BOLDE INDONESIA

CONFIDENTIAL

Pergudangan Eraprima KM.1 Blok G/G1

Jl. Daan Mogot Batu Ceper Jakarta Barat

EMPLOYMENT APPLICATION FORM

POSITION
APPLIED FOR

1. PERSONAL PARTICULARS

Name Marital Status

Address
Home Telp No Office Telp No Mobile No.
E-mail Address Driving Licence Car (Yes/No)
Sex Age Date of Birth Religion
IC No. Country of Birth Citizenship
Passport No. Date Place of Issue

2. EDUCATION
School Attended Highest Qualification Year Graduated

3. OTHER TRAINING
Type of Course Institution Qualification Year Graduated

4. LANGUAGES AND DIALECTS (Indicate Average /Good / Fluent)

Language Speak Write Reading

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5. PARTICULARS OF IMMEDIATE FAMILY (Spouse & Children)

Name of Spouse
Date of Marriage Occupation
Date of Birth Employer

Name of Children Age Date of Birth Relationship Occupation/school

6. PARTICULARS OF FAMILY MEMBER (Father, Mother, Brother & Sister)

Name Age Relationship Occupation Name of Company

7. EMPLOYMENT HISTORY (Starting from the last job)

1. Name & Address Company
______________________________________________________________________________________________
______________________________________________________________________________________________

Position From (Mth & Yr) Position Direct Supervisors Responsibilities

Reason for Leaving ________________________________________________________________________________

2. Name & Address Company

______________________________________________________________________________________________
______________________________________________________________________________________________

Position From (Mth & Yr) Position Direct Supervisors Responsibilities

Reason for Leaving ________________________________________________________________________________

3. Name & Address Company

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 ______________________________________________________________________________________________
______________________________________________________________________________________________

Position From (Mth & Yr) Position Direct Supervisors Responsibilities

Reason for Leaving ________________________________________________________________________________

Organization Sructure

8. EMERGENCY CONTACT

Name Relationship
Office Tel. No Mobile No
Address

9. LEISURE INTERESTS ………………………………………………………………………………………………………………..……….…………………………

10. REFEREES ( Give 2 Referees to whom reference may be made )

Name Address Telp. No. Occupation Years Known

11. PLEASE ANSWER THE FOLLOWING QUESTIONS ..

a. Have you been or are you suffering from any physical impairment or disease? YES / NO
b. Have you ever been discharged or dismissed from the service of your previous employer YES / NO
c. Have you ever been convicted in a Court of Law in any country? YES / NO
d. Have you ever been detained by the police or any government? YES / NO
e. Are you serving any bond with your current company? YES / NO
If Yes, What’s the duration outstanding? ………………………………………………………………...

Notes:

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Your application will be disqualified if it is found that you have either willfully suppressed material facts or knowingly given
false particulars.
If after engagement, it is found that you have knowingly made a false declaration, the Company reserves the right to
terminate your service without notice.

12. Proposed Joining Date ……………….. Salary Expected ……………………

13. Notice Period ……………………………...………………months

I, ………………………….. declare that above information and documents attached here to are true to the best of my knowledge
and belief, and that I have not willfully suppressed any material facts.

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