APPLICATION FORM
Please Note:
1. Please PRINT clearly.
2. Please ask for additional sheets of paper if necessary.
3. Please attach to this application, 1 – 4x6 cm photo along with your CV and a
photocopy of your ID
4. If the information written in this application is untrue, Company retains the right
to cancel the employment agreement.
Position Applied for :
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Name of Applicant :
_____________________________________________
A. PERSONAL DATA
1. Complete Name :
______________________________________________
2. Address :
______________________________________________
______________________________________________
Permanent resident ( ) Temporary ( )
3. Telephone :
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4. Place & Date if Birth :
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5. Religion :
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6. Nationality :
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7. Marital Status :
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8. Spouse :
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9. Children :
______________________________________________
10. Identity Card No. :
______________________________________________
11. Email :
______________________________________________
B. EDUCATIONAL BACKGROUND
1. FORMAL
Level School City Faculty Graduation Date
Senior High School
Academy/College
University
2. ADDITIONAL/INFORMAL QUALIFICATIONS
Type Institution City Year Remarks
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3. LANGUAGE PROFICIENCY
Please indicate level of proficiency: Excellent, Good, Fair
Language(s) Known Listening Reading Speaking Writing
1. English
2. Indonesian
3.
4. WORK EXPERIENCE
Name of Company Position Held Approx. Year Reason
Salary
1.
2.
3.
4.
5.
1. Describe what you enjoy(ed) about your current or most recent employment
position held ?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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2. Describe your duties and responsibilities in the company where you work(ed).
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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3. Draw the Organizational Structure in the company
where you are currently
working or the previous company where you worked.
C. OTHER INVOLVEMENTS
1. Please list areas of involvement (formal/informal):
Name of Organization Position Held Activity Year
1.
2.
2. Hobbies:
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3. Do you read: A lot ( ) Fair ( ) A little ( )
Topics that you enjoy reading :
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4. Newspapers/Magazines that you read:
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D. RELATED INFORMATION
1. How did you hear about our company?
_______________________________________________________________________
2. Why do you wish to work in our company? Why do you wish to move from the organization
Where you are presently employed ?
_______________________________________________________________________
3. Are you employed (self or other) beyond your primary employment? If yes, please describe
Yes ( ) No ( )
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4. Do you give your consent for us to contact previous employers?
Yes ( ) No ( )
________________________________________________________________________
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5. Have you ever had a serious sickness/surgery/accident? If yes, please describe:
Yes ( ) No ( )
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6. Do you regularly take medication? If yes, please explain.
________________________________________________________________________
7. Are you looking for a part-time or a full-time job?.
8. If the company needed to send you out of town, would you be willing to go?
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9. Are you willing to work on Saturday?
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10. What salary and benefits do you expect?
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11. When could you start working?
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12. Do you have any acquaintance(s) or relative(s) employed by our company?
Please mention name and your relationship!
________________________________________________________________________
13. Have you previously applied to our company? If so, when and what position?
_______________________________________________________________________
14. Please list at least three persons (non-relatives) who could be contacted as references
Name Phone No. Name of Company Relationship Occupation
1.
2.
3.
I hereby confirm that all information given in this application is true.
Name : _____________________________________________________
Date : _____________________________________________________
Signature : _____________________________________________________
Application Form-Multimatics Page 4 of 5 Human Resources Dept.