EMPLOYMENT APPLICATION

This is a legal document and is required to be completed in full and will also assist in the search of our data
base. We do not interview all candidates who apply. This document remains the intellectual value of
PT Geotechnical & Environmental Services Indonesia (Golder Associates) and will be treated as confidential.

Personal Details
Position

Date

Surname

Nationality

Name

Male

Mobile Number

Telephone Number (Home)

Email Address

Alternative Telephone Number

Current Address

Postal Address

Place and Date of Birth

Nationality

Identification Number

Passport Number

Languages

Female

Computer Programs you are familiar with (please indicate your

proficiency Beginner, Average, Expert )

Education
1) Name of Institution

Date obtained

Qualification

Majors

Achievement/s

2) Name of Institution

Date obtained

Qualification

Majors

Achievement/s

3) Name of Institution

Date obtained

Qualification

Majors

Achievement/s

4) Name of Institution

Date obtained

Qualification

Majors

Achievement/s

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EMPLOYMENT APPLICATION

Short Courses / Training

Institution

Course

Date obtained

Professional Memberships
Institute / Association

Details

Professional Achievements

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Membership
Number

Date admitted

EMPLOYMENT APPLICATION

Employment History
Name of Employer

Dates of employment

Position held

Reasons for leaving

Brief description of duties

Name of Employer

Dates of employment

Position held

Reasons for leaving

Brief description of duties

Name of Employer

Dates of employment

Position held

Reasons for leaving

Brief description of duties

Name of Employer

Dates of employment

Position held

Reasons for leaving

Brief description of duties

Name of Employer

Dates of employment

Position held

Reasons for leaving

Brief description of duties

References
Please give the names of persons you reported to directly and who can give a reference concerning your character and work performance

Name of Company

Name & Position

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Contact Numbers

EMPLOYMENT APPLICATION

Confidential Declaration
Please read carefully before signing.

1) Should you supply Golder Associates with a type or written Curriculum Vitae or Rsum that
contains relevant or potential discriminatory information or any details which is purely of a personal
or arbitrary nature, Golder Associates will construe this as willingness on your part to share said
information.
2) The purpose of the application is to facilitate the process of placing a suitable candidate in the event
of a vacancy. This is not an offer of employment.
3) I hereby authorize former employers to furnish Golder Associates with records of my employment,
reasons for leaving, and any work-rated information concerning my character, conduct and quality of
work and I release/indemnify all concerned from liability in connection herewith.
4) Should any information herein be incorrect, incomplete, false, or should there be any non-disclosure
of relevant information on my part, I hereby indemnify Golder Associates and previous employers
against any action whatsoever against them. Such Information or lack thereof may constitute
grounds for dismissal and an investigation may be made and may be used relative to my
employment status.
5) I am aware that it remains in the sole discretion of Golder Associates not to propose me for any
position for reasons, whilst not discriminating, and within good judgment of inherent job
requirements.
6) Golder Associates endeavours to ensure that all information supplied is treated as confidential and
will not be solicited to any third party unless authorized in writing.
I, __________________________________________________hereby declare and certify that the information supplied on this form is
true and accurate to the best of my knowledge.

Signed in ________________________________ on the _______ day of __________________20______.

_____________________________________
Signature of applicant

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