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HR Interview Date :
INSTRUCTIONS: User Interview Date : Monday, June 4th 2018
1. Please accomplish this form by fill up all blanks. Predictive Index Test
:
Write “NA” if not applicable. Date (if any)
Relationship
01/04/1995
Jember, Jawa Timur Male rezafurqana@gmail.com
Date of Birth
Place & Country of Birth Sex Email Address
(d/m/y)
Nationality
Name of Wife NA NA NA
or Husband: Full Name
Plc. & Country Birthday
of Birth (d/m/y)
Occupation of NA NA NA
Spouse: Company / Place Employed Position Held Telephone No.
NA
Details of Living Children (Eldest First)
Full Name Sex Date of Birth (d/m/y) Place & Country of Birth
FAMILY
1. NA NA NA NA
2. NA NA NA NA
3. NA NA NA NA
Surabaya,
Hani Mulyawati 12-04-1968 Indonesia NA
Mother: Jawa Timur
Full Name Plc. & Country of Date of Birth Nationality Occupation & Position
Birth (d/m/y)
PF-(ID)-[GEN]-HR-034/Ver.003/22.10.12/page 1 of 5 PR
Brothers/
Sisters (Include the
applicant) :
Jember, Jawa
Rifky Hadiansyah 10-10-1997 Indonesia Student
Timur
Samarinda,
Rido Fadilah Akbar 04-03-1999 Indonesia Student
Kalimatan Timur
Samarinda,
Rendi Hafiz 25-10-2001 Indonesia Student
Kalimatan Timur
Samarinda,
Rayhan Wardana 08-05-2005 Indonesia Student
Kalimatan Timur
Plc. & Country of Date of Birth
Full Name Nationality Occupation & Position
Birth (d/m/y)
Date of Date of
Name of College/Graduate School Graduated Entry
Degree Major GPA
& location (City, Country)
(d/m/y) (D/m/y)
Naval Architecture
Kalimantan, Institute of Technology
B & Ship Building 2012 2017 3.03
(ITK)
Engineering
(Balikpapan, Kalimantan Timur)
Note: The New Institute of
Government in 2012 whose join with
Sepuluh Nopember Institute of
Technology (ITS)
Scholastic or academic honors, Scholarship Government Kalimantan Timur & Have Tropy Spirit of Atlantic Challenge
scholarships/prizes: International in Vannes, France 2014
ACTIVITIES
ACADEMIC
Write down your extracurricular activities, incl. Participations in Organizations, Society, Professional, Sport, etc.
Name your hobbies and interests: Playing Football, Traveling and Read about Religion Book
Please specify your other skills: Ship Design 2d or 3d, Calculation Resistance, Stability, Construction of ship, Welding
Inspector, Ship Repair, Blasting & Painting & Marketing.
Have you had any illness, hospitalization or accidents in the past 3 years, which will present special
consideration to your job assignments? If yes, Please explain
NA
PF-(ID)-[GEN]-HR-034/Ver.003/22.10.12/page 2 of 5 PR
Please indicate the functions/Business you are interested to: (put V in the selected box)
after that I draw the leak area and marked the point of a dangerous area point.
then I discuss to the docking staff that we should preparing the equipment like a blander, Oxygen, LPG, to cut the torn
plate in the leak area so as not to dangerous when the docking process.
so at that time we work 1 day 1 night to move the ship slow and slowly. so that our work can be run with safety and
leakage that has a tear plate that can be cut.
State briefly why you are qualified for the position you are interested to
Well, I have all of the skills and experience that you’re looking for and I’m confident that I would be a superstar in this
project
1. I have experience negotiation with some customers in handling ship repair.
2. I have experience leading 40 employees in handling ship repair.
3. I’m also passionate with traveling
4. Able to operate Microsoft Office, AutoCad & Maxsurf
5. I have some experience to work in the field
6. I have engineering technical skill
7. Can speak with English language and Bahasa Indonesia
I’m also passionate about this industry and I’m driven to deliver high-quality work.
Please describe your strengths
I’m smart, I’m funny, I’m a great team leader, I work well with others, I’m prompt, I pay attention to details, I really
appreciate hard work, I’m never late, I can work weekends, I enjoy work that challenge me.
PF-(ID)-[GEN]-HR-034/Ver.003/22.10.12/page 3 of 5 PR
What government agencies you are frequently in contact with? (if any)
Badan Pengawas keuangan Pemerintah (BPKP), where my dad worked.
*Trophy Spirit of Atlantic Challenge International in Vannes, France *Beasiswa Kaltim Cemerlang
Yes
Are you willing to be assigned anywhere the company operates?
No, Why?
Yes
Channel of Application
Job Fair/Campus Recruitment SGS website Classified Ads
Walk – In Other Website Referral (specify name)
Letter / e-mail Executive Search JobsDB.com
Do you have relatives and/or friends who have worked with us at one time or another or are presently in our employ? If so
state name(s) and relationship(s)
Name Relationship Name Relationship
OTHER INFORMATION
NA
NA
Do you have relatives working with competitive firms? (Other companies producing same products as PT. SGS Indonesia)
Name Relationship Name Relationship
Ahmab Bashori ( PT. Sucofindo ) Friend
NA
PF-(ID)-[GEN]-HR-034/Ver.003/22.10.12/page 4 of 5 PR
How soon can you start working with us?
1 August 2018
RENUMERATION INFORMATION
Rp. 9.000.000,00
I hereby certify that all the information supplied by me on this application form is true and correct. Should untruths be discovered during my
employment in any position in this Company, I fully agree to being immediately dismissed for just cause.
LAY/DEC’04
PF-(ID)-[GEN]-HR-034/Ver.003/22.10.12/page 5 of 5 PR