PHOTO
APPLICATION FORM
Name :
ID Card No :
Current Home Address :
Sex : o Female o Male
Telp. Np. Office : HP :
Residence : Email :
Emergency Contact :
Date of Birth : Age :
Place of Birth :
Marital Status : Nationality :
Race : Religion:
Driving License : Do you own a car : o Yes o No
EDUCATION & PROFESSIONAL QUALIFICATION
FROM - TO STATE LEVEL ATTAINED MAJOR COURSE OR
NAME OF SCHOOL, COLLEGE
(STATE DATE) SUBJECT
CURRENT REMUNERATIONS (In Rupiah)
CURRENT EXPECTED
Basic :
Transport :
Meal :
Medical :
Incentive :
Bonus :
Pension Fund :
BPJS :
Take Home Pay :
PREFERENCES
Notice of Interview : days
Availability to join : month (s) notice
EMPLOYEMENT HISTORY (Commence with current or last employment)
Date of Employment :
Date Employment Ended :
Name of Employer :
Address of Employer :
:
State nature of employer's business :
Position Held :
Name & designation of Immediate :
Total number of employee in company :
Number of staff supervised by you :
Give details description of duties/responsibilities :
How did you get employed in this company :
(Through Advertisement, Recommendation, etc)
Reason for Leaving :
Last Drawn Salary :
Date of Employment :
Date Employment Ended :
Name of Employer :
Address of Employer :
State nature of employer's business :
Position Held :
Name & designation of Immediate Supervisor :
Total number of employee in company :
Number of staff supervised by you :
Give details description of duties/responsibilities :
How did you get employed in this company :
(Through Advertisement, Recommendation, etc)
Reason for Leaving :
Last Drawn Salary :
Date of Employment :
Date Employment Ended :
Name of Employer :
Address of Employer :
:
State nature of employer's business :
Position Held :
Name & designation of Immediate Supervisor :
Total number of employee in company :
Number of staff supervised by you :
Give details description of duties/responsibilities :
How did you get employed in this company :
(Through Advertisement, Recommendation, etc) :
Reason for Leaving :
Last Drawn Salary :
FAMILY DETAILS
OCCUPATIO
N NAME OF
RELATIONSHIP NAME ADDRESS AGE PRESENT EMPLOYER
/PAST
Father
Mother
Brother/sister
Spouse
Children
LANGUAGES
LANGUAGES
INDONESIA ENGLISH CHINESE (SPECIFY) JAPANESE………………. ………………..
SPOKEN o o o o o o
WRITTEN o o o o o o
HOBBIES,GAME & OTHER INTERESTS
ADDITIONAL INFORMATION - Give any additional information which you consider may be of interest to a prospective employer
, if possible state why you believe you are suitable for the position you are applying
ORGANIZATION CHART OF COMPANY MOST RELEVANT TO POSITION APPLIED FOR.
(previous or current employer)
State name of company, indicate where you fit in within the organization.
EMPLOYEMENT REFERENCES (From past & present employment)
NAME :
POSITION :
COMPANY NAME :
COMPANY ADDRESS :
TELP (OFFICE)/HP :
NAME :
POSITION :
COMPANY NAME :
COMPANY ADDRESS :
TELP (OFFICE)/HP :
PERSONAL REFERENCES (Give names or person of responsibility who have known you for at least 3 years)
NAME :
POSITION :
COMPANY NAME :
COMPANY ADDRESS :
TELP (OFFICE)/HP :
HANDPHONE :
YEARS OF ACQUAITANC :
NAME :
POSITION :
COMPANY NAME :
COMPANY ADDRESS :
TELP (OFFICE)/HP :
HANDPHONE :
YEARS OF ACQUAITANC :
NAME OF COMPANIES WITH WHICH YOU HAVE PENDING APPLICATION FOR EMPLOYMENT
(Give dates of application)
1.
2.
3.
