APPLICATION FORM
PERSONAL DATA
Name
Home Address
Do you live: Own House ( ) Sex:
Rented House ( ) Tel. No. (Off)
With parents ( ) (Res)
Others ( v ) (HP)
Date of Birth: Age: Place of Birth:
Marital Status: Nationality: Race: Religion:
Driving Licence: Do you own a car:
EDUCATION & PROFESSIONAL QUALIFICATION
FROM-TO NAME OF SCHOOL/COLLEGE STATE LEVEL ATTAINED MAJOR COURSE/SUBJECT
MEMBERSHIP OF PROFESSIONAL & OTHER SOCIETIES (State dates and position held)
Computer proficient Yes No Type:
Program/Languages:
Position applied for:
Are you interested in any other position: Salary Expected:
Current Salary:
Details of current remuneration package:
When are you available of work: Notice Period:
EMPLOYMENT HISTORY
(Comments with current of last employment)
Date of Employment: Date Employment Ended:
Company:
Company's Address:
State nature of the business:
Position held:
Name & designation of immediate supervisor:
Total number of employee in the company: Number of staff supervise by you:
Detailed description of duties/responsibilities:
How did you get employed in this company
(Through Advertisement, Recommendation, etc)
Reason for Leaving:
Last Salary:
Date of Employment: Date Employment Ended:
Company:
Company's Address:
State nature of the busines :
Position held:
Name & designation of immediate supervisor:
Total number of employee in the company: Number of staff supervise by you:
Detailed description of duties/responsibilities:
How did you get employed in this company
(Through Advertisement, Recommendation, etc)
Reason for Leaving:
Last Salary:
Date of Employment: Date Employment Ended:
Company:
Company's Address:
State nature of the business:
Position held:
Name & designation of immediate supervisor:
Total number of employee in the company: Number of staff supervise by you:
Detailed description of duties/responsibilities:
How did you get employed in this company
(Through Advertisement, Recommendation, etc)
Reason for Leaving:
Last Salary:
Date of Employment: Date Employment Ended:
Company:
Company's Address:
State nature of the business:
Position held:
Name & designation of immediate supervisor:
Total number of employee in the company: Number of staff supervise by you:
Detailed description of duties/responsibilities:
How did you get employed in this company
(Through Advertisement, Recommendation, etc)
Reason for Leaving:
Last Salary:
FAMILY DETAILS
RELATIONSHIP NAME AGE ADDRESS OCCUPATION NAME OF
PRESENT/PAST EMPLOYER
Father Present
Mother Present -
Brothers/ Present -
Sisters
Spouse
Children
MEDICAL DETAILS
Are you in good health? Yes No If no, why?
Please state with dates, any serious illness, allergies, operations, disabilities or accidents, you had:
Have you been refused insurance coverage? Yes No
Do you take alcohol/drugs? Yes No To what extend?
Have you ever been convicted in a court of law ? Yes No
If so, give details:
Are you involved in any administrative, civil or criminal case?
Are you debt? Yes No
If so, to whom, to what extend & for what reason?
Have you been dismissed or suspended from any position? Yes No
If so, state details:
Are you interested or engaged in any business? Yes No
What type of business?
Do you have any other source of income? Yes No
(Please specify)
LANGUAGES INDONESIA ENGLISH CHINESE (SPECIFY)
SPOKEN
WRITTEN
Hobbies, games & other interests
ADDITIONAL INFORMATION - Give additional information which you consider may be of interest to
prospective employer, if possible state why you believe you are suitable for the position you are applying.
ORGANIZATION CHART OF COMPANY MOST RELEVANT TO POSITION APPLIED FOR
(PREVIOUS OR CURRENT EMPLOYER)
State name of company, indicate where you fill in within the organisation
EMPLOYMENT REFERENCES
From past & present employment From past & present employment
Name: Name:
Position: Position:
Company Name: Company Name:
Company Address: Company Address:
Tel: (office) Tel: (office)
PERSONAL REFERENCES
Give names of person of responsibility who have known for you at least 3 years
Name: Name:
Position: Position:
Company Name: Company Name:
Company Address: Company Address:
Tel: (office) Tel: (office)
Year of Acquaintance: Year of Acquaintance:
Name companies with which you have pending applications for employment
(Give dates of application)
1
2
3
Have you applied with this office before?
I HEREBY CONFIRM ALL THE ABOVE DETAILS TO BE TRUE AND CORRECT. I AUTHORISE BMS CORPORATION TO CARRY OUT
REFERENCE CHECKS WITH PAST EMPLOYER AND REFERENCES IN CONNECTION WITH ITS APPLICATION
I UNDERSTAND THAT ANY MISREPRESENTATION OR COMMISSION OF INFORMATION WILL BE SUFFICIENT REASONS FOR
WITHDRAWAL OF AN OFFER OR SUBSEQUENT DISMISSAL, IF EMPLOYED.
Name
Date: Signature:
