Data Calon Karyawan Form

PT. ANDALAN TIGA BERJAYA

PT. ASMIN BARA JAAN

PT. ASMIN BARA BRONANG

OTHER

POSITION APPLIED :

SEX :

M F Photo (3 x 4)

FULL NAME : (match with ID Card)

(FILLED BY HR DEPARTMENT) NIK : FIRST DATE OF WORKING : EMPLOYMENT STATUS : DEPARTMENT CODE : DIVISION :

POSITION : PERSONAL LEVEL : SPK No. : INA BANK A/C No : DATE OF RESIGNATION :

PLACE/DATE OF BIRTH : ………………………………………. HEIGHT :……… CM WEIGHT ……… KG ID NUMBER :……………………………………… PASSPORT NUMBER : ……………………………………… DRIVER LICENSE NO : ……………………………………… KPA NO. :……………………………………… JAMSOSTEK NO. : ………………………………………

MATERIAL STATUS :

SINGLE

NATIONALITY : …………………………………

EDUCATION : SCHOOL/UNIV. MASTER BACHELOR DIPLOMA SENIOR HIGH SCHOOL JUNIOR HIGH SCHOOL PRIMARY SCHOOL

NAME

PERMANENT ADDRESS : …………………………………………….. …………………………………………….. POST CODE : ………….. PHONE ………..…………….. CURRENT ADDRESS : …………………………………………….. ……………………………………………… POST CODE : ………….. PHONE ………..……………..

MARRIED

DIVORCED

RELIGION : ……………………………..

ADDRESS

BLOOD TYPE : ………………………

MAJOR/GPA FROM

STATE FOREIGN LANGUAGES YOU MASTER AND FILL IN YOUR LEVEL OF LANGUAGE MASTERY. LANGUAGE READING LISTENING SPEAKING 1 2 3

TO

PASS/FAIL

WRITING

REFERENCES : NAME

COMPANY

ADDRESS/PHONE

1 2

LIST OF ACHIEVEMENTS.

ORGANIZATION

FAMILY RELATIONSHIP. RELATION NAME

HOBBIES AND ACTIVITIES

SEX (M/F)

DATE OF BIRTH (AGE)

HIGHEST EDUCATION

OCCUPATION POSITION COMPANY

FATHER MOTHER BROTHERS/SISTERS (INCLUDING YOURSELF) 1 2 3 4 5 6 SPOUSE CHILDREN 1 2 3 TRAINING/COURSES NAME OF TRAINING

1 2 3

INSTITUTION

VENUES

DURATION FROM UNTIL

FINANCED BY

4 5 6 7 8 9 EMPLOYMENT HISTORY : STATE YOUR EMPLOYMENT HISTORY AS COMPLETELY AND ACCURATELY AS POSSIBLE BEGINNING FROM THE PRESENT OR LAST EMPLOYMENT TO PREVIOUS ONES. 1. SERVICE YEARS

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

YEARS MONTH FROM TO TYPE OF BUSINESS :

TOTAL EMPLOYEES :

LINE SUPERIOR :

DIRECTOR :

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

2. SERVICE YEARS

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

TOTAL EMPLOYEES : DIRECTOR :

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

3. SERVICE YEARS

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

TOTAL EMPLOYEES : DIRECTOR :

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

4. SERVICE YEARS

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

TOTAL EMPLOYEES : DIRECTOR :

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

PUT AN "√" IN THE CORRECT RESPONSE BOX

YES

NO

REMARKS

HAVE YOU PREVIOUSLY APPLIED TO OUR COMPANY/GROUP ? IF SO WHEN AND WHAT POSITION ? ARE YOU ALSO APPLYING TO OTHER COMPANIES ? IF YES PLEASE MENTION WHAT COMPANIES AND POSITION APPLIED? ARE YOU UNDER CONTRACT AGREEMENT WITH OTHER COMPANIES ? DO YOU HAVE ANY OBJECTIONS IF WE CONTACT YOUR PREVIOUS EMPLOYER FOR HAD IT ? DO YOU HAVE ANY ACQUAINTANCE (S) OR RELATIVE (S) EMPLOYED BY, OUR COMPANY/GROUP ? PLEASE MENTION NAME AND YOUR RWLATIONSHIP ?

WHAT SERIOUS ILLNESS/SURGERIES/ACCIDENTS HAVE YOU EVER HAD ? WHEN HAVE YOU HAD IT ? HAVE YOU EVER UNDERGONE ANY PSYCHOLOGICAL TEST BEFORE ? IF SO, WHEN, WHERE AND FOR WHAT PURPOSE ? HAVE YOU EVER BEEN INVOLVED IN ANY ADMINISTRATIVE, CIVIL OR CRIMINAL CASES ? IF ACCEPTED , DO YOU AGREE TO BE LOCATED ANYWHERE IN INDONESIA ? PLEASE MENTION THE PREFERRED CITIES OR REGIONS ! DESCRIBE ANY KIND OF JOBS THAT ARE IN LINE WITH YOUR CAREER PLAN ! PLEASE STATE YOUR CURRENT MONTHLY INCOME AND FACILITIES ? DESCRIBE ANY KIND OF JOBS THAT YOU DON'T LIKE ? STATE SALARY AND FACILITIES DESIRED ! IF ACCEPTED, WHEN CAN YOU START WORKING ?

HEREBY CERTIFY THAT THE INFORMATION GIVEN ABOVE IS TRUE AND IF UNDER ANY CIRCUMSTANCES, ANY MISREPRESENTATION OR OMISSION OF INFORMATION IS FOUND, I UNDERSTAND THAT I SHALL BE HELD RESPONSIBLE.

…………………………………..20 ……….

( ……………………………………….) APPLICANT