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PT NEXWAVE
Jl. Dr. Sahardjo No. 266, Menteng Dalam, Jakarta 12870 ph : (021) 829 0809 fax : (021) 829 2502

APPLICATION FOR EMPLOYMENT Paste Passport-Size

Post Applied For: (1) __________________________________ (2) __________________________________ Photograph Here

Full Name: ________________________________________________(As in ID) Chinese Character: ________________

Address: Local:___________________________________________________________________________________

Overseas:____________________________________________________________________________

E-Mail:______________________________________________________________________________ Sex: Male / Female *

Tel: _________________ (Home) _________________ (Pager/Handphone*) _________________ (Office) Age: __________________________

Give particulars of your family members and indicate your relationship with them Birth Date: ____________________
(e.g. spouse, father, mother, children, brothers & sisters. Use separate sheet, if necessary) Birth Place: ___________________

Name Age Relationship Occupation & Company KTP No.: _____________________

Citizenship: _________________

Citizenship Certificate No./ Date:

PERSONAL PARTICULARS

__________________/__________

Religion: _______________________

Dialect Group: __________________

Race: ________________________

Marital Status *: Single / Married /

Widowed / Divorced

TO NOTIFY IN CASE OF EMERGENCY Expected Salary:

Name: _________________________________ Relationship: ______________________________ IDR___________________

Address: ___________________________________________________________________________ Notice Period Required:

Postal Code: ___________________ Tel (Home/Office) : ________________ / __________________ ___________________

School / Institute Attended Year Highest Standard / Qualification Obtained Language

(Attach detailed results/transcripts) (Degree Class / Special Awards) Stream
Joined Left
EDUCATION / COURSE
LANGUAGE PROFICIENCY

Written (Please Tick) Spoken (Please Tick)

Language Remarks
Excellent Good Average Excellent Good Average

* Delete where not applicable

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Games / Hobbies Scholarships, Special Awards, Prizes, etc. Club, Assocation Membership Remarks
ACTIVITIES

Basic Monthly Salary

Date
Name of Employer Job Title Please indicate net or gross Reason(s) For Leaving
From To Starting Last Drawn
EMPLOYMENT HISTORY

Allowances (Please state monthly amount) Bonus, if any

Name of Employer Others
Meals Transport Mobile (Please indicate number of months)
BENEFITS

1 Draw below the organisation chart showing your position in your present job.
ADDITIONAL INFORMATION

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2 Briefly describe your work experience, giving particular emphasis to the areas which are relevant to the job you are applying (in point form).

What are your careers objectives now and in 3 to 5 years' time (You may like to discuss the type of organisation and the sort of work you are looking for and
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the levels you hope to attain).

4 Please indicate the area you would be interested to work in (in order of preference).

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Give the names, addresses and occupations of two referees (not relatives) who know you in your employment or private life and to whom references may be
made:
REFEREES

Name

Address & Tel

Occupation &
Company

Years Known

Please answer the following questions:

1. Are you a car owner? * Yes / No Do you hold a driving licence? * Yes / No
2. Have you been or are your suffering from any physical impairment or disease? * Yes / No
3. Have you ever been discharged or dismissed from the service of your previous employers? * Yes / No
4. Have you ever been convicted in Court of Law in any country? * Yes / No
5. Have you ever been detained by the Police or any Government? * Yes / No
6. Have your any relatives / friends presently employed by this Company? * Yes / No
OTHERS

If yes, please specify : Name: ______________________________ Dept / Job Title: ____________________________________

If you answer to any of these questions is Yes, please give details as follows:

Note:

Your application will be disqualified if it is found that you have either wilfully suppressed material facts or knowingly given fasle particulars.
If after engagement, it is found that you have knowingly made a false declaration on the form, the Company reserves the right to terminate your service
without notice.

I , ___________________________________________, declare that the above information and documents attached hereto are true to the best of my
knowledge and belief and I have not wilfully suppress any material fact.

Date Signature of Applicant

For Official Use Only

Applicant Referred By: ( ) Advertisement ( ) Agency ( ) Own Application ( ) Employee ( ) Others

1st Interview by: _______________________________________ Date : _____________________

2nd Interview by: _______________________________________ Date : _____________________

Remarks:

Outcome : ( ) Not Selected ( ) Keep In View ( ) Shortlisted for Second Interview

Appointment Grade Department Commencing Date Salary

Date: __________________________________ Approved by: ______________________________________

* Delete where not applicable