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Inovasi Employee Application Form

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Rivaldo Siregar
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39 views3 pages

Inovasi Employee Application Form

Uploaded by

Rivaldo Siregar
Copyright
© © All Rights Reserved
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
You are on page 1/ 3

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EMPLOYMENT APPLICATION FORM

POSITION APPLIED FOR MOBILE DEVELOPER

1. PERSONAL PARTICULARS

Name RIVALDO SIREGAR Marital Status -


Address JL KEPUTIH TEGAL TIMUR IIIC NO 31
Home Tell No Office Tell No Mobile No.
E-mail Address Driving License Car (Yes/No)
Sex Age Date of Birth Religion
IC No. City of Birth Citizenship
Passport No. Date Place of Issue

2. PERSONAL BIO

3. EDUCATION
School Attended Highest Qualification Year Graduated

4. OTHER TRAINING
Type of Course Institution Qualification Year Graduated

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5. TOOLS AND SKILLS
Name Description Level of Expertise

6. LANGUAGES AND DIALECTS (Indicate Average /Good / Fluent)


Language Speak Write Reading

7. PARTICULARS OF IMMEDIATE FAMILY (Spouse & Children)

Name of Spouse
Date of Marriage Occupation
Date of Birth Employer

Name of Children Age Date of Birth Relationship Occupation/school

8. PARTICULARS OF FAMILY MEMBER (Father, Mother, Brother & Sister)


Name Age Relationship Occupation Name of Company

9. EMPLOYMENT HISTORY (Starting from the last job)


1. Company Name : ______________________
Address : ______________________

Position From (Mo. & Yr.) Position Direct Supervisors Responsibilities


Until ( Mo. & Yr. )

Reason for Leaving : ______________________

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2. Company Name : ______________________
Address : ______________________

Position From (Mo. & Yr.) Position Direct Supervisors Responsibilities


Until ( Mo. & Yr. )

Reason for Leaving : ______________________

3. Company Name : ______________________


Address : ______________________

Position From (Mo. & Yr.) Position Direct Supervisors Responsibilities


Until ( Mo. & Yr. )

Reason for Leaving : ______________________

10. LEISURE INTERESTS:

11. REFEREES (Give 2 Referees to whom reference may be made)

Name Address Telp. No. Occupation Years Known

12. PLEASE ANSWER THE FOLLOWING QUESTIONS


a. Have you been or are you suffering from any physical impairment or disease? YES/NO
b. Have you ever been discharged or dismissed from the service of your previous employer YES/NO
c. Have you ever been convicted in a Court of Law in any country? YES/NO
d. Have you ever been detained by the police or any government? YES/NO
e. Are you serving any bond with your current company? YES/NO
If Yes, What’s the duration outstanding? ………………………………………………………………...

Notes:
Your application will be disqualified if it is found that you have either willfully suppressed material facts or knowingly given false
particulars.
If after engagement, it is found that you have knowingly made a false declaration, the Company reserves the right to terminate
your service without notice.

13. Proposed Joining Date ………………… Salary Expected Rp………………


14. Notice Period ……………………………...………………months

I, ………………………………declare that above information and documents attached here to are true to the best of my knowledge and
belief, and that I have not willfully suppressed any material facts.

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