APPLICATION FORM (Academic)

Position Applied For: Teacher / Leader Date: 26th of January 2024

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A. Personal Data

Name : Dewi Zulviana

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Place / Date of Birth : Palu / 10 November

Marital Status : x Single □ Married □ Divorced

□ Other _______________________________________

Nationality : Indonesian

ID No. / Passport No. :

Religion : Moslem

Current Mailing Address : ___________________________________________________

Permanent Mailing Address : ___________________________________________________

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Phone No. & Mobile/HP No : 081809000881

E-mail : dewizulviana.d@gmail.com

Interests & Hobbies : Go the gym, travelling

Medical History

1. Allergies / Diseases / Chronic Illnesses

Please specify: antibiotics which end with “lin”, e.g. penicillin, ampicillin, amoxicillin
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2. Hospital Confinement

Hospital Period Remarks

Family Data

Spouse’s Name Date of Birth (dd-mm-yy)

x x

Child’s Name Date of Birth (dd-mm-yy)

□M □F

□M □F

□M □F

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Personal Values That Motivate My Life and Goals

1. Study the following list of fourteen values:

10 12 2
 A materially comfortable life An exciting life

9 A wealthy life 8 Wisdom

1 A healthy 7 Friendship

14 A famous life 6 Love

4 A happy life 11 Salvation
13 A pleasurable life 5 Family security
3 2
Inner harmony (inner peace) Self-respect

Try ranking the above values in order of importance to you and what you consider important
for your future life. Think about why you believe the values are important.

2. Try to develop your own list of values that are the important motivators in your life. List
them in order of importance. You may find it helpful to summarize your thoughts in the
spaces provided.

Life goals: Personal Values:

1. Stay healthy, so I can do things. 1. Loyalty and commitment

2. Getting my Master’s Degree soon 2. Helpful

3. Have my own learning centre / school 3. Quite particular, detail oriented

4. Travel to all continents of the world 4. Diligent

5. Have my own gym and Personal Trainer 5. Fast learner

6. Can play guitar and piano fluently 6. Hard worker

7. Live in foreign country 7. Creative, dislike boring routines

8. Teach a class or workshop 8. Spontaneous, come up with ideas at times

9. Buy me / family (my mum) house 9. Not the type of “nosy (kepo)” person

10. Enjoy life to the fullest 10. Avoid dramas

Self-concept & Personal Beliefs

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The school aims to educate the students with love and care according to God’s will.
What is GOD to you ?

God is my life. Whatever happens in my life is by God’s will. For whatever I do in my life is
because I do it for the sake of seeking for Allah’s blessings, since I’m a moslem. I’m a true
believer that every little thing I do, Allah (God) is involved.

Skill, Knowledge and Attitude

1. What personal values or decisions led you to apply for a position in a school ?

I’m a very hard-working person, very loyal and honest. I always give my best to do
things.

2. When you face challenges in your work place, how do you release your stress or tension?

Step back a bit, give myself some time to do a thing called self-reflection.

3. How would you handle a child who is not confident in trying new things offered in the
classroom?

Be his / her friend, not his / her teacher, but a friend. Have all ears up for him / her by
talking to him / her. Encourage him / her for every small thing that he / she does, and
never forget to reward him / her by complimenting or praising him / her. Be consistent
with the encouragement and compliment until he / she is comfortable in his / her own
skin and can be an independent child.

4. How would react to conflict with co worker or parents?

Based on my experience ever happened with the co-worker, I took no notice of it and did
my job professionally. If I’m the one who feels having problems, I would come and talk
to him / her. But if the others feel they have problems with me, then they should be the
ones who come to me and talk to me, or else, just ignore and do things professionally.
Might not be comfortable but gotta do what I gotta do. This happened before, until the
principal called me and the co-worker into her office. We talked for some time and we
apologized each other.

With the parents, also happened to me once that the school I worked at was nearly been
sued. So I had to meet the parents in person, apologizing on behalf of the school’s names,
try to compromise with the parents and put their demands on our consideration.

5. How would you contribute to the school?

Be innovative, be committed, to give my best for the school.

Expectations
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 1. What is your expectation when applying for a position in the school? For example: higher
salary, more challenging work, prospective career, etc. Please explain.

Prospective career supported by good salary.

2. What do you expect the school to provide you with ?

Appreciation. Small thing but give big impact to people’s performances. We, teachers,
always teach children to say thank you, sorry, you’re welcome and please. But in real
life, we teachers or adults are the one who never say those things. Fact!

3. In what range of amount is your salary expectation ?

Rp 10,000,000. Ten million rupiah, take home pay.

4. Other Information : feel free to check more about me through my Instagram @dewi.zd

I hereby certify that the answers given herein are accurate and complete to the best of my
knowledge. I understand that false or misleading information given in this application or
interview (s) may result in immediate discharge. I understand, also, that I am required to
abide by all rules and regulations of the school.
I am willing to be placed in any class levels as needed by the school.
I am willing to follow school calendar and holiday schedules.
I am willing to work overtime when required, including Saturdays or Sundays to attend
necessary trainings or other events organized by the school (Although overtime is very rare
and not recommended but would some time required).

Signature : ______________________________

Name : Dewi Zulviana Date :27 Januari 2024