Job Application Form

PERSONAL INFORMATION
Full Name :
____________________________________________________________________
Place / Date of Birth :
____________________________________________________________________
Religion :
____________________________________________________________________
Gender : Male Female Blood Type: Height/Weight:
____ ____ /____
Martial Status :
Single Married Date:__________ Divorce Date:__________ Photo
Social Media : Instagram : Facebook :
__________________ ___________________
Account
Twitter : Others :
__________________ ___________________
Tax ID No. (NPWP) :
____________________________________________________________________
Nationality :
Indonesia Others _________________________
Email Address :
____________________________________________________________________
ID Number (KTP, : _______________________________________________
Eff Date: __________
SIM, Passport) _
Mobile Number (1) :
_____________________________ Mobile Number (2) : _____________________________

ADDRESS
Permanent :
Address
State :
City : Zip Code :
Province :
Residential Status : Private owned Rent Parents Others
Phone Number :
Present Address :

State :
City : Zip Code :
Province :
Residential Status : Private owned Rent Parents Others
Phone Number :
FAMILY INFORMATION
Birthdate Gender Last
Name Birthplace Occupation
(dd/mm/yyyy) (M/F) Education
Parents
Father
Mother
Siblings
1st Child
2nd child
3rd child
4th child
5th child

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6th child
7th child
Spouse
Children
1st Child
2nd child
3rd child

EMERGENCY CONTACT
Full Name : Kinship :
Permanent :
Address
State :
City : Zip Code :
Province :
Residential Status : Private owned Rent Parents Others
Phone Number : Mobile Number :
EDUCATION
Entry – Graduation
School Name City Major Information
Years
Primary School
Junior High School
High School
College
Others
LANGUAGE SKILLS (*fill with Good/Average/Poor)
Language Reading Writing Speaking Listening

WORKING EXPERIENCES
Company Name :
Industry : Position :
Years of Service : to Latest Salary :
Reason to Resign :

Company Address :

Job Description :

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Company Name :
Industry : Position :

Years of Service : to Latest Salary :

Reason to Resign :

Company Address :

Job Description :

Company Name :
Industry : Position :
Years of Service : to Latest Salary :
Reason to Resign :

Company Address :

Job Description :

REFERENCES (former boss/HR)

Name Position Company Address & Phone No. Work Relation

*) Strikethrough unselected options

Have you worked in Lippo Group / Cinepolis? YES / NO *)

1.
If YES, specify company name, position & work period!

Have you applied for a job at Lippo Group of companies before? YES / NO *)
2.
If YES, please specify company name & how is the result?

Do you have family / siblings working for Lippo Group of companies? YES / NO *)
3.
If YES, specify name, kinship, position & company name!

Do you have a history of chronic illness or a physical / psychological illness or been hospitalized for long periods of time? YES / NO *)
4.
If YES, explain what the illness is & how long?

Have you ever been involved in a criminal case (deception, sharp weapons, drugs, corruption, etc.) YES / NO *)
5.
If YES, please explain!

Have you ever had any dependence on drugs, alcohol or other addictive substances? YES / NO *)
6.
If YES, please explain!

Do you have a history of engaging in bank loans, credit cards or loans at the office where you work? YES / NO *)

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7. If YES, please explain!

Have you ever been laid off or asked to resign by the Company? YES / NO *)
8.
If YES, please explain!

Have you ever been in jail for being involved in civil or criminal law cases? YES / NO *)
9.
If YES, please explain!

Do you have another job or other business activity outside your current job? YES / NO *)
10.
If YES, please explain!

11. Have you got Covid-19 Vaccines ? YES / NO *)

If YES, what type of Vaccines

Do you have ever been or are in the process of becoming a member of a party, organization or other community? YES / NO *)
12.
If YES, please explain!

Where do you find this job?

Applied position
Expected salary (before tax
deduction)
Availability to join

I hereby declare that the data provided is true. I agree that Cinépolis Indonesia verifies the information provided on this form, at the time of
the interview and / or through other media. If in the future the information above is not true / false, I am willing to resign without making
any claim to the Company.

Best Regards,______________,_________________

_________________________________

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