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Data Calon Karyawan Form

This document appears to be an application form for employment. It requests personal information such as name, address, contact details, education history, employment history, languages spoken, references, medical history, and availability to work. It also asks the applicant to disclose any family or acquaintances already employed at the company, and to sign certifying the truth of the information provided.

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Anastacia Neni
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© Attribution Non-Commercial (BY-NC)
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2K views5 pages

Data Calon Karyawan Form

This document appears to be an application form for employment. It requests personal information such as name, address, contact details, education history, employment history, languages spoken, references, medical history, and availability to work. It also asks the applicant to disclose any family or acquaintances already employed at the company, and to sign certifying the truth of the information provided.

Uploaded by

Anastacia Neni
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PT. ANDALAN TIGA BERJAYA PT.

ASMIN BARA BRONANG

PT. ASMIN BARA JAAN OTHER

POSITION APPLIED :

SEX :

M F

FULL NAME :
(match with ID Card)

Photo (3 x 4)

(FILLED BY HR DEPARTMENT) NIK : FIRST DATE OF WORKING : EMPLOYMENT STATUS : DEPARTMENT CODE : DIVISION :

POSITION : PERSONAL LEVEL : SPK No. : INA BANK A/C No : DATE OF RESIGNATION : PERMANENT ADDRESS : .. .. POST CODE : .. PHONE .... CURRENT ADDRESS : .. POST CODE : .. PHONE ....

PLACE/DATE OF BIRTH : . HEIGHT : CM WEIGHT KG ID NUMBER : PASSPORT NUMBER : DRIVER LICENSE NO : KPA NO. : JAMSOSTEK NO. :

MATERIAL STATUS :

SINGLE

MARRIED

DIVORCED BLOOD TYPE :

NATIONALITY :

RELIGION : ..

EDUCATION : SCHOOL/UNIV. MASTER BACHELOR DIPLOMA SENIOR HIGH SCHOOL JUNIOR HIGH SCHOOL PRIMARY SCHOOL

NAME

ADDRESS

MAJOR/GPA FROM

TO

PASS/FAIL

STATE FOREIGN LANGUAGES YOU MASTER AND FILL IN YOUR LEVEL OF LANGUAGE MASTERY. LANGUAGE READING LISTENING SPEAKING 1 2 3

WRITING

REFERENCES : NAME 1 2 COMPANY ADDRESS/PHONE

LIST OF ACHIEVEMENTS.

ORGANIZATION

HOBBIES AND ACTIVITIES

FAMILY RELATIONSHIP. RELATION NAME

SEX (M/F)

DATE OF BIRTH (AGE)

HIGHEST EDUCATION

OCCUPATION POSITION COMPANY

FATHER MOTHER BROTHERS/SISTERS (INCLUDING YOURSELF) 1 2 3 4 5 6 SPOUSE CHILDREN 1 2 3 TRAINING/COURSES NAME OF TRAINING

INSTITUTION

VENUES

DURATION FROM UNTIL

FINANCED BY

1 2 3

4 5 6 7 8 9 EMPLOYMENT HISTORY : STATE YOUR EMPLOYMENT HISTORY AS COMPLETELY AND ACCURATELY AS POSSIBLE BEGINNING FROM THE PRESENT OR LAST EMPLOYMENT TO PREVIOUS ONES. 1. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR : JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION : TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION: NAMES/ADDRESS/PHONE OF COMPANY POSITION WORKING FIELD

2. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

3. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

4. SERVICE YEARS YEARS MONTH FROM TO TYPE OF BUSINESS : LINE SUPERIOR :

NAMES/ADDRESS/PHONE OF COMPANY

POSITION

WORKING FIELD

TOTAL EMPLOYEES : DIRECTOR : DESCRIBE THE ORGANIZATION STUCTURE SHOWING YOUR POSITION:

JOB DESCRIPTION OR DESCRIBE DUTIES AND RESPONSIBILITIES IN YOUR CURRENT/LAST POSITION :

PUT AN "" IN THE CORRECT RESPONSE BOX HAVE YOU PREVIOUSLY APPLIED TO OUR COMPANY/GROUP ? IF SO WHEN AND WHAT POSITION ? ARE YOU ALSO APPLYING TO OTHER COMPANIES ? IF YES PLEASE MENTION WHAT COMPANIES AND POSITION APPLIED? ARE YOU UNDER CONTRACT AGREEMENT WITH OTHER COMPANIES ? DO YOU HAVE ANY OBJECTIONS IF WE CONTACT YOUR PREVIOUS EMPLOYER FOR HAD IT ? DO YOU HAVE ANY ACQUAINTANCE (S) OR RELATIVE (S) EMPLOYED BY, OUR COMPANY/GROUP ? PLEASE MENTION NAME AND YOUR RWLATIONSHIP ?

YES

NO

REMARKS

WHAT SERIOUS ILLNESS/SURGERIES/ACCIDENTS HAVE YOU EVER HAD ? WHEN HAVE YOU HAD IT ? HAVE YOU EVER UNDERGONE ANY PSYCHOLOGICAL TEST BEFORE ? IF SO, WHEN, WHERE AND FOR WHAT PURPOSE ? HAVE YOU EVER BEEN INVOLVED IN ANY ADMINISTRATIVE, CIVIL OR CRIMINAL CASES ? IF ACCEPTED , DO YOU AGREE TO BE LOCATED ANYWHERE IN INDONESIA ? PLEASE MENTION THE PREFERRED CITIES OR REGIONS ! DESCRIBE ANY KIND OF JOBS THAT ARE IN LINE WITH YOUR CAREER PLAN ! PLEASE STATE YOUR CURRENT MONTHLY INCOME AND FACILITIES ? DESCRIBE ANY KIND OF JOBS THAT YOU DON'T LIKE ? STATE SALARY AND FACILITIES DESIRED ! IF ACCEPTED, WHEN CAN YOU START WORKING ?

HEREBY CERTIFY THAT THE INFORMATION GIVEN ABOVE IS TRUE AND IF UNDER ANY CIRCUMSTANCES, ANY MISREPRESENTATION OR OMISSION OF INFORMATION IS FOUND, I UNDERSTAND THAT I SHALL BE HELD RESPONSIBLE.

..20 .

( .) APPLICANT

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