Application Form

Emp.No.
: ____________
Employment Application Form
Position Applied For :
Second Choice :
Date Available For Employment :
Full Name (Mr./Mrs./Miss) :

Permanent Address :
Email Address : Post Code :

Tel. Number (Mobile) : Religion :
Tel. Number (Home) : KTP Number :
Place, Date of Birth : ASTEK Number :
Marital Status : Single Blood Group :
Married, ......... Child(ren) Height :
Separated / Divorced Weight :
What Personal interests or hobbies do you engage in? :
How did you know about the vacancy? :
YEAR DIPLOMA/
NAME OF SCHOOL / MAJOR COURSE
BACHELOR/MASTER/ GPA
FROM TO UNIVERSITY OR STUDY
DOCTOR
Any other qualifications? ____________________________________________________________________

__________________________________________________________________________________
Spoken Written Read

Language Proficiency
Fluent Fair Poor Fluent Fair Poor Fluent Fair Poor
Bahasa Indonesia
English
Others :
1
Employment Record
Total Working Experience : ________ years

(Start with your present position and work backwards)
Position :_______________________________ From : ______________ To : _________________

Name of Company : _________________________
Nature of Business : ________________________ Name of Superior : ____________________________
Address : ________________________________ Telephone : ______________________________
________________________________
Commencing Salary : ________________________ Last Salary : _______________________________
Kind of Work You Performed (Complete Description) : Reasons for Leaving :
________________________
________________________________________ _________________________________________
Position :_______________________________ From : ______________ To : _________________
Name of Company : _________________________
Nature of Business : ________________________ Name of Superior : _________________________
________________________________
________________________
________________________________________ _________________________________________
Position :_______________________________ From : ______________ To : _________________
Name of Company : _________________________
Nature of Business : ________________________ Name of Superior : _________________________
________________________________
________________________
________________________________________ _________________________________________
Skills
Shorthand Yes / No Speed : (wpm)
Electric Typewriter Yes / No Speed : (wpm)
Computer Yes / No Programs :
Family Particulars
Name Date of Birth / Age Occupation
Father
Mother
Spouse
1st Child Male / Female
2nd Child Male / Female
3rd Child Male / Female
References (Do not include relatives, or former employers)

Name Positions Address Telephone
2
General
(Mark with an X) Yes No
Have you any relatives / friends working at Midplaza Group ? (if yes, give the names)
...........................................................................................................................................
...........................................................................................................................................
Have you ever been discharge from employment because you conduct and work was not
satisfactory ?
Have you any physical handicaps, chronic disease, or other disability?
Have you had any serious illness, injury or operation within the last 5 years? (if yes, describe)
.....................................................................................................................................................
Have you ever been arrested and convicted of a crime?
Are you prepared to do shift work?
Name two of your most substantial Accomplishments:

1. ..............................................................................................................................................................
2. ..............................................................................................................................................................
What are your strongest personal assets and liabilities?

1. ..............................................................................................................................................................
2. ..............................................................................................................................................................
3. ..............................................................................................................................................................
Declaration
The statements made by me in this application are true complete and correct. A false statement or dishonest
answer to any question may be grounds for my immediate discharge from employment with Midplaza Group. I
fully comprehend that Midplaza Group may require me to be medically examined any time.
_______________________ __________
Applicant’s name / signature Date

Application Form

Uploaded by

Copyright:

Available Formats

Application Form

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Application Form

Uploaded by

Copyright:

Available Formats

Emp.No.

Full Name (Mr./Mrs./Miss) :

Email Address : Post Code :

Any other qualifications? ____________________________________________________________________

Spoken Written Read

Total Working Experience : ________ years

Position :_____________ From : To : _

References (Do not include relatives, or former employers)

Are you prepared to do shift work?

Name two of your most substantial Accomplishments:

What are your strongest personal assets and liabilities?

You might also like