APPLICATION FOR EMPLOYMENT

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Please complete the application in English. If there is no information to be given or a particular item does
not apply to you, please write "N/A" for Not Applicable.

♦ Position and Salary

Position Applied for

1 ……………………………………………………… 2 ………………………………………………………..

Minimum Monthly Salary Desired …………………………………IDR/Month Date Available for Employment …../ ........ /……

♦ Personal Information

Name Mr./Mrs./Miss (English) ………………………………………………………… Height .......................... Weight ........................

Date of Birth ......./……../……. Place of Birth ……………………………………….. Nationality …………….. Email …………………

Age …………Yrs. Sex ............................. Identification No. ……………………………………………………Expiry Date .../…/…

Family Card No (KK). ………………………………………………………

BPJS Kesehatan No. ……………………………………. BPJS Ketenagakerjaan No. …………………………………..

Religion  Hindu  Moslem Blood Type ......................

 Christian/Chatolic  Buddha ……………
♦ Contact Address ( KTP / ID )

Road …………………………………...……………………………………………….
Province ………………………………………………………….

♦ Current Address

Road …………………………………...…………………………………………………………
Province ………………………………………………………………

♦ Phone Number

Whatsapp No. ……………………………. Mobile Phone No. …………………………… Mobile Phone No. …………………………….

♦ Family Details

Marital Status  Single  Married  Divorced  Widowed

Number of Children ……………… Studying …………………………………

Family Members First Name - Last Name Age Occupation/Position Address/Office Telephone No.

Father

Mother

Sibling(s) 1.

2.

3.

4.

5.

Spouse
 ♦ Educational Background

Institute City From To Major/Department Cert./Degree

Grade

High School

Commercial/Vocational/College

University

Others

♦ Previous Employment (Including Temporary Work and Practical Training) from present to past

Date/Month/Year
Previous Company's
Position Reason for Leaving
Name Salary
From To

….../….../……..... ….../….../…….....

….../….../……..... ….../….../…….....

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Benefits provided in your latest employment Service Charge Commission

……………….................... ………………................
Meal Allowance Incentive Cost of Living Position Allowance
………………........ ……………….............. ………………................. ………………..
Bonus Month(s) Transportation Allowance Telephone Allowance Provident Fund
………………..... ……………….............. ………………................ ……………….................%

♦ Language & Computer Skills

Languages Conversation Reading Writing

Good Fair Poor Good Fair Poor Good Fair Poor

Indonesia

English

………………

………………

English Touch Typing (word/min.) .................. Computer Skills (Please specify programmes) ……………………………………………….....
♦ Other Data

1. Have you ever been or are you suffering from any physical impairment, or disease including any nervous/mental disorder?

 Yes  No
Please tick any of the following ailments you have now or have ever had within previous year.

…... High Blood Pressure ……………………………... …... Ulcers …………………………………......

…... Arthritis or Rheumatism ………………………….......... …... Diabetes …………………………………....
…... Heart Trouble ………………………………... …... Hepatitis …………………………………..
…... Major Operation ……………………………………………….. …... Epilepsy …………………………………….
…... Back Injury …………………………………………….. …... Tuberculosis ………………………………....

2. Do you smoke?  Yes  No

3. (For female) Please state whether you are now in pregnancy.
 Yes / How many months? ……………Month(s)  No
4. Have you ever been charged, detained or convicted in a court of law in this or any other country?
(other than for a minor traffic violation)?
 Yes  No
5. Have you completed the military service?  Yes  No
If no, specify when ……………………………..... If exempted, specify reason ………………………………………………………

6. Hobbies, Sports, other Interests ………………………………………………………………………………………………………………….

7. Emergency contact
Name ………………………………………………… Relationship ……………………………………………………………...
Address ………………………………………………………………………………………………………………………………….......
Telephone Number ……………………………………………………….

8. Have you any relative working in this company (Family, friends, colleagues)?  Yes / Name ……………………………………….
 No
9. May inquiry be made of your present employer regarding your qualifications and character?  Yes
 No
10. Have you been certified by the Office of Skill Standard and Testing Development? (If yes, please specify and enclose certificate.)

 Yes in the field of ………………………………………………………Level…… 

♦ Work References (At least 2 previous direct superiors/bosses)

Name Company Position Tel. No.

I hereby confirm that all the answers and statements given by me on are true and correct in every aspect. However, should the
company employ me, and should it be found afterwards that any of the information given by me is false and inaccurate, I shall allow
the company to dismiss me from its employment immediately without any compensation.

I certify that I have not made and will not make any offering, directly or indirectly, of any gift, gratuity, favour, entertainment, loan or any
other thing of monetary value to obtain employment.

……../………/…….. ……………………………………..
Date Applicant's Signature