No.

Doc FM-06-HR-005
RUSSINDO GROUP CORPORATION
No. Rev 0
Date 2 January 2019
JOB APPLICATION FORM
Page 1 of 7

JOB TITLE : REF NO :

NAME OF APPLICANT :
DEPARTMENT/SERVICE :

DOCUMENT REQUIREMENT
Please sure your document on your hand or soft file before interview season:

NO DESCRIPTION PLEASE CHECK (V)

AVAILABLE NOT AVAILABLE

1 CURICULUM VITAE, SIGN

2 PHOTOGRAPH 3X4, 1 SHEET

3 ID CARD FROM INDONESIA

GOVERNMENT

4 COLOR COPY OF EDUCATION.

LAST 2 LEVEL. 1 SHEET

5 COLOR COPY OF EDUCATION

SCORE, LAST 2 LEVEL. 1 SHEET

6 COLOR COPY OF DRIVING

LICENSE

7 COLOR COPY OF SKILL OR

CERTIFICATE SCORE,

8 COLOR COPY OF BPJS CARD

 No. Doc FM-06-HR-005
RUSSINDO GROUP CORPORATION
No. Rev 0
Date 2 January 2019
JOB APPLICATION FORM
Page 2 of 7

APPLICANT SECTION
Position applied for:

Personal details
Given name: Family name:
Preferred name:
Address:

Mobile:
Telephone :
Email:

Parents details
a. Father
Name :
Place, date of birth :
Address :
Religion :
Occupation :
Last Education :

b. Mother
Name :
Place, date of birth :
Address :
Religion :
Occupation :
Last Education :

Education
Education title Institution Year completed
 No. Doc FM-06-HR-005
RUSSINDO GROUP CORPORATION
No. Rev 0
Date 2 January 2019
JOB APPLICATION FORM
Page 3 of 7

Current qualifications
Qualification title Institution/training provider Year completed

Are you currently undertaking study/training?

(tick one) Yes No
If yes, course/program name:
NO
(tick one) Full time Part time Distance Other

(tick one) Full time Part time Distance Other

(tick one) Full time Part time Distance Other

(tick one) Full time Part time Distance Other

Previous employment (most recent first)

 No. Doc FM-06-HR-005
RUSSINDO GROUP CORPORATION
No. Rev 0
Date 2 January 2019
JOB APPLICATION FORM
Page 4 of 7

Employer name/
establishment Dates from/to Position held Reason for leaving Salary/Wage

Do you agree to have referees contacted in relation to this

application? (tick one) Yes No
(Reference checks will be conducted legally in an ethical manner and all information derived
will remain confidential.)
Please provide details of three people who can speak on your behalf regarding your work
history.
Office use
Position held/working relationship check
Name Contact No. (eg supervisor) initial/date

What type of work are you

available for? (tick one) Full time Part time Casual
When will you be available for work?

Please provide any other information that you identify as being pertinent to this application
(eg medical conditions, disabilities)
MEDICAL CONDITION :

Do you agree to relocate? (tick one) Yes No

Are you willing to travel? (tick one) Yes No

 No. Doc FM-06-HR-005
RUSSINDO GROUP CORPORATION
No. Rev 0
Date 2 January 2019
JOB APPLICATION FORM
Page 5 of 7

Do you hold a current driving licence? (tick one) Yes No

Have you been convicted of a criminal offence? (tick one) Yes No

Will you work on target timing? (tick one) Yes No

MEMBERSHIP OF PROFESSIONAL ORGANISATIONS

Please list any professional organisations of which you are a member which are relevant to the
job for which you are applying. If you are not a member of a professional organisation please
put ‘N/A’ in this part of the application

Professional Organisation Subject/Level of Membership

N/A N/A

SUITABILITY FOR ROLE

 No. Doc FM-06-HR-005
RUSSINDO GROUP CORPORATION
No. Rev 0
Date 2 January 2019
JOB APPLICATION FORM
Page 6 of 7

Declaration
I declare that, to the best of my knowledge, the information given is true and correct. I
understand that inaccurate, misleading or untrue statements or knowingly withheld information
may result in termination of employment with this organisation. I understand that this
application does not constitute an offer of employment. I understand that, in some cases,
police and credit checks will be required and I will be notified if this applies to this application.

Signed: Date:

EMPLOYER SECTION
Confidential – reference checks For office use only

Reference Comments Would re-employ? Initial Date

name
Yes No

Action

Interview arranged for:

Offer of employment made
Position:
Letter of advice sent: By:
Letter of appointment signed: By:

Induction due on: /

Payroll details entered: / By:

Probationary period expires on: /

Notes
 No. Doc FM-06-HR-005
RUSSINDO GROUP CORPORATION
No. Rev 0
Date 2 January 2019
JOB APPLICATION FORM
Page 7 of 7

Application unsuccessful

Letter of advice sent: / By:

Application to be destroyed on: /

Notes