APPLICATION FORM

Application Number : .........................

PLEASE FILL WITH CAPITAL FONT

A. IDENTITY
Full Name :
Place / Date of Birth :
ID No./Driving Licence : Nationality :
Current Addres in Jakarta : Current Addres outside Jakarta :

Postal Code : Contact No. : Postal Code : Contact No. :

B. EDUCATION
1. Formal Education
Education level Name of School Faculty Major Study Prog. Place Period Note
Junior High School
Senior High School
Diploma
Bachelor
Master
2. Why did you choice that major ( last education) :

3. Please mention your final project :

4. Non Formal Education:

Course/Training's Name Place Period Note
1.
2.
3.
5. Foreign languages :
Language Active Passive
Poor Fair Good Poor Fair Good
1.
2.
3.
6. Kind of skills :
Skill Poor Fair Good
1. Welding ……………………..
2. Driving: motor / mobil / Forklif / …………
3, CNC
4, Autocad
5, Computer : MS-Office / Foxpro / clipper / Vbe / Orecle / ……..
6, ………………………………….
7, ………………………………….
FM/HRD/004
Revisi : 5
C. FAMILY BACKGROUND
1. Marital Status Single / Engage since :
Married since :
Divorce since :
2. Family Relation (for married candidate : Husband / Wife and Children)
Name Place/Date of Birth Education Occupation
Husband/Wife *)
Daughter/Son 1
Daughter/Son 2
Daughter/Son 3
Daughter/Son 4
3. Family Relation (Father, Mother, Brother/Sister)
Name Male/Female Place/Date of Birth Education Occupation
Father
Mother
Daughter/Son 1
Daughter/Son 2
Daughter/Son 3
Daughter/Son 4
Daughter/Son 5
Daughter/Son 6
Daughter/Son 7
4. Family Relation (Father/Mother in law)
Name Male/Female Place/Date of Birth Education Occupation
Father in law
Mother in law

D. WORKING EXPERIENCE
1. Working Experience
No. Company's Name Position Period of employment Salary Reason of Resignation
1.
2.
3.
2. Please describe (simple description) about your position above :

3. Who was your last supervisor's name and how many of subordinates do you have :

4. What kind of problems did you encounter? How did you solve them?

5. ID Card ASTEK / JAMSOSTEK :

6. Please describe your opinion about your last company :

7. Have you ever made improvements in your last company ? Yes No

Please describe :

8. Who motivate you to become successfull ?

9. How do you solve problems & make decisons in the workplace?

E. INTEREST AND PERSONAL CONCEPT

1. What is your career aim:

2. What is your reason for work :

3. Why do you want to work for ourcompany ?:

4. What is your expected salary : Rp.

5. What kind of facilities do you expect :

6. What date are you ready for the job :

7. Please choose the kind of job below according to your interest

Kind of Job Number Kind of Job Number
Production Marketing / Sales
Service / Maintenance Finance
Engineering (R&D) Accounting
Production Planning Control (PPC) HRD
Information Technologi Training
Lain-lain :

8. a. Favorite job environment : Office Manufacturing Outdoor Laboratorium

b. Nonfavorite job environment: Office Manufacturing Outdoor Laboratorium

9. Are you willing to relocate to another city ? Ready Not Ready

10. What kind of personality type do you like :

11. Are you ready for

a. Rotation/Mutation anywhere Yes No c. Overtime Yes No

b. Shift system Yes No

12. What kind of decisions are difficult for you to make ? :

F. SOCIAL ACTIVITY
1. Do you have any references in this company? Yes No If yes, please mention :

No. Name Company Position Contact No. Relation

1.
2.
2. Please mention your references from another company :
No. Name Company Position Contact No. Relation
1.
2.
3. Hobbies :

4.How do you spend your spare time ?

5. Your organization experionces :

G. OTHERS
1. What kind of strongpoint sdo you have :

2. What kind of weakpoints do you have :

3. Have you ever been hospitalized ? Yes No, If yes please mention :

No. Kind of sickness Period of Sickness Effect

I hereby declare that all the above data & information are true and correct.

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