APPLICATION FORM
Please read all the questions carefully and answer them as thoroughly as possible. All
information provided will be kept confidential. It is our company policy that all employment
is based on individual merit and equal opportunity.
Please indicate the position you are applying for:
A. Personal Details
Complete Name: Title
Mr/ Mrs/ Miss/ Ms
Place/Date of Birth: Nationality: Civil Status :
Single Married
Divorced
Since:
Religion: Blood Type: E-mail Address: ID Number:
Permanent Address : Post Code Contact No.
(H)
Present Address : Post Code Contact No.
(H)
(O)
(M)
B. Family Details
Relationshi M/ Place/Date of
Name Occupation
p F Birth
Father
Mother
Spouse
Relationshi M/ Place/Date of
Name Occupation
p F Birth
Children
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Is there any member of your family or relatives, working with company? Yes
No
If Yes, please give details:
Name Relationship Department / Unit Location
C. Employment Record (Beginning with the latest or present
employment)
Period Date
Reason for
Name of Company Industry (Start– Position
Leaving
Completed)
1
2
3
State your performance appraisal score for the latest 3 years
1st year (at the latest) 2nd year (at the latest) 3rd year (at the latest)
Score/scale: Score/scale: Score/scale:
Note: Use additional sheets if necessary
D. Educational Background
Period Date
Level Institution Major Degree (Start -
Completed)
Elementary
High School
College/
University
Post-Graduate
Note: Use additional sheets if necessary
E. Training, Courses Undertaken/Completed
Type of Certificat Period Date
Details of
Training/Cours Institution ion (Start -
Training/Course
e Yes / No Completed)
Note: Use additional sheets if necessary
F. Skills (Computer, Technical, Language, etc)
Type of Skills Proficiency
Basic Intermediate Advanced
Basic Intermediate Advanced
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Basic Intermediate Advanced
G. Membership in Organization
Name of Kind of Period Date
Position
Organization Organization (Start - Completed)
H. Others
Have you been charged or convicted of any criminal offence? Yes / No
Do you have any objections to a criminal record check being conducted? Yes / No
Have you had any problem in any employment regarding dishonesty? Yes / No
Have you experienced any serious medical condition e.g. tuberculosis,
diabetes, asthma or epilepsy? If Yes, please explain the condition below. Yes / No
Have you incurred any physical or emotional illness which may impair
your work performance? If Yes, what is the nature of the illness? Yes / No
Do you have any special medical needs?
Yes / No
If Yes, what the nature of this requirements?
I. References
No Address/
Name Position Company
. Phone
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J. Compensation & Benefit Information
What is your current monthly salary (take home pay)?
What is your expected salary for the position?
When can you start
Other Desired Benefits?
Are you ready to be located outside Jakarta for business trip? (if
Yes
needed)
No
Jakarta, ________________
(Complete Name)
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