PLEASE ATTACH YOUR

PHOTOGRAPH HERE

APPLICATION FOR EMPLOYMENT

Date of application

First Name Last Name Nick Name Sex

Male Female

ID Number (No. KTP) Family Registration Number (No. Kartu Keluarga)

Place, Date of Birth Nationality Religion Marital Status Children

Permanent Address

Present Address

Contact Information : Home Phone / Mobile / Email

EMPLOYMENT POSITION
Position(s) Applying for

Date Available for Employment

Salary Desired

EDUCATION
DATES ATTENDEND
NAME OF INSTITUTION LOCATION DEGREE MAJOR SUBJECTS
FROM TO
 EMPLOYMENT
Please describe every position which you have held sicne you first began to work. Start with present or last position held and work back
to the first also account for all periods of unemployment and state reason

DATES ATTENDED NAME & ADDRESS OF REASON FOR TAKE HOME PAID
POSITION
FROM TO EMPLOYER / COMPANY / ORG LEAVING SALARY

HAVE YOU EVER BEEN DISMISSED OR ASKED TO LEAVE YOUR JOB YES / NO
IF YES BY WHOM AND WHEN

TRAININGS

List of Training that you have

DATE
TRAINING FACILITATOR CRTIFICATE NUMBER
FROM TO
 LANGUAGES

Name the languages and indicate the accent of competence (slight, fair, excellent)

LANGUAGE SPEAK READ WRITE UNDERSTAND

DATE
TRAVEL ABROAD (countries) PURPOSE TO VISIT
FROM TO

HOBBIES SPORTS AND SPARE TIME ACTIVITIES

PARTICULARS OF FAMILIES
NAME SEX DATE OF BIRTH RELATIONSHIPS EDUCATION / OCCUPATION

EMERGENCY CONTACT
NAME RELATIONSHIP PHONE NUMBER ADDRESS
HAVE YOU EVER APPLIED OR WORKED FOR THIS COMPANY OR ITS ASSOCIATES YES / NO
IF YES WHEN AND WHERE ?

DO YOU HAVE ANY RELATIVE OR FRIEND WORKING IN THIS COMPANY OR ITS ASSOCIATES ? YES / NO
IF YES PLEASE STATE NAME AND POSITION

MAY WE APPROACH YOUR PRESENT EMPLOYER YES / NO

PREVIOUS EMPLOYER (S) YES / NO

REFERENCES

Please give names three prominent persons other man relatives

NAME ADDRESS PHONE ACCUPATIONS/POSITION

USE THIS SPACE FOR COMPLETING ANSWERS TO ANY FOREGOING QUESTIONS OR FOR OTHER INFORMATION

DO YOU SUFFER OR HAVE SUFFERED FROM ANY SERIOUS ILLNESS OR DISABILITY YES / NO
IF YES PLEASE GIVE PARTICULARS

Please make sure before signing this form, that you have answered all questions completely and correctly.
This applicant will not be considered for employment if any of the information furnished hereabove is foud to be incorrect.
In case appointment has already been made he/she will be able for dismissal without notice

I DO SOLEMNLY AFFIRM THAT THE INFORMATION FURNISHED IN THIS APPLICATION FORM IS CORRECT

TO THE BEST OF MY KNOWLEDGE AND BELIEF AND THAT I HAVE WITH HELD NOTHING

WHICH WOULD AFFECT MY EMPLOYEMTN IN THIS COMPANY

PLACE AND DATE : ……………………………………… SIGNATURE : ………………………