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CANDIDATE APPLICATION FORM (3x4)

(Please fill with CAPITAL letter)

PERSONAL PROFILE

Full Name

Gender male | c Female )*

Body Height & Weight cm kg

Birthplace & Date of Birth

Ethnic
c Bataknese | Javanese | c Sundanese | c Chinese | c Others : )*

Religion
c Buddhist | c Hindu | Moslem | c Catholic | c Christian | c Others : )*

Marital Status
)*
Cellphone Number

E-mail

Last Address
District : Province :

Ownership )*
c Own | c Boarding | c Parents | c Relatives | c Rent | c Others :

)* Please gives check sign (P)

FAMILY MEMBER
Relationship Complete Name Gender Birthplace, Date of Birth Education Phone Number

Father Male
Mother Female
Brother / Sister

Brother / Sister

Brother / Sister

Brother / Sister

NUCLEAR FAMILY
Relationship Full Name Gender Birthplace, Date of Birth Education Phone Number
Husband Male
Wife Female
Child

HRD/FRM/2019/XI/001/Ver 1.00 0/3

Please draw a chart to explain your recent / latest position level in the organizational structure

(Please write a short essay about detail your job description in your latest workplace)

HRD/FRM/2019/XI/001/Ver 1.00 0/3

 WORK EXPERIENCE
(Fill the from the newest to the latest experince)
Company JobTitle/Position Work Period Reason For Leaving

REFERENCE
(Please fill with superior level or HR name in latest company)

Name Department Relationship Phone Number

Current/Last
Salary (Gross) Current Benefit
Expected Salary
| Rp.
Notice Period

OTHER QUESTIONS
Please circle which applied

1. Are you willing to work in shift? Yes / Yes

No / No

2. Are you willing to work overtime? Yes / Yes

No / No

3. Are you willing to be placed in other city? Yes / Yes

No / No
4. Do you know any employee in this company? If yes, who is it?

5. What is your relationship with those names?

PERNYATAAN AUTENTIFIKASI INFORMASI

Saya menyatakan dan menjamin bahwa semua informasi di atas adalah benar dan saya tidak menyembunyikan fakta yang
sesungguhnya. Saya memberikan kewenangan kepada Himalaya Group untuk menghubungi semua pihak yang bersangkutan
untuk keperluan verifikasi dan untuk mendapatkan informasi lainnya mengenai saya secara lisan maupun tertulis dari waktu ke
waktu apabila hal itu dianggap perlu. Apabila dikemudian hari ditemukan bahwa data yang saya sampaikan diatas tidak benar
dan/atau ada pemalsian, maka saya bersedia dihilangkan haknya sebagai karyawan Himalaya Group dan dikenakan tuntutan
perdata dan pidana sesuai ketentuan hukum dan perundang-undangan yang berlaku.

Jakarta, ____________________

Nama lengkap

HRD/FRM/2019/XI/001/Ver1.00 0/ 3