Employee Application Form
Recent Photo
The following information will help us assess your employment opportunity with Archipelago International
(hereinafter called the “Employer”). All portions of this application pertaining to you must be completed. We
appreciate the time you spend completing this application form.
Position applied : ____________________________________________
Salary Expectation : ____________________________________________
Notice Period : ____________________________________________
PERSONAL DATA
Full Name : Date of Birth :
Address :
City : Post Code :
Telephone :
Email :
Marital Status : Religion :
Height / Weight :
FORMAL EDUCATION
Year of
University/School Major Academic Degree
Graduation
HR/Application Form/001 Page 1
Employee Application Form
RECORD OF PREVIOUS EMPLOYMENTS
1. Company Name :
______________________________________________________
Industry : ______________________________________________________
Position : ______________________________________________________
Period : From ___________________ To __________________________
Supervisor’s Name : ______________________________________________________
Last salary : Rp ___________________________________________________
Reason for leaving : ______________________________________________________
2. Company Name :
______________________________________________________
Industry : ______________________________________________________
Position : ______________________________________________________
Period : From ___________________ To __________________________
Supervisor’s Name : ______________________________________________________
Last salary : Rp ___________________________________________________
Reason for leaving : ______________________________________________________
REFERENCES (Non – Relatives)
1. Name :_______________________ Mobile Number :______________________
Occupation :_______________________
Email Address : ____________________________________________________________
2. Name :_______________________ Mobile Number :______________________
Occupation :_______________________
Email Address : ____________________________________________________________
3. Name :_______________________ Mobile Number :______________________
Occupation :_______________________
Email Address : ____________________________________________________________
4. Name :_______________________ Mobile Number :______________________
Occupation :_______________________
Email Address : ____________________________________________________________
HR/Application Form/001 Page 2
Employee Application Form
GENERAL INFORMATION
Are you presently employed ? YES ❑ NO ❑
Can we contact your present employer for a reference ? YES ❑ NO ❑
Do you have any health limitations/illnesses? YES ❑ NO ❑ If yes, please fill out the table below.
HEALTH RECORDS
LIMITATION/ILLNESS HOSPITALIZATION REMARKS
YES NO
DECLARATION
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.
(……………………………..)
Applicant
HR/Application Form/001 Page 3
Interview Form
APPLICANT NAME:
POSITION APPLIED: DEPARTMENT:
INTERVIEW DATE: MEDIUM: ❑ONLINE ❑FACE-TO-FACE
1. GENERAL ASSESSMENT
GRADE : [Link] 2. Average 3. Good 4. Excellent
1st 2nd 3rd
Subject Comment Comment Comment
Interview Interview Interview
Appearance/
Grooming
Communication
Skills
Attention to
Detail
Problem
Solving Skills
Leadership
Skills
Attitude/
Behavior
2. ARCHIPELAGO VALUES ASSESSMENT
GRADE : [Link] 2. Average 3. Good 4. Excellent
1st 2nd 3rd
Subject Comment Comment Comment
Interview Interview Interview
Integrity
Honesty, truthfulness
and consistency of
one’s action
Enthusiasm
Enjoyment,
optimism/interest in
one’s work
Excellence
One’s quality of work
and the intention to
do better
Ownership
The state of owning
one’s action or work
Compassion
Kindness and
sympathy towards
others
HR/Interview Form/002 Page 1
Interview Form
3. TECHNICAL ASSESSMENT (as applicable for the applied position)
GRADE : [Link] 2. Average 3. Good 4. Excellent
Competency Grade Remarks
4. LANGUAGE PROFICIENCY
GRADE : [Link] 2. Average 3. Good 4. Excellent
Language Speaking Reading Writing
English
5. ADDITIONAL INFORMATION (use as applicable)
6. OVERALL CONCLUSION
Interviewer’s Name
Position
Interview Date
Overall Conclusion
HR/Interview Form/002 Page 2
Interview Form
For Human Resources Department Only
Notice Period : __________________________________
Basic Salary : __________________________________
Transportation Allowance : __________________________________
Housing Allowance : __________________________________
Mobile Allowance : __________________________________
Others : __________________________________
Approved by, Acknowledged by,
________________ ________________ ________________
(Department Head) (Human Resources) (General Manager)
HR/Interview Form/002 Page 3