YAYASAN DYATMIKA SEKAR BAWANA

APPLICATION FOR EMPLOYMENT

(Private & Confidential)
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POSITION APPLIED FOR : _________________________________________

PERSONAL PARTICULARS
* Dr/Mr/Mrs/Miss/Mdm Alias/Other Name (If any)
Full name as in Identity card/Passport (Please underline surname/family name)

Residential Address Telephone No.

Home :
Mobile Phone/Pager*:
Office :
Email:
Home Country Address (if different from residential address) Telephone No.
Home :
Mobile Phone:
Date of Birth (dd/mm/yyyy) Place of Birth (Country/City/State) Nationality

*Identity Card/Permanent Resident/Passport No. For PR holders, state date of issue Race/Dialect

*Old Identity Card No.(where compulsory in country of employment) Religion

Marital Status (Single/Married/Divorced/Others-please specify) Gender (Male / Female) Driving Licence : Yes / No *
Class :
Possess own vehicle: Yes/No*

EDUCATION
School/Institution Course/Majors From To Highest Qualification

PROFESSIONAL QUALIFICATIONS (Post Graduate Studies/Certificate/Diploma)

Name of Institution From To Qualification

SCHOLARSHIPS/MERIT AWARDS
Type of Scholarship/Award Value From To

* Delete if inapplicable
PRESENT & PAST EMPLOYMENT (Please start with your latest employment)
1 Position Held Date Salary (state currency type) Other form of
From(mm/yyyy) To (mm/yyyy) Starting Last Drawn Compensation (if any)
Employer

Address Type of Industry

May we contact this employer? Yes / No * Telephone No. :
Contact Person & Position
Reason for Leaving

Responsibilities

2 Position Held Date Salary (state currency type) Other form of

From(mm/yyyy) To (mm/yyyy) Starting Last Drawn Compensation (if any)
Employer

Address Type of Industry

May we contact this employer? Yes / No * Telephone No. :
Contact Person & Position Held
Reason for Leaving

Responsibilities

3 Position Held Date Salary (state currency type) Other of

From(mm/yyyy) To (mm/yyyy) Starting Last Drawn Compensation (if any)
Employer

Address Type of Industry

May we contact this employer? Yes / No * Telephone No. :
Contact Person & Position Held
Reason for Leaving

Responsibilities

4 Position Held Date Salary (state currency type) Other form of

From(mm/yyyy) To (mm/yyyy) Starting Last Drawn Compensation (if any)
Employer

Address Type of Industry

May we contact this employer? Yes / No * Telephone No. :
Contact Person & Position
Reason for Leaving

Responsibilities

REMUNERATION
Expected Salary On Successful Appointment Earliest Possible Date for Appointment
PARTICULARS OF PARENTS, SIBLINGS, SPOUSE AND CHILDREN
Name Relationship Date of Birth Occupation Employer/School
1
2
3
4
5
6
7
8

GENERAL INFORMATION
Language Skills
Spoken
Written

Computer Literacy
Software Applications
Operating System / Language

Professional Membership / Association

Name of Institute Country Membership Type

Hobbies
Indoor Activities
Outdoor Activities

REFEREES (Please provide two referees who know you in your employment or private life (non-relative) and to whom reference may be made)

Name Address Occupation Contact Number

EMERGENCY CONTACT
Name Relationship Address Contact Number

* Delete if inapplicable
DECLARATION OF APPLICANT (If your answer is 'yes', please give details in the space provided)
1 Are you an undischarged bankrupt? Yes / No *

2 Have you ever been charged, convicted in any court of law or Yes / No *
detained under the provisions of any written law?

3 Have you ever suffered any physical disabilities, illness or mental Yes / No *
illness e.g. diabetes, tuberculosis, epilepsy, high blood pressure,
etc.?

4 Have you had an operation or been treated for any illness during Yes / No *
the past 5 years?

5 Are you in debt? Yes / No *

6 Do you have obligations of any loans either as a borrower or surety? Yes / No *

7 Have you ever been dismissed or suspended from any employment? Yes / No *

8 Do you have any friends or relatives working for our Company? Yes / No *

9 At the moment, are you also applying at other company / institutions? Yes / No *

10 Are you planning to apply at Government Institution (PNS) Yes / No *

11 If you are married. Are you willing to postphone your pregnancy until Yes / No *
1 year of working period? (female employee)

12 Are you willing to follow a 3 - 6 months probation? Yes / No *

Declaration

I declare that the above information and documents attached hereto are true and correct. I understand that any false
answers or statements made by me on this application or any supplement thereto will be sufficient grounds for
immediate termination of my services.

____________________________________ ________________________
Signature of Applicant Date of Application

FOR OFFICIAL USE

Date of Interview Interviewed By

Source :
Advertisement / Referred By Agencies / Staff Recommendation *
Comments

Position Offered : Department : Supervisor :

Approved For Hire By Grade Starting Salary Starting Date