PRIVATE & CONFIDENTIAL

APPLICATION FOR EMPLOYMENT

INSTRUCTIONS

1. This form has been designed to provide us with the basic information for easy processing of your application for
employment with us. It also serves as our personnel record should you be employed.
2. It is essential for all relevant parts of this application form to be completed.
3. The Company reserves the right to terminate the employment of the applicant if any one of the particulars supplied by
the applicant in this application form is found to be untrue after engagement.

Position Applied For: Application Engineer

How do you know about this position?

 Job websites  Newspaper

 Employment Agency  Walk in

 Recommended by employees, pleases state name: _____________________________________

☑ If others, please indicate source: From sales friend

1. PERSONAL PARTICULARS

Name (as in IC, please underline surname) Name in Chinese Characters (if applicable)
Arif Hidayatulloh

Nationality / Citizenship Permanent Resident : Yes / No Identification No:

Indonesian KTP/ID Card : 3327042903930005
Entry Permit No: Foreign Identity No:

Date of Birth : February 21, 2025 Place of Birth

Address Contact Details
Perum. Graha Asri Cikarang
Bekasi – Jawa Barat – Indonesia Home: -

Mobile: +62852-1226-1818

Email Address: arifhidayat880@gmail.com

Driving License : Yes / No Class : C (Car)

2. NATIONAL SERVICE (If applicable)

Enlistment Date Completion Date Unit Vocation Rank at Completion

If exempted, please state reasons: ____________________________________________________

3. FAMILY PARTICULARS – Give details of your spouse, children, parents & siblings.

Name Relationship Nationality Date of Birth Occupation Company

RIFA AZIZAH Wife Indonesia 27-12-1995 Homemaker -

ABDULLAH AL AZZAM Son Indonesia 29-09-2019 Not working -

SHAFIYA ABDILLAH Daughter Indonesia 19-01-2021 Not working -

MADINA HANA Daughter Indonesia 27-10-2024 Not working -

AINUN NAJIB Brother Indonesia 12-12-1988 Farmer -

AAN FAUZI Brother Indonesia 09-04-1996 Farmer -

AMBAR WATI Sisters Indonesia 10-05-2000 Not working -

4. CONTACT PERSON / NEXT-OF-KIN (In case of emergency)

Name Relationship Contact Number

RIFA AZIZAH Wife +62 859-7376-4346

AINUN NAJIB Brother +62 838-3388-9212

5. EDUCATIONAL PROFILE – Attached photocopies of all academic certificates

Qualification Institution Year Commenced Year Completed

Bachelor's Degree (S1) PELITA BANGSA UNIVERSITY 2012 2016

Information Technology (IT)
Senior High School MA NURULHIDAYAH 2008 2011

Junior High School MTS MINHAJUTTHULAB 2005 2008

Primary Education SD N 1 TUNDAGAN 1999 2005

6. PROFESSIONAL CLUB MEMBERSHIPS

From To Association / Club / Society/ Company Position Held

7. EMPLOYMENT HISTORY – Start with your latest or present company. It is the policy of the Company to conduct
reference check with your previous employer.

From To Company Position Salary Allowances Bonus Reason for

Leaving

2017 Present PT. NT Sales Engineer IDR • BPJS Kesehatan Bonus 1x Looking for
Indonesia Sub Leader 10.976.747 • Jamsostek better
• THR 1x opportunities
• Calls & Internet

8. LANGUAGE PROFILE – Please circle Good (G), Fair (F) or Poor (P)

Language Spoken Written Language Spoken Written

English
G/F/P G/F/P G/F/P G/F/P

G/F/P G/F/P G/F/P G/F/P

Dialect (please specify) G/F/P G/F/P Others (Please Specify) G/F/P G/F/P
1.____________________ 1._________________
G/F/P G/F/P G/F/P G/F/P
2.____________________ 2._________________

9. COMPUTER LITERACY & OTHER SKILLS – Please indicate the software

Microsoft Office (Word, Excel, PowerPoint)

Shorthand wpm Typing 37 wpm

10. HOBBIES / INTERESTS / GAMES

Soccer, Cycling

11. CHARACTER REFEREES – Please name two referees other than relative who know you well

Name Relationship Occupation Year(s) known Contact No

Mr. Alex Friend Sales Engineer 2017 +62 812-8884-3765

Mr. Iyus Neighbor Employee 2018 +62 888-0961-1646

 12. ADDITIONAL INFORMATION

1) What is your expected Basic Salary $1000

2) What length of notice is required by your current employer? One-month notice

3) Have you been or are you suffering from any disease / illness / major medical condition / Yes / No
mental disorder or physical impairment?
4) Have you been discharged or dismissed from the service of your previous employers? Yes / No

5) Have you been convicted in a court of law in any country? Yes / No

6) Have you been served with a garnishee order or writ of seizure and sale or been Yes / No
declared a bankrupt?
7) Do you have any relatives working in the company presently? Yes / No

8) Have you applied for any employment with the Company before? Yes /No

If your answer to any of the above is yes, please give details in the space provided.

13. DECLARATION

I declare that all information given herein are true and correct. I understand that a misrepresentation or omission of facts
will be sufficient cause for cancellation of consideration for employment or dismissal from the Company’s service if I
have been employed.

__________________________
Signature / Date : May 28, 2025

14. FOR OFFICIAL USE

Assessment of Applicant

IF RECOMMENDED FOR APPOINTMENT  Accepted  KIV  Rejected

Appointed : New / Replacement __________________________________

Position : ____________________________________ Commencement Date:______________________

Salary: _________________ Allowances (if any): _____________________________________________

Interviewed by: ____________________________ Approved by: ________________________________