APPLICATION FORM
No. QR/HNRD/PRS/[Link].00
page 1 of 5
CONFIDENTIAL
1. This form should be answered written in block capital letters by the applicant.
2. If any information given is not true, the company has the right to cancel or terminate the work
relationship or as demanded in law procedure.
3. * Cross where not appropriate.
Job Applied :
A. PERSONAL DATA
Full Name
Place/Birthdate
Hobbies
Religion
Ethnic
Group
Formal Education
Title
Issued in
KTP No
Telp. No./E-mail
Address
Male/Female *
B. FAMILY
1.
Marital Status
2.
Members of family ( Husband/Wife and Children )
If they have passed away, please mention their last education & job.
How many children do you have? _______
Family
Spouse
Child 1
Child 2
Child 3
Single
Engaged
Name
Married
Divorced
M/F
Birthdate
Education
Job
APPLICATION FORM
No. QR/HNRD/PRS/[Link].00
page 2 of 5
CONFIDENTIAL
3.
Do you have other dependents besides your wife or children ?
4.
House Status
Private owned
Rent
5.
Parent Owned
Contract
Relative owned
Other .....................
Parents family (including applicant)
If they have passed away, please mention their last education & job.
Applicant is the ________ child of __________ children.
Family
Name
M/F
Father
Mother
Birthdate
Education
Job
Child 1
Child 2
Child 3
C. EDUCATION
1.
Formal Education (begin from Senior High School)
no
Institution Name
Major
Place
a.
From
19___
To
19___
b.
c.
2.
Have you ever failed in school ?______________How many times ?______________
Why?____________________________________________________________________________
3.
Did you ever get any achievements in any field? If yes, please describe briefly.
4.
Do you posses any computer skills? If yes, please describe briefly.
5.
Courses Attended
APPLICATION FORM
No. QR/HNRD/PRS/[Link].00
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CONFIDENTIAL
no
Topic Of Course
Organizer
Period
a.
b.
c.
6.
D.
1.
Foreign Language
a.
Speak
Read
Write
b.
Speak
Read
Write
WORKING EXPERIENCE (please mention the last 3 company)
Name of Company
Line of Business
Period of work (month-year)
up to
The last position
The job description
Last nett salary
Reason for leaving
2.
Name of Company
Line of Business
Period of work (month-year)
The last position
The job description
Last nett salary
Reason for leaving
up to
APPLICATION FORM
No. QR/HNRD/PRS/[Link].00
page 4 of 5
CONFIDENTIAL
3.
Name of Company
Line of Business
Period of work
(month-year)
up to
The last position
The job description
Last nett salary
Reason for leaving
E.
REFERENCES
Name your references (not less than two, not in this company, nor your friend or family)
no
Name
Position
Relationship
Telp No.
1.
2.
F. INTEREST AND PERSONAL CONCEPT
1.
Please indicate by number, your choice of job type, according to your preference.
Kinds of job
Accounting
Engineering
Finance
General Affair
Marketing/Sales
No.
Kinds of job
Personnel
Production/Manufacturing
Research
Service/Maintenance
Other____________________
2.
Why do you choose the first 2 numbers in the above?
3.
The working environment you prefer :
Office
Factory
Laboratory
No.
Field
Why?
4.
Why do you want to join this Company?
5.
What do you know about this Company
6.
Do you have any objection to work overtime, to be stationed anywhere deemed necessary by the
APPLICATION FORM
No. QR/HNRD/PRS/[Link].00
page 5 of 5
CONFIDENTIAL
Company?
7.
When will you be able to start working?
8.
What is your expected salary?
9.
What kind of Fringe benefits (facilities) do you desired?
10.
Name the person (s) or your relative (s) in our company
11.
Did you ever do the Psychological test (IQ, Aptitude, Personality test) ? If yes, please mention
where, when and for what purpose?.
12.
Did you ever involve in criminal cases? If yes, please describe the case, sanction, where and when!
13.
Social Activities
no
Name of Organization
a.
b.
c.
Hereby, I certify that the above statements are true and correct.
Jakarta, ............................................
( ____________________________ )
Period
Position
