Form HRD REC.

03 - Rev 2 ENG

PT YAMAHA INDONESIA MOTOR MANUFACTURING

APPLICATION FORM
: : : ( ) Internet ( ) Media ( ) Campus ( ) Relatives ( ) Friends

Test Number :

POSITION APPLIED
How were you referred to us *Name of Refferal Source A. PERSONAL DATA 1 2 3 4 5 6 7 Full Name Gender Place & Date of Birth (dd-mm-yyyy) Nationality Identity Card No NPWP No Driving License

: : : : : : : ( ( ) A License No : ) C License No : ( ( ) B License No : ) No License ( ) Indonesian ( ) Male , ( ) Female / ( ) Foreigner Height : / Race : cm Weight : kg

Address (as IC No)

: : Post Code :

Current Address

: : Post Code : Home Cellular : : ( ) Engaged ( )B ( ( ) Married ) AB ( ( Office E-mail : :

Contact No.

10 11 12

Status Blood Type Size

: : :

( (

) Single )A

) Divorced )O

Male : - Clothes (14 - 18) : _______________ - Pants (27 - 45 ) : _______________ : _______________

Female : - Clothes (S / M / L / XL / XXL) : _______________ - Pants (S / M / L / XL / XXL) : _______________ : _______________

- Safety Shoes 13 Health Information A B Accident History Hospitalized : : : ( ( ) Yes ) Yes

- Safety Shoes

( (

) No ) No

If Yes, When If Yes, When Note : Numbers with sign MUST be answered.

B. FAMILY DATA RELATION Father Mother Siblings 1 2 3 4 5 NAME M/F PLACE & DATE OF BIRTH EDUCATION OCCUPATION POSITION

RELATION Husband/Wife Children 1 2 3 4 5

NAME

M/F

PLACE & DATE OF BIRTH

EDUCATION

OCCUPATION

POSITION

Filled by HR-Recruitment :

FGD & INTERVIEW HRD Candidate/ ____________ call, day : _________________/ date : _____________________/ time : _______________ Schedule : ______________________________________ Candidate/ ____________ call, day : _________________/ date : _____________________/ time : _______________ Schedule : ______________________________________ Candidate/ ____________ call, day : _________________/ date : _____________________/ time : _______________ Schedule : ______________________________________

TEST & INTERVIEW USER Candidate/ ____________ call, day : _________________/ date : _____________________/ time : _______________ Schedule : ______________________________________ Candidate/ ____________ call, day : _________________/ date : _____________________/ time : _______________ Schedule : ______________________________________ Candidate/ ____________ call, day : _________________/ date : _____________________/ time : _______________ Schedule : ______________________________________
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FINAL INTERVIEW & MCU Candidate/ ____________ call, day : _________________/ date : _____________________/ time : _______________ Schedule : ______________________________________
Candidate/ ____________ call, day : _________________/ date : _____________________/ time : _______________ Schedule : ______________________________________

MCU Result 3 Join Date

: OK / NG : _________________________________

C. FORMAL EDUCATION BACKGROUND INSTITUTION / NAME OF SCHOOL PERIODE DEGREE MAJOR PLACE STARTED YEAR GRADUATED YEAR GPA

EDUCATION

Primary School Junior High School Senior High School Academic University Post Graduate

D. INFORMAL EDUCATION BACKGROUND PERIODE NO NAME OF INSTITUTION SUBJECT / TOPIC LOCATION START END CERTIFICATE YES / NO

E. SKILLS AND QUALIFICATION LANGUAGE ENGLISH JAPAN

(Note : A = Expert ; B = Advance ; C = Intermediate ; D = Basic) READ WRITE SPEAK LISTENING OTHERS

COMPUTER PROGRAMMING AND OPERATING SYSTEM MOST PROFICIENT (Use comma for separator)

F. ORGANIZATION MEMBERSHIP PERIODE ORGANIZATION NAME ACTIVITIES POSITION LOCATION START END

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G. EMPLOYEMENT HISTORY PRESENT EMPLOYMENT Employer

Nature of Business

: : :

Job Description :

Address

Phone Number Employment Date Position Title Salary

Reason for Leaving

: : from _____________________ to _______________________ Please Illustrate Your Position in Company Organization : : : :

PREVIOUS EMPLOYMENT Employer

Nature of Business

: : : :

Job Description :

Address Phone Number Employment Date Position Title Salary

Reason for Leaving

: from _____________________ to _______________________ Please Illustrate Your Position in Company Organization : : : :

PREVIOUS EMPLOYMENT Employer

Nature of Business

: : : :

Job Description :

Address Phone Number Employment Date Position Title Salary

Reason for Leaving

: from _____________________ to _______________________ Please Illustrate Your Position in Company Organization : : : :

H. CANDIDATE PERSONAL WORKING DATA EXPECTATION Salary Benefits What date are you available to start work Type of Job you prefer Type of Job you do not prefer Have you ever been in selection process with us before ? If yes, When ? Position you have applied ? : : : : : : : ( ) Yes ( ) No

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I. ADDITIONAL DATA 1 2 3 4 Tell us what do you like to do during your spare time Tell us about your hobbies What kind of magazine/newspaper/book you like to read Please list at least 5 of your strenghts

Please list at least 5 of your weaknesses

Have you ever live abroad (beside your home country) Where : How long : Purpose of Visit :

7 8 9 10

When did you last participate on Psychological Test, where, and for what purpose ? Are you willing to work with shift system ? Are you willing to assigned outside your point of hire ? In connection to company's policy on contract period, are you prepare to be dismissed in case you are not qualify to company's standard ? ( ) Yes ( ) No

11

Referee (In case we need to ask more about you, we will contact your referee) NAME ADDRESS PHONE NUMBER OCCUPATION RELATION

12

Whom can we contact in case of emergency ? NAME ADDRESS PHONE NUMBER OCCUPATION RELATION

13

Do you have family (father, mother, siblings, uncle, auntie, ect.), friends, or acquaintances working for Company? [ ] Yes or [ ] No . If Yes please fill the data below : NAME DEPT. / DIVISION POSITION RELATIONSHIP

Note : Numbers with

sign MUST be answered.

I certify that information which contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired or during my work periode.

Jakarta,

PHOTO

Signature Full Name

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revisi 2011