Employee Personnel Data Form

Position Applied

Interviewed by

PHOTO
3X4

Date

* No Need to Fill

Personal Data Section

Full Name

First Name

Permanent Address

Last Name

Prefix:Mr/Mrs/Ms

City

Post Code

(NPWP address)

Country

Current Address

City

Post Code

(ID address)

Country

Home Phone

JAMSOSTEK

Office Phone

NPWP

Mobile Phone

ID #

Email Address

Gender

: Male / Female

Religion

Marital Status

: Single / Married

Race

Kids Name

KTP

Passport

1
2
3

Highest Education

Nationality

Birth City/Country

No. of Sibling

Date of Birth (dd/mm/yy)

Are willing to travel

:(

Yes

:(

No

(Age:

Emergency Contact Section

1st Priority
Name

Relationship

Address

Home Phone

Mobile Phone

Post Code

City/Country

2nd Priority
Name

Relationship

Address

Home Phone

Mobile Phone

Post Code

City/Country

Dependent Data Section

First Name

Last Name

Birth (dd/mm/yy)

Gender

Marital Status

F / M

Single/Married

F / M

Single/Married

F / M

Single/Married

F / M

Single/Married

F / M

Single/Married

F / M

Single/Married

Relationship

Education / Qualification
Name of High School

Qualifications

Year

Science / Social
Science / Social
Science / Social
Name of University

Majoring

Year

Course / Training

Issued Organization

Year

Proficiency
Language

Computer

Spoken
Fair

Good

Written
Fluent

Fair

Fair

Good

Fluent

Good

Expert

Interests

Others

Other Activities
Sports

Hobbies

Working Experiences
Recent Employer

Main Responsibilities

Reason for Leaving

Main Responsibilities

Reason for Leaving

Main Responsibilities

Reason for Leaving

Main Responsibilities

Reason for Leaving

Company :

Address:

Position :

Salary :

Other Allowances :

Other Benefit :

Period:

Previous Employer

Company :

Address:

Position :

Salary :

Other Allowances :

Other Benefit :

Period :

Previous Employer

Company :

Address:

Position :

Salary :

Other Allowances :

Other Benefit :

Period :

Previous Employer

Company :

Address:

Position :

Salary :

Other Allowances :

Other Benefit :

Period :

Expected Salary: Rp
Expected Allowances: Rp
Expected Benefit : Rp

OTHER EMPLOYMENT RELATED INFORMATION

Do you have any friends or relatives (either directly or through marriage) currently

Yes

No

working in Johnson Controls?

If yes, please state the following :
Name : ____________________

Position : ________________________

Relationship :______________________

Have you previously applied to join Johnson Controls?

Yes

No

Yes

No

Have you ever used or are you addicted to any narcotics or illegal substances?

Yes

No

Have you ever been convicted of a crime (other than traffic offenses)?

Yes

No

If yes, please state the position applied : ______________________________________

Are you suffering or have you suffered from any illnesses, mental or physical, or from any
other disablement?

If you are offered employment with Johnson Controls, when can you start?
How much notice do you require to give your current employer?
Are you serving bond with your present employer?

Yes

No

CAREER GOALS
What is / are your career objective (s)

How can Johnson Controls fit your career objective (s)

APPLICANT'S CERTIFICATION
I,

, certify that the above information given by me and the statements made in this

application are true and complete and that no pertinent details have been withheld. I fully understand that any false
information contained in this application may result in the termination of employment with Johnson Controls (Indonesia)
Pte. Ltd. without notice or compensation.

Signature

Date :

Form Related for Jamsostek

Blood Type

IC end Date

Mother's Name

Spouse Blood Type

Blood Type Child 1

Blood Type Child 2

Blood Type Child 3

Education Level

Marriage Date