HAVE YOU APPLIED WITH THIS OFFICE BEFORE? o YESo NO STATE DATE :
FOR CONSULTANT'S USE ONLY
Indicate your impressions gained from interviewing the applicant by making an (x) on the scale of each heading
FOR CONSULTANT'S USE ONLY
1. Appearance
o Very Untidy o Somewhat careless o Satisfactory Personal o Neat and tidy better o Unsually well
about personal appearance than average groomed and very
appearance appearance neat
2. Friendliness
o Appears very distant o Approachable; fairy o Warm, friendly; o Very Sociable and o Extremely
and aloof friendly sociable outgoing friendly; very warm
and outgoing
3. Poise
o At ease; jumpy o Somewhat tense; o Reasonable o Sure of himself/ o Extremely well
and very nervous easily irritated at ease herself composed
4. Personality
o Unsatisfactory o Doubtful o Average and o Very good; above; o Outstanding
satisfactory average excellent all
around
5. Conversational Ability
o Talks very little; o Tries to express o Average fluency and o Talks well and does o Excellent expression
expresses himself/herself clearly expression not waste words extremely fluent;
poorly forceful
6.Alertness
o Very slow to grap o Rather slow requires oGrasp ideas with o Quick to understand o Exceptionally alert
ideas more than average average speed perceives well understands new
explanation ideas instantly
7.Knowledge
o Poor, no appropriate o Limited knowledge o Average knowledge o Well informed; o Excellent knowledge
knowledge at all covering some areas not covering all knowledge covers with faultless
areas fully most areas coverage
8.Qualifications
o Not relevant to job o Some relevant to o Satisfactory; as o Very suitable o Ideal for job;
job good as might be for job perfect match
expected
9. Skill
o None approriate o Some skill in job o Reasonable o Well skill in job o Excellent skill and
area amount; average area ideal for job
for job
10. Experience
o No relation between o Some experience o Average; o Very good and o Excellent and
background and job in relevant area background cover relevant experience ideal background
job area
11. Drive and Initiative
o Poorly defined goals; o Make little effort o Average effort; o High desire to o Sets high goals;
acts without purpose to achieve goals some initiative achieve; strives hard always takes initiative
CONSULTANT RECOMMENDATION
Dressing and Appearance :
Language Ability/Voice :
Other Information/Comments :
Day/date Consultant's Signature
I HEREBY CONFIRM ALL THE ABOVE DETAILS TO BE TRUE AND CORRECT. I AUTHORISE PT. PERSOLKELLY Recruitment INDONESIA TO CARRY OUT
REFERENCE CHECKS WITH PAST EMPLOYERS AND REFEREES IN CONNECTION WITH THIS APPLICATION AND I AGREED TO GIVE MY LATEST COPY OF
SALARY SLIP FROM MY CURRENT EMPLOYER FOR THIS APPLICATION WHEN REQUIRED.
I HEREBY CONSENT TO PT. PERSOLKELLY Recruitment INDONESIA AND ITS AFFILIATES COLLECTING, USING AND DISCLOSING MY PERSONAL DATA
TO PROSPECTIVE EMPLOYERS TO COLLECT USE AND DISCLOSE THESE PERSONAL DATA FOR PURPOSES OF EVALUATING MY SUITABILITY FOR
EMPLOYEMENT. I ACKNOWLEDGE THAT THE FULL PRIVACY POLICY IS AVAILBLE AT www.persolkelly.co.id OR AT MY REQUEST
I ALSO AGREE NOT TO SEEK OR ACCEPT EMPLOYMENT EITHER DIRECTLY OR INDIRECTLY FROM ANY CLIENT PT. PERSOLKELLY Recruitment
INDONESIA TO WHOM I HAVE BEEN SENT FOR AN INTERVIEW, FOR AT LEAST THREE MONTHS AFTER DATE OF INTERVIEW.
I UNDERSTAND THAT ANY MISREPRESENTATION OR OMISSION OF INFORMATION WILL BE SUFFICIENT REASON FOR WITHDRAWAL OF AN OFFER OR
SUBSEQUENT DISMISSAL, IF EMPLOYED.
Saya menyatakan bahwa semua informasi yang saya berikan di sini adalah benar. Saya memberikan wewenang kepada PT. PERSOLKELLY Recruitment INDONESIA
untuk melakukan cek referensi kepegawaian dari perusahaan tempat saya bekerja sebelumnya dan kepada pihak yang berhubungan dengan aplikasi ini. Saya setuju untuk
memberikan salinan dari slip gaji terakhir dari perusahaan tempat saya bekerja saat proses wawancara berjalan ketika dibutuhkan.
Saya dengan ini mengizinkan PT. PERSOLKELLY Recruitment Indonesia dan afiliasinya mengumpulkan, menggunakan dan mengungkapkan data pribadi saya kepada calon
Pemberi Kerja untuk mengumpulkan, menggunakan dan mengungkapkan data pribadi ini untuk tujuan mengevaluasi kesesuaian saya untuk pekerjaan. Saya juga mengakui
bahwa Kebijakan privasi lengkap tersedia di www.persolkelly.co.id atau atas permintaan saya.
Saya juga setuju untuk tidak melamar atau menerima tawaran kerja baik secara langsung ataupun tidak langsung dari klien PT. PERSOLKELLY Recruitment Indonesia,
kepada siapa saya telah diproses untuk interview, sedikitnya 3 (tiga) bulan setelah tanggal interview.
Saya memahami bahwa apabila ditemukan ketidakbenaran dalam informasi yang saya berikan, maka hal tersebut dapat menjadi alasan yang cukup untuk penarikan dari proses
rekrutment yang sedang berlangsung atau pembatalan bagi surat perjanjian kerja, bilamana sudah ditandatangani.
Day/date Signature
