APPLICATION FORM

Date:
Position Applied For:

A. PERSONAL IDENTITY

Full Name:
Nick Name:
ID Card (KTP)/Passport No:
Date of Birth:
Permanent Address:

Residential Status:
Current Address:

Sex:
Marital Status:
Religion:
Mobile Phone: Home Phone:
Email Address:

B. FORMAL EDUCATION

Level of
Institution Major From – To HQA/GPA
Education

to
University
to

Academy to

High School to

to
Others
to

C. NON FORMAL (Course / Seminar)

Name of Course Year

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 D. LANGUAGE PROFICIENCY

Language Spoken Written

E. FAMILY DETAIL

Relation Full Name Place & Date of Birth Education Occupation

Father

Mother

Sibling
including
yourself

FOR MARRIED
Relation Full Name Place & Date of Birth Education Occupation

Spouse

Children

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 F. EMPLOYMENT HISTORY

Start from the latest employer

Present/Last Employer:

Period of Service Current Reason for

Company Nature Of Business Position
From To Salary Leaving
Rp.
Rp.

Rp.
Rp.

Rp.
Rp.

Rp.
Rp.

Rp.
Rp.

Rp..

Current Allowance :

Current Bonus :

Draw Your Current Organization Structure That describe Your Position Job Description

Why do you apply for this position? What makes you qualified for this role?

Why do you want to work for our company?

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What were your best accomplishments in your last or previous role?

Describe a time when you had to make a tough choice. What did you have to choose between and why did
you choose it?

Provide a short list of your personal and/or professional strengths.

What are the areas of work that you consider still need an improvement?

Have you ever applied to/worked for this Company before? YES or ✔ NO If yes, please
explain (include date):

Do you have any family, relatives, friends or colleagues that work in Keppel Land? If yes, please
provide details.

Notice period required by current employer?

Where did you hear about the job vacancy in Keppel Land?

✓ Job Portal Reference

Linkedin Head Hunter Campus Ad

CONTACT REFERENCE (to give recommendation on your work result)

*Note: Minimal two persons with at least one (1) direct user
No Name Company Position Phone Number

1.

2.

3.

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 G. SALARY EXPECTATION & BENEFIT

Salary Expectation: Rp.

Benefit:

H. EMERGENCY CONTACT (Family Member)

Full Name:
Relation:
Address

Mobile No: Phone No.:

FURTHER INFORMATION :
Would you consider relocation, if there is an overseas working opportunity?
Driving licenses you hold: ■☐ SIM A ☐ SIM B ■
☐ SIM C
Vehicle you own: ☐ Car ■
☐ Motorbike

I. DECLARATION

I hereby authorise the Company to verify any information provided by me in this application form as it deems fit. I
understand that a misinterpretation or omission of facts called for it here will be a sufficient cause for cancellation of
consideration for employment, or dismissal from the Company’s service if I have been employed. I also understand that my
employment is subject to me being certified medically fit for employment, by the Company’s doctor. By signing the below, I
confirm that the information provided on this application and my resume are accurate and truthful to the best of my
knowledge.

Name:

Date:

-------------------------------------------------------------------------

Signature of Applicant

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