EMPLOYMENT APPLICATION FORM

*Please do not change Application Form line Format

* Please send only excel format or PDF.
* Please use quotation Mark (') for Numbers or long answer

ADVICE This application will be kept strictly confidential; thus, please fill in complete information.

Put N/A where it's not applicable; if you write in English, please use capital letters. Photograph

Position Applied for : 1 Expected Salary Only

You heard of this position from

Are you willing to be placed anywhere in Jakarta? YES NO If no, please describe

Have you got COVID19 Vaccinated ? YES NO If yes : Dose 1 Dose 2

Dose 3 Dose
PERSONAL DATA

Fullname : Mr./Mrs./Ms. (ID CARD NAME) Uniform Size

ID Card Address

Present Address

Tel. Phone :

Line : Instagram : Linkedin

E-mail address Age Years Height cms. Weight kgs.

Date of Birth Place of Birth

Nationality Religion

ID. Card No./Passport No.

Issued by Expiry Date

Marital Status Single Married Separated Widowed Divorced

Spouse's Name Age Occupation / Firm

Address / Tel.

Number of Independents:

Please give Name, Age, Sex of each.

 EDUCATION RECORD

Certified (Diploma,
Educational Level Name and Address of School/College From-To-Year Bachelor, etc/Score)
Major

Primary

Secondary

Vocational

University

Others

MAJOR TRAINING COURSES OR SEMINAR ATTENDED

Course/Topic Institute of Organizer Date of Training Certificate Obtained

PROFICIENCY IN LANGUAGE
Please tick "√" where applicable.

Speak Read Write

Languages
Good Fair Poor Good Fair Poor Good Fair Poor

English

Japanese

Other

OTHER SKILLS

Typing Japanese wpm English wpm Fax Operation

Computer Program : Word Excel Power Point Pagemaker Other…………..

 EMPLOYMENT RECORD

Please list all employments, starting with present or most recent job.

Employment Date
Company's Name and Address Position Held Final Salary Reason for leaving
From To

Can we contact your employer (s)? Yes No

Are you self employed? Yes No

HEALTH

Have you had any serious illness or injury during the past 5 years? Yes No

If YES, please describe :

Do you have any congenital disease or congenital disorder ? Yes No

If YES, please describe :

Do you have any physical handicaps, chronic diseases, or other disabilities? Yes No

If YES, please describe :

COVID19 History Yes No If Yes, record history Times (e.g 1 Time, 2 Times)

If YES, please describe :

(Date,Symptoms, etc)

MISCELLANEOUS

Ability to drive a vehicle Car Motobike Other

Driving license (if any) : Type of vehicle

Kind Yearly Permanent License No.

Your interest in social and recreational activities

Club or association you are a member of

1 2 3 4

Your hobbies :
Have you joined the military service? Yes No Exempted

Please list relatives or friends currently employed in this Company (if any).

Name Position Phone Number

Person to contact in case of emergency :

Name Relationship

Address Tel.

Persons of Reference (Not a relative; former supervisors are preferable)

Name Position / Work Place Phone Number

If you are accepted, what is your notice period Days

I certify that all information given in this application is true and complete to to the best of my knowledge. I understand that wilful misrepresentation,

false statements or omission of facts will be adequate ground for dismissal.

Applicant's Signature Date