PT.

Seagull Cooling Tower

Komplek Gading Bukit Indah P No.17 Kelapa Gading Barat,
Kelapa Gading Jakarta
Tel: 021-45852853
Website: www.seagull-ct.com

APPLICATION FOR EMPLOYMENT

1. Please read the form through carefully and decide on your reply before attempting to complete the form.
2. The applicant is WARNED that any falsification in this application will result in rejection of the
application, or if not detected until after appointment, in instant dismissal of the applicant.
3. All information given will be treated as strictly confidential.

Post Applied For : SITE ENGINEER

Name of Company Applied To : PT. Seagull Cooling Tower

NAME & ADDRESS

a) Full Name : Mr / Mrs / Miss MOHAMAD YUSUF HADRION

(Please give full name (s) in Capitals)
b) Address: Jl. Gaharu No. 142 A Beringin Indah Phone No. (House)
(H/P) 081275526860
(Office)
E-mail address mhdhadrion@gmail.com

PERSONAL DETAILS

a) Age 25 Years, Height/Weight : 167 /70 g) BPJS No.

b) Date of Birth 28 Januari 1997 Kesehatan : 0001725814067

c) Race Melayu Ketenagakerjaan: 20085397170

d) Religion Islam h) Passport No.

e) Nationality / Citizenship i) Driving Licence (Categories). A and C

Indonesia
j) NPWP No. 656751534216000

f) ID No. k) Bank A/C No. / Branch

1471092801970001

HEALTH

a) Present state of health Healthy

b) Physical disabilities or handicap, if any (eg. sight, hearing, speech, lameness, heart).
-

c) Serious Illness or Accidents suffered since birth, with approximate date

-
 PT. Seagull Cooling Tower
Komplek Gading Bukit Indah P No.17 Kelapa Gading Barat,
Kelapa Gading Jakarta
Tel: 021-45852853
Website: www.seagull-ct.com

MARITAL STATUS

Please indicate :Single / Married / Divorced / Widowed

If married : Name of Spouse

Nationality Occupation

Employer’s name and address :

Spouse’s Income Tax No.

Details of Children : Names Age Sex

FAMILY DETAILS

Father Mother

Name Indriadi Hadijah Desmalina

Occupation - Civil Servant

In case of emergency, please contact the following person:

Name Hadijah Desmalina Relationship Mother

Tel No. (Hse. / Off.) H/P 08127542619

Please list your brothers and sisters in order of age and give their occupation.

Names Age Occupation

1. Mohamad Hadriansyah 32 Banker

2. Novrita Hadriadi 31 Housewife
3.
4.
5.
6.
 PT. Seagull Cooling Tower
Komplek Gading Bukit Indah P No.17 Kelapa Gading Barat,
Kelapa Gading Jakarta
Tel: 021-45852853
Website: www.seagull-ct.com
EDUCATION DETAILS

Schools / Colleges / University attended

Year Qualifications
Education institute Level and Grades
From To
Universitas Sebelas Maret 2014 2019 S1 Mechanical Engineering (3.10)

Give details of any other qualifications you have obtained and in your opinion are relevant to the post for
which you are applying.

Languages / Dialects Spoken Written

(Please indicate fluent / fair / a little)
Indonesian Fluent Fluent
English Fair Fluent

ACTIVITES

State game and / or interests you enjoy and at what level (school, state, national or as a hobby).

Futsal and Badminton

 PT. Seagull Cooling Tower
Komplek Gading Bukit Indah P No.17 Kelapa Gading Barat,
Kelapa Gading Jakarta
Tel: 021-45852853
Website: www.seagull-ct.com

PREVIOUS EMPLOYMENT

Give details including temporary work if any, (start with your present job and work back to the first).

Name and Address of Period Position Last Drawn Reason for

Employer Salary Leaving
VPOWER GROUP 2020 2022 Mechanical - -
Personal

REFEREES AND TESTIMONIALS

Please name 2 references whom we can approach for your credentials.

Name Occupation Address and Telephone Number

POSITION NOW SOUGHT WITH THIS FIRM

Appointment Desired Monthly Emoluments Expected

First choice Site Engineer Rp. 7.500.000

Alternative Mechanical Technician RP. 7.000.000

If now employed, state reasons for change

Date available for employment : 20 June 2022 .

*****************

I certify that the above information is accurate. All my certificates / documents forwarded are genuine and I
have not been convicted to any criminal offences. I accept summary dismissal for false declaration of the
above facts.

Date : 06 june 2022 Signature of Applicant :

* Please attach photostat copies of your certificates and testimonials and bring along the originals for the
interview.