IDENTITY

PERSONNEL ID

Position Proposed

:
:

Identity Card No.

Author
Date of Issue

:
:
:

Full Name
Date of Birth

Valid to

Place of Birth

Place of Issue

Country of Birth

Nationality

Driving License No.

Ethnic Origin

Date of Issue

Valid to

Place of Issue

Sex

Male

Marital Status

Female
Single
Married

GLASSES ( CYLINDER )
Since

Right :

Widow / Widower

Left :

Divorced

Blood Type

AB

BANK DETAIL ( filled by : your account in BII or BCA )

Religion

Moslem

Hindu

Name

Christian

Buddhist

Account no.

Bank Name

Branch

Catholic
ADDRESS
Permanent Address
House Number / Street

RT

RW

City

Kelurahan

Kecamatan

Telephone #

Zip Code

Temporary Address
House Number / Street

RT

RW

City

Kelurahan

Kecamatan

Telephone #

Zip Code

Emergency Address
Contact Person

Relation

House Number / Street

RT

RW

City

Kelurahan

Kecamatan

Telephone #

Zip Code

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FAMILY TREE
Member

Name

Sex Age

Place/Date of
Birth

Country of
Birth

Education

Previous employ.

Father
Mother
Sibling ###
###
###
###
###
###
###
###
Spouse
Children###
###
###
###
###
EDUCATION
Education
Establishment

Institute Name & Location

From

To

Certificate

Branch of Study

Primary School
Secondary School
High School
Academy
Under Graduate School
Post Graduate School
COURSE - TRAINING
Subject

Organizer

Place / City

Year

Sponsored by

LANGUAGE PROFICIENCY ( Filled by : poor, fair, good, excellent )

Language

Speaking

Writing

Listening

HOBBY

READING HABIT
Reading Materials

SOCIAL ACTIVITY
Organization

Remarks

Position

Favorite Topics

THE AWARD RECEIVED

Years

2 of 6

( due to the achievement or participation )

3 of 6

WORKING EXPERIENCE
From

To

Name of Company

Position

Salary

Reason for Resign

REFERENCE
Name

Address / Phone No.

Occupation / Company

Relation

DESCRIBE YOUR TASKS & RESPONSIBILITIES IN THE PREVIOUS / CURRENT EMPLOYMENT

DRAW THE CHART OF ORGANIZATION STRUCTURE IN YOUR PREVIOUS / CURRENT COMPANY AND SHOW YOUR POSITION

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ANSWER

QUESTIONS
Yes No
Have you ever applied for any position in PT Ecco Indonesia before ?
If yes, when and for what position ?
Besides in this company, where else are you applying currently ?
What position is ?
Do you still bind with a contract of work with your current company ?

Do you have relative(s): friend(s) who is/are working in this company ?

Have you ever suffered from a chronical/serious desease/severe accident/

surgery ?
Have you ever undergone psychotest or psychological examination ?
For what purpose ?
What kind of employment/position do you think match your ambition at
present or in future ?
What kind of work environment do you enjoy most ?
(Factory, Office, Laboratory, Site)
Why are you interested in working with PT Ecco Indonesia ?

What factors do you recognize as your own strong points ?

What factors do you recognize as your own weak points ?

What subjects give you difficulties in decision making ?

What kind of people do you dislike most ?

Who was the best boss you ever had ? Why ?

Who was the worst boss you ever had ? Why ?

In your opinion, which of your qualifications are the most important for this
job ?
What was your best experience in your career ?

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Explanation

ANSWER

QUESTIONS

Explanation
What was your worst experience in your career ?

In connection with work, what is the most important to you ?

In connection with your future plan/career, what are your short term plans /
activities that you have been doing ?
How much is your nett income currently ?

If you admitted, how much salary do you want to earn ?

What kinds of fasilities do you get from your company right now ?

If you admitted, what kinds of fasilities do you expect ?

I shall be fully responsible for any incorrect information above

..., 20..

Applicant/signature

DECISION
( Filled by Personnel Dept. )
The salary of probation period

Rp.

The salary after probation period

Rp.

Facilities Given

Employee Status

Casual

Starting date of Employment

Expatriate < 183 d's

Expatriate > 183 d's
Management Trainee
Probation
Permanent
.
Director/Personnel Manager Signature

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