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GRAHA SAPTAINDRA
Jl. TB. Simatupang Kav. 18 Cilandak Barat, Jakarta 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3379 & 81
Postal Code :
Email Address : Phone.*) PHOTOGRAPH
PERMANENT ADDRESS
Female
Born Marital Status Driving A:
Place Date Month Year Single Widow/ WidowerLicense B:
Since :
Marriage Divorce
Date Date
House / home stay Glasses Car/ Motorcycle Blood Type:
Own Contract Cylinder : . Type/ Mark/ Year A
Parents Rent Right : . Owner Own Parent B
Others:. Left : . Office Others AB
Cost of Contract: O
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PT SAPTAINDRA SEJATI
Graha Saptaindra
Jl. TB Simatupang Kav.18, Cilandak Barat Jakarta Selatan 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3381
PAGE 4
PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005
GRAHA SAPTAINDRA
Jl. TB. Simatupang Kav. 18 Cilandak Barat, Jakarta 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3379 & 81
COURSE / TRAINING
AREA / TYPE CONDUCTED BY PLACE/CITY LENGTH OF COURSE YEAR
SOCIAL ACTIVITY
ORGANIZATION KIND OF ACTIVITY POSITION YEAR
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PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005
Graha Saptaindra
Jl. TB Simatupang Kav.18, Cilandak Barat Jakarta Selatan 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3381
ANSWER
QUESTIONS
YES NO REMARKS
Have you ever applied before ? When and what position ?
Besides this application where to have you applied for and as what ?
Are you contracted with your present employee ?
Are employed to any part time job ?
If yes please specify ?
Are there any relatives of yours working for this organization. If yes please state ?
Have you ever been taken ill for a serious illness. When and why ?
Do you have any physical abnormalities that trouble you ?
Are there any family members that are constantly falling ill ?
Have you ever been treated by a psychologist or phsyciatric ?
Please state when, where and what for ?
Have you ever been convicted by police for criminal activities ?
If employed are eligible for assignment else where ?
If the company needs you, are you willing to work on extended hours during
working days or holiday ?
Are you willing to work on shift, if the company asked you ?
What criteria of work type do you desire to work in ?
What type of work do you like ?
a). Planning b). Organize c). Research d). Technics e). Marketing
f). Human Resources g). Production h). Finance I). Accounting j). General
Do you have any obligation if we refer to you past / present organization ?
Why do you want to work for this organization ?
What are you strengths ?
What are you weakness?
Have you ever been overseas ? When and why ?
What type of character are you most pleased with ?
What type of character are you most disturbed by ?
What sort of matters do you feel difficult to make a decision ?
Work familiarization that you most welcome ( manufacturing, laboratory, site )
Revisi : 1
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PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005
GRAHA SAPTAINDRA
Jl. TB. Simatupang Kav. 18 Cilandak Barat, Jakarta 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3379 & 81
REFERENCE
NAME ADDRESS OCCUPATION RELATIONSHIP
Revisi : 1
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PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005
Graha Saptaindra
Jl. TB Simatupang Kav.18, Cilandak Barat Jakarta Selatan 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3381
QUESTIONS ANSWER
This above statements have been understood by me and furbished with sincerity.
I solely take responsibility on the false information if any is stated.
Note : Do not enclose the original of your certificates, testimonials or other document ; but typed, non returnable copies will
suffice. The original will be checked when you are accepted.
20.
Applicant
Revisi : 1
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