No. Dok.

: FO-QP-PU-HRD-002/01
FORMULIR Berlaku sejak : 1 Desember 2011
APPLICATION FORM Revisi : 00
FULL TIME / PART TIME Halaman : 1 dari 5

CONFIDENTIAL

PERSONAL INFORMATIONS

Full Name :

Address : Photo
4x6

Telephone No. : Office :

Home :

Mobile :

E-mail address :

Marital Status : Gender : Male / Female

Date of Birth : Age :

Place of Birth : Nationality :

Religion :

ID Card No : (KTP/ SIM/ PASSPORT)

Do you have driving license? Yes No Class : A/ B1/ B2/ C

I. EDUCATIONAL / PROFESSIONAL QUALIFICATIONS

A. Academic Qualifications

Institution Qualification Year Graduated

B. Professional Institution/ Body

1 Employment Application Form - PU

 No. Dok. : FO-QP-PU-HRD-002/01
FORMULIR Berlaku sejak : 1 Desember 2011
APPLICATION FORM Revisi : 00
FULL TIME / PART TIME Halaman : 2 dari 5

Certificate/ Diploma/
Professional Institution/ Body Year Graduated
Member Status Obtained

C. Other Training/ Seminar Attended

Type of Course Institution Qualification Year

III. LANGUAGES AND DIALECTS

Language (s) Spoken Written
Fair Good Excellent Fair Good Excellent
Fair Good Excellent Fair Good Excellent
Fair Good Excellent Fair Good Excellent

IV. FAMILY INFORMATION

(If you are married)
Relationship Name Date of Birth Age Occupation
Husband
Wife
Children 1
Children 2
Children 3

(If you are Single)

Relationship Name Date of Birth Age Occupation
Father
Mother
Children 1
Children 2

2 Employment Application Form - PU

 No. Dok. : FO-QP-PU-HRD-002/01
FORMULIR Berlaku sejak : 1 Desember 2011
APPLICATION FORM Revisi : 00
FULL TIME / PART TIME Halaman : 3 dari 5

Children 3

V. HEALTH
Do you ever have serious illness? Yes No
State your illness and period of illness:

VI. EMPLOYMENT HISTORY (Start with your present employer)

Name of Company :
Telephone No :
Type of Business :
Position Held : From: To:
Starting Salary : Last Drawn Salary :
Reason for Leaving :

Name of Company :
Telephone No :
Type of Business :
Position Held : From: To:
Starting Salary : Last Drawn Salary :
Reason for Leaving :

Name of Company :
Telephone No :
Type of Business :
Position Held : From: To:
Starting Salary : Last Drawn Salary :
Reason for Leaving :
3 Employment Application Form - PU
 No. Dok. : FO-QP-PU-HRD-002/01
FORMULIR Berlaku sejak : 1 Desember 2011
APPLICATION FORM Revisi : 00
FULL TIME / PART TIME Halaman : 4 dari 5

VII. REFERENCES
List two references below. Relatives should not be included.
Name Relationship Occupation & Email Phone No.
Employer Address

VIII. PRIVATE INFORMATION

Have you ever been convicted of a criminal offence? Yes No

If yes, state nature:

Do you have any friends or relatives in our employment? Yes No

If yes, state name (s):

IX. SALARY AND AVAILABILITY

Expected Salary :
Earliest Available Date:

I declare that the information provided above is true and complete in all aspect. I
understand that any misrepresentation or omission of information may be
considered sufficient for withdrawal of an offer or subsequent dismissal form
employment.

I authorize any of the persons or organizations referenced in this application to give

you any and all information concerning my previous employment, education or any
other information they might have, personal or otherwise with regards to any of the
subjects covered by this application and release all such information to you. I
authorize you to request and receive information.

I acknowledge that I have been advised that this application will remain active for no
more than 90 days from the date it was made.

4 Employment Application Form - PU

 No. Dok. : FO-QP-PU-HRD-002/01
FORMULIR Berlaku sejak : 1 Desember 2011
APPLICATION FORM Revisi : 00
FULL TIME / PART TIME Halaman : 5 dari 5

SIGNATURE :

DATE :

5 Employment Application Form - PU