JOB APPLICATION FORM

Position Applied:

 PERSONAL DATA
Full Name
Place/Date of Birth
National ID Number
NPWP Number
Marital Status
Email Address
Phone Number
Permanent Home Address Current Home Address
(based on your National ID Number): (if different from Permanent Home Address):

Phone Number: Phone Number:

 FAMILY
Name Education Occupation
Father
Mother
Spouse
Children 1
Children 2
Children 3
...

Please list 3 persons that we can contact, in case of emergency:

Phone
Name Relationship Address
Number
Family / non-family
living together in
one house
Family / extended
family living in
different address
Friends / relatives

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 EMPLOYMENT APPLICATION FORM

 EDUCATION
Formal Education
School/ Institution Start –
Faculty Major Location GPA
Name Finish Year
Diploma
I/II/III*
Bachelor
Master
Doctoral
*mark that fit your education

Informal Education / Training / Course / Seminar

No Subject / Topic Duration Provider Certificate
1. Yes/No*
2. Yes/No*
3. Yes/No*
4. Yes/No*
5. Yes/No*
*mark that fit you

 SKILLS
Language (foreign language)
Writing Speaking
No Language
Poor Fair Good Poor Fair Good
1.
2.
3.

Job-related skill (computer program, programming language, assessment tools, etc).

Rating
No Skill Name Description & Application
Poor Fair Good
1.
2.
3.

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 EMPLOYMENT APPLICATION FORM

 JOB EXPERIENCES
(Start from the latest)
Join Leave
Company Name Position Salary
Date Date

May HR contact
Supervisor’s
Supervisor’s Name Supervisor’s Email your
Phone Number
Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?

Summary of Job Description Reason For Leaving

Join Leave
Company Name Position Salary
Date Date

May HR contact
Supervisor’s
Supervisor’s Name Supervisor’s Email your
Phone Number
Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?

Summary of Job Description Reason For Leaving

Join Leave
Company Name Position Salary
Date Date

May HR contact
Supervisor’s
Supervisor’s Name Supervisor’s Email your
Phone Number
Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?

Summary of Job Description Reason For Leaving

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 EMPLOYMENT APPLICATION FORM

 ACTIVITIES & CAREER INTEREST

Organization Activities
DD-MM-YY –
No Organization Name Position Place
DD-MM-YY
1.
2.
3.
4.
5.

Please mention your hobbies!

What would you do in your spare time?

In which division and position are you interested in the future?

Where do you know about Veda Praxis and where you know the job vacancy from?

Please explain, why you want to work in Veda Praxis?

Are you available working long hours and on weekends/public holiday when request?
(please explain)

If Yes, when will be the latest time you are willing to work? (Please select from below options)
Anytime After Midnight 23.00 21.00 19.00

 REMUNERATION
Please mention the salary and benefit expectation.
Current Monthly Salary Desired Monthly Salary
Net/Gross Net/Gross
Current Benefit
Benefit Amount

 OTHER INFORMATION
Have you applied to Veda Praxis before? If yes, please mention the time and position applied.

Do you have relatives and or friends who worked in Veda Praxis? If yes, please mention the
name(s) and relationship(s).

Do you also apply to any other company? If yes, please mention the company and position

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 EMPLOYMENT APPLICATION FORM

applied.

Do you have any part-time jobs? If yes, please explain.

Have you ever had serious illness or undergone surgery or gotten into serious accident? If yes,
please explain.

Do you have any serious illness that require specific condition for working? If yes, please
explain.

In your opinion, what is your 5 strength?

1.
2.
3.
4.
5.
In your opinion, what is your 5 weakness that you need to improve ?
1.
2.
3.
4.
5.
Please mention further information which may be helpful in considering your qualifications.

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 EMPLOYMENT APPLICATION FORM

STATEMENT APPLICATION:
By completing and sending all application documents to Veda Praxis, I, the undersigned, certify
that:
 All information provided during the recruitment and selection process is correct.
 I truthfully declare that I have never been involved in type of legal case and currently not
undergoing any legal proceedings.
 I am an integrity, honesty, and have a good self-concept person in everyday life and in
social media (cyberspace), do not engage in and do not engage in self-concept activities
that endanger myself and will harm the company and co-workers .
 I have a clean self-image on social media, do not use social media for things that are
against morals, law, politics, SARA.
 I am willing to not bring the good name of the Company, management and colleagues in
conflicts that occur in the personal sphere, including but not limited to: family, friends and
communities.
 I understand that if after I have been accepted to work at Veda Praxis and found that
things are not in accordance with the terms above, I am willing to resign or be terminated
from the company without demanding for any consequences from the company, including
being willing to waive clauses related to Termination of Employment and severance pay
in PKWT and PKWTT.

I hereby certify that all the information given above is true and if under any circumstances
omission or misrepresentation is found, I understand that I shall be fully held responsible. By
sending this data, I acknowledge and agree that the data will be used in the recruitment and
staffing process, including being stored and processed in a third-party HRIS application.

Date :
Applicant Signature

( )

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