Application Form

Wisma Tamara, 15th - 17th Fl.

Jl. Jend. Sudirman Kav. 24 Jakarta 12920 Attach Photo
Phone: (62-21) 2557 7878 (Hunting) Fax: (62-21) 5206378 Here

Please fill in this form as detail as possible in English.

Time available: 30 (thirty) minutes.

Personal Information
Position apply Payroll Officer
Name Siti Maryah
ID Number (KTP) 3173065812850006
Place of Birth Jakarta Date of Birth 18/12/1985
Gender (Male/Female) Female Email Address hya.sitimaryah@gmail.c
om
Status  Single  Married  Others
Home Phone 021-5561963 Handphone 08561563993
Present Address Jalan Malioboro III Blok E3 No.4 Kel. Tegal Alur Kec. Kalideres
Jakarta Barat 11820
 Owned by yourself  Owned by relatives  Rent  Others

Education
Type of Name and Location of Major Years Attended Graduated
School School of Study From Year to (Tick One)
Year
Junior Junior High School 45 1998 – 2001  Yes No
High School Jakarta
Senior Senior High School 33 2001 – 2004  Yes No
High School Jakarta
Institution/  Yes No
College
University 1.Gunadarma University Information 2004 – 2008  Yes No
System
2.  Yes No

Training / Courses
Name of Training / Courses Organization/ Institution Years Attended
From Year to Year

1
Application Form
Wisma Tamara, 15th - 17th Fl.
Jl. Jend. Sudirman Kav. 24 Jakarta 12920
Phone: (62-21) 2557 7878 (Hunting) Fax: (62-21) 5206378

Language
Language Read Write Speak
English Good Good Fair
Mandarin
Hokkien
Cantonese
Please fill in with one of these categories: Excellent, Good, Fair, A Little.

Family Information
Parents Name Age Education Occupation
Father Mochamad Ahwan 65 Senior High School Retired
Mother Rochani (Passed Away) 59 Junior High School Housewife
Brothers/ Name Age Education Occupation
Sisters
1 Mochamad Robiansyah 35 Senior High School Technician Supervisor
2 Achmad Yani 30 Bachelor Degree Network Engineer
3
4
5

Name of Husband/ Wife Age Education Occupation

Wahyu Setiono 33 Bachelor Degree Doctor
Children Name Age Education Occupation
1 Fathiya Aleeyasha Setiono 5 Kindergarten A
2 Qisya Sheinafia Setiono 3 Nursery A
3
4
5

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Application Form
Wisma Tamara, 15th - 17th Fl.
Jl. Jend. Sudirman Kav. 24 Jakarta 12920
Phone: (62-21) 2557 7878 (Hunting) Fax: (62-21) 5206378

Person to Contact in Case of Emergency

Full Name Wahyu Setiono Phone 021-5561963
Nature of Husband Handphone 081224501400 /
Relationship 085779252559
Address Jalan Malioboro III Blok E-3 No.4 Tegal Alur – Jakarta Barat 11820
This information is to facilitate contact in the event of an emergency and is not used in the selection process.

Employment History (Please start with the most recent position)

From Month/ Company/Address Title/ Position Reason for
Year to Held Leaving
Month/ Year

2009 – June 2018 PT Bank DBS Indonesia Senior HR Family reasons

Shared
Services
Job Duties/ 1.Payroll process 4.Loan Transfer
Responsibilities 2.Tax calculation and 5.
3.Handling Everything about BPJS-TK, BPJS 6.
Kesehatan, Health & Life Insurance, Pension
Fund / DPLK

From Month/ Company/Address Title/ Position Reason for

Year to Held Leaving
Month/ Year

2008 – Jan 2009 Gunadarma University Assistant Lab. Looking for better career prospect,
professional growth and work
opportunities.
Job Duties/ 1. 4.
Responsibilities 2. 5.
3. 6.

3
Application Form
Wisma Tamara, 15th - 17th Fl.
Jl. Jend. Sudirman Kav. 24 Jakarta 12920
Phone: (62-21) 2557 7878 (Hunting) Fax: (62-21) 5206378

From Month/ Company/Address Title/ Position Reason for

Year to Held Leaving
Month/ Year
2005 – Jan 2008 Gunadarma University Librarian

Job Duties/ 1. 4.
Responsibilities 2. 5.
3. 6.

Character Referees (Referees should be non relatives. Please list at least one referee who was your
previous Manager/Supervisor)

Name Relationship Phone Occupation / Office Address

Company
Alexander DR Jiun Vice President 081315151159 PT Bank DBS Ciputra World 1 -
HRSS & HRIS Indonesia DBS Bank Tower 33rd
Jakarta
Marendra E Eko Direct Manager 081280176617 PT Bank DBS Ciputra World 1 -
Prabowo Indonesia DBS Bank Tower 33rd
Jakarta
Seskia Vice President 08118995799 PT Bank DBS Jakarta
Indonesia

For fresh graduated applicant

Please tell your important and proud moment during your school/college, either in school/college activities
or outside school/college activities

For experienced applicant

Please tell your great achievement so far, draw the organization structure that describes your current
position and describe your job responsibilities

4
Application Form
Wisma Tamara, 15th - 17th Fl.
Jl. Jend. Sudirman Kav. 24 Jakarta 12920
Phone: (62-21) 2557 7878 (Hunting) Fax: (62-21) 5206378

Please mention one thing that disappoint you (failure or things that you want to change if
time can be rewind) and what is the lesson learned

5
Application Form
Wisma Tamara, 15th - 17th Fl.
Jl. Jend. Sudirman Kav. 24 Jakarta 12920
Phone: (62-21) 2557 7878 (Hunting) Fax: (62-21) 5206378

Once you receive our acceptance notice, how long can you report to our bank?
 Less than 1 month  1 month  In 2 months  Above 2 months

This is to certify that above information is true and genuine, if it is false, my employment might be terminated
by the bank.

__________________ ____________________
Applicant’s Signature Date