PT APEXINDO PRATAMA DUTA TBK.

Gedung Office 8 lantai 20-21, SCBD Lot 28

Jl. Jend Sudirman Kav 52-53 Jakarta 12190
HUMAN RESOURCES DEPARTMENT

POSITION APPLIED : DATE:

APPLICATION FOR EMPLOYEMENT FORM

- The Content of this Form have no obligation for both parties
- This form should be completed in English

THE SOURCE OF INFORMATION FOR POSITION APPLIED (please choose)

1. Apexindo Website 4. On my own

2. Newspaper adv. 5. Apexindo Empoyee (please mention)
3. Friend/Relatives 6. Other (please mention)

PERSONAL DETAIL
FULL NAME : NICKNAME:
DATE OF BIRTH : PLACE :
ID/PASSPORT NUMBER :
ADDRESS :
CITY : COUNTRY: ZIP CODE :
CONTACT NUMBER : HOME : MOBILE :
EMAIL ADDRESS :
NATIONALITY : ETHNIC:
MARITAL STATUS : RELIGION :

FAMILY DETAILS
No. Family Relation M/F Name Place & DOB Education Occupation
1 Father M
2 Mother F
3 Spouse
4 Child/Sibling/Self
5 Child/Sibling/Self
6 Child/Sibling/Self
7 Child/Sibling/Self
8 Child/Sibling/Self

You are child number from total children of

FORMAL EDUCATION
Formal Years Degree & Graduate NEM / GPA
No. School/ University Name Education Major
 Formal Degree & Graduate NEM / GPA
No. School/ University Name Education From To Major
1 Sr. High School Yes/No
2 Academy Yes/No
3 University Yes/No
4 Post Graduate Yes/No
5 Yes/No

INFORMAL EDUCATION, TRAINING, COURSE, SEMINAR

Date Of
Certifacate
No. Institution Name Location Sucject/ Topic Month & Year Certified Certificate Attached
Validity
1 Yes/ No Yes/No
2 Yes/ No Yes/No
3 Yes/ No Yes/No
4 Yes/ No Yes/No
5 Yes/ No Yes/No

FOREIGN LANGUAGES
No. Language Speaking Written
1 English Fair Good Excellent Fair Good Excellent
2 Fair Good Excellent Fair Good Excellent
3 Fair Good Excellent Fair Good Excellent

No. Skill Name Level

1 Fair Good Excellent
2 Fair Good Excellent
3 Fair Good Excellent
4 Fair Good Excellent
5 Fair Good Excellent

GENERAL INFORMATION
No. Strenght(s) Weakness(es) Interest/ Hobby
1
2
3
4
5

WORKING EXPERIENCES (START WITH CURRENT JOB, INCLUDING TEMPORARY WORK & VOCATIONAL
TRAINING)

Name & Type of Month & Years

Rig (Land Rig,
Rig W/O, Jack Up, Geothermal/ Reason for
No. Company Name Position Client
Location Semi, Tender) Oil Project From To Leaving

1
 2

10

WORKING REFERENCES
No Name Company Name Location Position Title
1
2
3
4
5

GENERAL
Your expected salary on the position applied (Brutto / Nett)
Are you willing to relocate? Yes / No (if No please explain)
Are you willing to travel? Yes / No (if No please explain)
Have you been or are you suffering from any serious physical disability or disease? Yes/No (if Yes please explain below)

I declare that the above mentioned statements are true and ready for any retribution if company found impropriate data.

)
(signature of applicant)