APPLICATION FORM Pas photo
(Write in Capital Letters) 3x4
Position Applied For EXPECTED SALARY Available Starting Date
A. PERSONAL INFORMATION
PERSONAL DATA
Full name : Male Female
Place / Date of birth :
Address :
City : Post code :
Telephone (residence) : Telephone (office) :
Hand Phone :
E-mail Address :
I.D. Card Number : Date of Expiry :
Marital Status : Number of Children :
Religion : Blood Group :
Height / Weight : Hobby :
Distinguishing Marks :
FAMILY RECORD
Father Name Age Occupation
Mother Name Age Occupation
Husband/Wife Name Age Occupation
Children Name 1. Age M/F
2. Age M/F
3. Age M/F
Contact person in case of emergencies Phone
B. EDUCATION
Name and address of school, Degree or Certificate
From To Major Course or
university or other Training SMA/SMK/
(MM/YY) (MM/YY) Study D1/D2/D3/D4/S1/S2
Institutions.
C. RECORD OF PREVIOUS EMPLOYMENT
1. Company Name : Telephone :
Address : Position :
Nature of business : Salary :
Employment dates : from to Supervisor’s Name :
Duties :
Reason for leaving :
2. Company Name : Telephone :
Address : Position :
Nature of business : Salary :
Employment dates : from to Supervisor’s Name :
Duties :
Reason for leaving :
3. Company Name : Telephone :
Address : Position :
Nature of business : Salary :
Employment dates : from to Supervisor’s Name :
Duties :
Reason for leaving :
4. Company Name : Telephone :
Address : Position :
Nature of business : Salary :
Employment dates : from to Supervisor’s Name :
Duties :
Reason for leaving :
REFERENCES (Non – Relatives)
1. Name : Phone/Mobile : Company :
E-Mail : Years Known :
2. Name : Phone/Mobile : Company :
E-Mail : Years Known :
3. Name : Phone/Mobile : Company :
E-Mail : Years Known :
OTHER ACTIVITIES
Name of Organization From date To date Status
D. GENERAL INFORMATION
Have you ever applied to any of KAGUM properties? Yes No
Which property? When
Are you presently employed? Yes No
Have you ever been discharged from employment? If yes, please explain
Have you any objection to our contacting your previous employers? Yes No
Have you had any serious illnesses, injuries or operations within the last five (5) years? If so, please describe
Do you have any immediate family members, i.e. husband, wife, parents, child, brother, sister, working within
KAGUM Properties ? Yes No
If yes, who and in which property?
(1)
(2)
(3)
Excellent Good Average Not Good
Language Proficiency
English
Mandarin
Other
Computer
Word
Excel
Other
Serious Illness
Lungs Veneral Disease Heart Hypertension
Ayan Diabetes Cancer Other
The Positive in Yourself
STRENGTH WEAKNESS
I certify that all statements made on this application are true and complete to the best of my knowledge.
I understand that misrepresentation or omission when discovered, will subject me to discharge and I hereby
authorize any investigation relating to my work experience, education, or reputation for the purpose of my
application for employment.
Signature,
E. INTERVIEW SHEET
CODE : [Link] [Link] 3. Good 4. Excellent
Interviewer’s by HRD HOD GM
Name
Date of Interview
OBSERVATION
APPEARANCE
PERSONALITY
INITIATIVE LEADER ABILITY
COMMUNICATION SKILL
MOTIVATION
STABILITY
TECHNICAL SKILL
CO-OPERATIVE ATTITUDE
EXPERIENCE BACKGROUND
Overall Comment
ACCEPTED/NOT ACCEPTED
For Human Resources Department Only
REFERENCE CHECKING
1 Name / Company : Date : Comment :
2 Name / Company : Date : Comment :
Recommended ( ) Yes ( ) No
Site Inspection ( ) Yes ( ) No
Hired ( ) Yes ( ) No ( ) Put on Hold
APPROVED FOR HIRE
Position :
Starting Date :
Level :
Basic Salary : Rp.
Operational allowance : Rp.
Others Benefit : Rp.
Gross Salary : Rp.
Approved by, General Manager Date :