PT.
Samsung SDS Global SCL Indonesia
Centennial Tower, 17th Floor, Suite A1
Jln. Gatot Subroto Kav 24 - 25
Jakarta Selatan, 12930
Phone : +62-21-2295-8066
Fax : +62-21-2295-8060
EMPLOYMENT APPLICATION
POSITION APPLIED
Photo
(1) PERSONAL INFORMATION
Full Name Chinese Character (if applicable)
(BLOCK LETTERS) Underline Family
name
Local Address :
Foreign Address (if applicable):
Contact No. (Handphone)
Marital Status: Gender
Date of Birth: Email Address:
Place of Birth Race / Religion:
NRIC/ Passport No. Dialect Group:
Nationality PR Start Date:
Valid Driving License: No Yes
National Service Completed Exempted
(state reasons)
(2) HEALTH
Do you have any illness? If yes, please specify illness and period
ILLNESS PERIOD
(3) IMMEDIATE FAMILY INFORMATION
Name Age Relationship Occupation Company
(4) EDUCATION
DATE
NAME OF INSTITUTION QUALIFICATION OBTAINED
FROM TO
(5) OTHER TRAINING
TYPE OF COURSE INSTITUTION QUALIFICATION YEAR COMPLETED
(6) OTHER SKILLS / COMPUTER KNOWLEDGE
(7) LANGUAGES PROFICIENCY
INDICATE:
FAIR / GOOD / EXCELLENT
SPEAK READ WRITE
(8) EMPLOYMENT HISTORY
Start with your present (or most recent) employer
Employment (Company Name) :
Job Title : Last Drawn Salary :
Date Joined : Date Resigned :
Job Description / Responsibilities :
Reason of Leaving :
Employment (Company Name) :
Job Title : Last Drawn Salary :
Date Joined : Date Resigned :
Job Description / Responsibilities :
Reason of Leaving :
Employment (Company Name) :
Job Title : Last Drawn Salary :
Date Joined : Date Resigned :
Job Description / Responsibilities :
Reason of Leaving :
Employment (Company Name) :
Job Title : Last Drawn Salary :
Date Joined : Date Resigned :
Job Description / Responsibilities :
Reason of Leaving :
(9) COMPENSATION
Current salary : (per month)
Expected salary :
(per month)
Earliest Join Date :
(10) REFERENCES
List two references (Relatives should not be included)
Occupation /
Name Years Known Contact Number
Company Name
(11) HOBBIES
(12) GENERAL (please circle the appropriate
answers)
(a) Have you ever been convicted of a criminal offence? Yes / No
(b) Have you ever been dismissed or suspended from any service of any employer? Yes / No
(c) Are you a bankrupt / discharged bankrupt? Yes / No
(d) Have your attended any interview at Samsung before? Yes / No
(if yes, please specify )
(e) Do you have any relatives or friends in our employment? Yes / No
(if yes, please state name/position/relationship )
(f) Are you referred by an existing Samsung employee, please specify name: Yes / No
(if yes, please specify name: )
(g) Are you recommended by any employment agency? Yes / No
(if yes, please state name and person-in-charge )
(13)
DECLARATION
I declare that the information provided above is true and complete in all aspects. I understand that any misrepresentation
or omission of information may be considered sufficient for withdrawal of an offer or subsequent dismissal from
employment.
Signature of Applicant Date
FOR OFFICIAL USE
1) 1st interview date By
2) 2nd interview date By
3) 3rd interview date By
* Accepted/Rejected/KIV until
Name
Salary to offer
Increment after confirmation Signature
Join Date Date
* Please delete accordingly
