluent
 IV. EMPLOYMENT HISTORY / PENGALAMAN KERJA
( Please write from your present employment )

YEAR/PERODE COMPANY JOB DESCRIPTION POSITION SALARY REASON FOR LEAVING

PERUSAHAAN POSISI
TAHUN/PERIODE GAJI ALASAN KELUAR

Gambarkan Struktur Posisi Anda di Perusahaan yang sekarang / terakhir

Describe your position structure in your current company/ latest company
 Outstanding achievements and accomplishment in the work :
Prestasi atau penghargaan yang pernah diperoleh selama bekerja :

1. …………………………………….

2. …………………………………….

3. …………………………………….

4. …………………………………….

V. OTHERS ACTIVITY / AKTIVITAS LAIN

ORGANIZATION TYPE OF ORGANIZATION POSITION YEAR / PERIODE

ORGANISASI JENIS ORGANISASI JABATAN TAHUN / PERIODE

VI. OTHERS INFORMATION / INFORMASI TAMBAHAN

For Further reference and recommendation about the employee can be obtained from:
Referensi dan rekomendasi mengenai anda dapat diperoleh dari :

Name Address & Telp Occupation Relation with Employee

Nama Alamat & Telp Pekerjaan Hubungan dengan karyawan
  Have you ever had serious illness? / Apakah anda pernah menderita sakit berat ?

 Never / Tidak Pernah

 Yes / Pernah
Name of illness…………………………………...
When / Kapan…………………………………….
How Long / Lama Sakit………………………….
Dirawat di…………………………………………

 Leadership experience / Pengalaman Kepemimpinan :

( In the job and in social activities / didalam pekerjaan dan aktivitas sosial )

 Social Interest/ Hobbies :

 What is your career objective?/ Apakah tujuan dari karir anda ?

 Expected Salary/ Gaji yang diharapkan:

……………………………………………………………………………………………………………………………………………………………………

 Availability of working/ Waktu mulai bekerja :

……………………………………………………………………………………………………………………………………………………………………

I hereby certify that foregoing statement are made truthfully and that the information is correct to the best of my knowledge and
belief. I understand that furnishing of false information during the recruitment process including this application may lead to
termination of my appointment with the company.

Date / Tanggal :…………………

Signature,

………………..