CONFIDENTIAL
PT PELAYARAN TEMPURAN EMAS Tbk
& Subsidiaries
EMPLOYMENT APPLICATION FORM
NAME : …………………………………………………… PHOTO
APPLIED POSITION : …………………………………………………… (ATTACH HERE)
FILL OUT THIS FORM WITH CAPITAL LETTERS
JOB VACANCY INFORMATION SOURCE
Career Day Internet : …………………. Relation
Advertisement Friend Others ………………………….
PERSONAL INFORMATION
Full Name : …………………………………………………………. Male Female
Birthplace : …………………………………. Date Month Year
Present Address : Citizenship : …………………………………………......
………………….……………………………………………. Home Phone : ……………………………………………..
………………….……………………………………………. Mobile Phone : ..……………………………………………
City : ………………………..…. ZIP : …….……… Email : ……………………………………………..
ID Card / Passport Number : Residence Ownership Status :
…………………………………………..
Personal Family Rent Others ………………...
Driving License Number :
…………………………………………..
Taxpayer Identification Number :
…………………………………………...
Religion : Muslim / Catholic / Christian / Hindu / Buddhist / Others…………………………………………………
Blood Type : A B AB O Weight : /kg Height : /cm
F/HRD-R&S/02 rev.00 – [1]
Parents / Family Address : Citizenship : ……...……………………………………….
……………………………………………………………….. Home Phone : .…………………………………………….
.
……………………………………………………………….. Mobile Phone : ………………………………………………
City : ………………………..…. ZIP : …….………
Own a Vehicle : Yes No Vehicle Ownership Status:
Personal Family Company Others ………………
Type / Model : Year :
FAMILY
Marriage Status Single Married Others ………………………………….
Relationship Name Date of Birth Latest Education Occupation
Father
Mother
Siblings 1.
(include yourself) 2.
3.
4.
5.
Spouse
Child 1.
2.
3.
Dependents (Please state – Total, Relationship and Age) :
………………………………………………………………………………………………………………………………..
If there is an emergency situation, person we can contact (Please state – Name, Relationship, and Telephone Number) :
Name : ........................................ Relationship :............................. Telephone Number : ..................................
EDUCATION
Graduation
Education Institution Name Location Department GPA
Year
High School
Diploma/Academy
Bachelor
Master/Doctorate
F/HRD-R&S/02 rev.00 – [2]
LANGUAGE ABILITIES
Verbal Writing
Foreign Language
Poor Average Good Excellent Poor Average Good Excellent
1.
2.
REFERENCES (except family)
Name Company Position Telephone How Long Know You in What
Number capacity
1.
2.
WORK EXPERIENCE (fill out from the latest job)
Company Name
Address
Telephone Number
Business Field
Entry Position
Period (From - To)
Number of Subordinate
Last Position
Period (From - To)
Number of Subordinate
Job Desc (Last Position)
Immediate Supervisor
Reason of Resignation
F/HRD-R&S/02 rev.00 – [3]
Draw your latest position at your company’s organization structure
Working Achievement
1.
2.
3.
OTHERS
Please state and explain the kind of job which fit into your career plan
…………………………………………………………………………………………………………………………………………....
Please state and explain the kind of job you don’t like and feel reluctant to do
……………………………………………………………………………………………………………………………………………
Are you willing to undergo these things?
1. Psychology Test Yes No
2. Probation Period Yes No
3. Business Trip to Other Cities Yes No
4. Placed at Different Location Yes No
Please answer these questions :
Do you have a side job? If yes, state the name of your company and position Yes No
……………………………………………..
Do you have relatives who work in our company? If yes, please state their name Yes No
and relationship with you..…………………….........................
Have you ever / currently suffered severe illness or accident that makes you Yes No
hospitalized? If yes, please state ……………………………………
Is it okay if we ask for reference from your previous company? Yes No
If you are accepted, when can you start working? ………………………….…………………….
I hereby declare that all the given information above is true. If I falsify information, I’m ready to accept all the
consequences, and Management have a right to terminate my employment or doing other necessary course of action. If
I’m accepted, I agree to abide by the rules and regulations of PT. Pelayaran Tempuran Emas, Tbk.
City Signature
Date Month Year Full Name
F/HRD-R&S/02 rev.00 – [4]
PT PELAYARAN TEMPURAN EMAS Tbk
& Subsidiaries
SALARY INFORMATION FORM
Name :…………………………………….
Applied Position :…………………………………….
Salary in Previous / Current Company Expected Salary
F/HRD-R&S/02 rev.00 – [5]
