Application

PT. INDOTECH SCIENTIFIC

Form

APPLICATION FORM

Position of interest 1. Quality Leader/ QMS Reference No.

2. Date

I. PERSONAL DATA
Full Name Azwin Indra Pratama Putra Nickname Azwin
Gender Male
Address Jl Flamboyan No A 19 D Perumahan Ciputat Baru RY 004/ RW 006, Ciputat
Tangerang Selatan
ZIP Code 15413
Telephone Home HP 081381076699
Place/Date of Birth Semarang, 21 Januari 1980
Religion Moslem
Marital Status Married Children 2 (Two)
ID No. 3674042101800001

II. EDUCATIONAL BACKGROUND

Education Institution Name City Major GPA Graduate on
Elementary SDI Al Azhar Jakarta 1992
Junior High SMPN 12 Jakarta 1995
Senior High SMPN 46 Jakarta 1998
Bachelor Degree STISI Bandung 2.78 2004
Master Degree

III. COURSE/OTHERS
Activity Administrator Year Period Certificate No.
Awareness QMS ISO 9001 : 2008 &
Premysis Consulting 2010 October BC/IQA/10/111295
Internal Auditor ISO 9001 : 2008
5S Kaizen/ 5R Premysis Consulting 2010 December BC/5S/10/112702
Completed 6 Virus Leadership Freddway Int. Learning 2013 July
Good Mining Practice Al Kautsar Training 2014 May 6873/GMP/V/2014
Integrated System QHSE Training Neville Clark 2015 May NCI – P 13996
Penerapan & Auditor System SMKP APKPI 2017 January 12.2017.0511
Awareness ISO 9001 : 2015, 1400 :
Proxsis Synergy 2018 April 0012/TRN-SSI/IV-18
2015 dan 45001 : 2018
Internal Auditor ISO 9001 : 2015,
Proxsis Synergy 2018 April 0037/TRN-SSI/IV-18
1400 : 2015 dan 45001 : 2018
Executive Briefing Integrated
Penaraya Valencia
Management System ISO 9001 : 2019 February
Consulting
2015, 1400 : 2015 dan 45001 : 2018
 Application
PT. INDOTECH SCIENTIFIC
Form

IV. EDUCATIONAL INFORMATION

1. Achievement during your education (ex. top rank, cum laude,
etc.)
a. Year
b. Year
c. Year
d. Year
2. Who is the sponsor of your education cost?

3. Paper/Journal that has been published

4. Foreign language Speaking Reading Writing

skills Fluent Average Fluent Average Fluent Average

5. TOEFL/TOEIC/IELTS Test
□ Yes, in …………. (year) Administrator: ………………………………….. Score: ………………
□ No

V. SOCIAL ACTIVITY AND OTHERS

1. Organization/Institution Membership
Organization Name Location Position Period

2. Activity in your spare time (hobby)

3. Newspaper/Magazine that you read

4. Your favorite topic to read

 Application
PT. INDOTECH SCIENTIFIC
Form

VI. GENEALOGIST

1. You live in
a. ownhouse b. parent’s house c. rent d. boarding house e. ……………
2. You are …………. child from ……. brothers/sisters
3. Parents Name Age Last Education Occupation
Father
Mother
Address

Telephone
4. Siblings Name Age Education Occupation
1
2
3
4
5
5. Husband/Wife Name Age Education Occupation
1
2
6. Children Name Age Education Occupation
1
2
3
4
5
7. If there is an accident happen to you, who should we contact
Name
Address

Telephone
 Application
PT. INDOTECH SCIENTIFIC
Form

VII. OCCUPATION BACKGROUND

Company Details Now Before
Company Name
Address

Telephone
Your Top Position
Job Description

Period
Number of Staff
Basic Salary
Allowance

Facility

Reason of resignation

Achievement during your working period

Describe your career day

 Please submit your certification of work

 Application
PT. INDOTECH SCIENTIFIC
Form

VIII. POINTS ABOUT APPLICATION

1. Have you ever applied in Pandu Holding Company/Indotech Scientific before?

□ Yes, I applied as …………………………….. □ No
2. What is your reason applying in Indotech Scientific?

3. Where did you know about this vacancy?

4. Working circumstances that you like and the reason

a. Office b. Workshop c. Outdoor d. ……………………. Reason

5 Your expected salary

Your expected allowance
Your expected facility
6. Do you agree to:
Doing 3 months of probation period □ Yes □ No
Doing assignment in other city □ Yes □ No
Placed in other city □ Yes □ No
Working overtime □ Yes □
No
 Application
PT. INDOTECH SCIENTIFIC
Form

IX. OTHERS
1. Have you ever working/have a connection with customer or bidder of Pandu Holding
Company/Indotech Scientific?
□ Yes, customer/bidder name: □ No

…………………………………………………..
2. Have you ever working/have a connection with group/affiliation of Pandu Holding Company
□ Yes, company name: □ No

…………………………………………………..
3. Do/Have you ever suffer from critical illness?
□ Yes, name of illness: □ No

…………………………………………………..
4. Have you ever been in a critical accident?
□ Yes, time of accident: □ No

…………………………………………………..
5. Are you smoking?
□ Yes □ No
6. Blood type: O/A/B/AB
7. Vehicle that you use
Property that you own: Personal/Parent’s/……………………………..
Driving license that you have: SIM A/SIM C
8. Employee that you know in Pandu Holding Company/PT Indotech Scientific
……………………………………………………………………………………………………………
9. Please write two name who can give reference for your working experience
Reference 1 Reference 2
Name/Position
Company
Address
Phone
Connection with you
Can we contact the person above right now?

10. If you are accepted in Indotech Scientific, when are you ready to start working?

This application form is fulfilled by me with honesty as the things should be. If Indotech Scientific found
something that doesn’t right in the future, I am ready to be charged with the applicable law in Indonesia.

…………………., ………………………………………..

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