PERSONAL APPLICANT DATA

POSITION APPLIED

NAME (FULL NAME)

PERMANENT ADDRESS (COMPLETE) :

PHONE NUMBER

EMAIL ADDRESS

IDENTITY NUMBER

NPWP NUMBER

GENDER
[ ] MALE

HEIGHT WEIGHT

RELIGION

NATIONALITY

ETHNIC

[ ] FEMALE

BORN
PLACE

DATE

MARITAL S
MONTH

YEAR

[ ] SINGLE
[ ] MARRIED

OWNERSHIP STATUS - HOME

VEHIC
TYPE
YEAR

[ ] OWN

[ ] LEASE

[ ] OWN BY PARENTS

[ ] BOARDING HOUSE

STATUS

FAMILY STRUCTURE (INCLUDING YOURSELF)

FAMILY
RELATION
FATHER
MOTHER
BROTHER /
SISTER / ME

HUSBAND
WIFE
CHILDREN

NAME

M/F

AGE

LAST
EDUCATION

LAST WORKING
COMPANY

FM-HRD-001.1

FILL THE DATA IN CAPITAL LETTER

PHOTO

MARITAL STATUS
[ ] WIDOWED
[ ] DIVORCED

VEHICLE

[ ] PRIVATE
[ ] OFFICE
LAST WORKING EXPERIENCE
POSITION

[ ] PARENTS
[ ] OTHERS

REMARKS

FORMAL / INFORMAL EDUCATIONAL BACKGROUND

LEVEL

NAME OF SCHOOL

YEAR
FROM
TO

PLACE

MAJOR

PLACE/CITY

NAME OF COURSE

TYPE OF
DIPLOMA

COURSE / TRAINING
TYPE

PROVIDER

YEAR

SUPPORTED BY

LANGUAGE (PLEASE FILL IN WITH : GOOD, FAIR OR INSUFFICIENT)

LISTENING

TYPE OF LANGUAGE

READING

SPEAKING

WRITING

SOCIAL ACTIVITY
ORGANIZATION

TYPE OF ACTIVITY

POSITION

YEAR

HOBBY & ACTIVITY (DURING THE LEISURE TIME) :

HOW MUCH DO YOU READ?

[

] LESS

] MEDIUM

] A LOT

HOW MANY BOOKS DO YOU READ A YEAR?

TOPICS:

WHAT KIND OF MAGAZINE / NEWSPAPER DO YOU READ?

NEWSPAPER

MAGAZINE

WHAT IS THE BEST BOOK HAVE YOU EVER READ?

COMPUTER LITERACY:
CAPABILITY OF OPERATING HARDWARE :
o Plotter
o Scanner

o Server
o Workstation
o Printer

o LAN

CAPABILITY OF OPERATING SOFTWARE :

o Power Point
o Microsoft PRJT
o Acess
o Primavera

o Windows NT
o Excell
o Winword

o Autocad

o COREL, E-SPT

GPA

WORKING EXPERIENCE HISTORY

MONTH

YEAR

ADDRESS/PHONE

YEAR

ADDRESS/PHONE

YEAR

ADDRESS/PHONE

YEAR

ADDRESS/PHONE

FROM
TO
TYPE OF BUSINESS

COMPANY NAME

NAME OF SUPERVISOR :
EMAIL

REASON FOR LEAVING :

MONTH
FROM
TO
TYPE OF BUSINESS

COMPANY NAME

NAME OF SUPERVISOR :
EMAIL

REASON FOR LEAVING :

MONTH
FROM
TO
TYPE OF BUSINESS

COMPANY NAME

NAME OF SUPERVISOR :
EMAIL

REASON FOR LEAVING :

MONTH
FROM
TO
TYPE OF BUSINESS

COMPANY NAME

NAME OF SUPERVISOR :
EMAIL

REASON FOR LEAVING :

REFERENCE (TO WHOM WE MAY ASK ABOUT YOURSELF?)

NAME

ADDRESS/PHONE

PERSON WE CAN CONTACT IN CASE OF EMERGENCY

NAME

ADDRESS/PHONE

START

POSITION
:

END

TOTAL EMPLOYEE

SALARY

: Rp.

NAME OF DIRECTOR

START

POSITION
:

END

TOTAL EMPLOYEE

SALARY

: Rp.

NAME OF DIRECTOR

START

POSITION
:

END

TOTAL EMPLOYEE

SALARY

: Rp.

NAME OF DIRECTOR

START

POSITION
:

END

TOTAL EMPLOYEE

SALARY

: Rp.

NAME OF DIRECTOR

UT YOURSELF?)
COMPANY

RELATION

COMPANY

RELATION

MERGENCY

DESCRIBE YOUR DUTIES AND RESPONSIBILITIES IN YOUR LAST COMPANY

DRAW THE ORGANIZATION CHART TO SHOW YOUR LAST POSITION

DESCRIBE YOUR VALUES

1

What is the most important thing in life?

What is the most important for your worklife?

What are you work values and goals

What's your core value?

What's your competitive edge?

What's your competitive edge?

How would you want from people perceive you?

SPONSIBILITIES IN YOUR LAST COMPANY

HART TO SHOW YOUR LAST POSITION

BE YOUR VALUES

NO
1

QUESTION
Have you applied in this Group/Company before?
When and what position ?
Are you applying to other Companies in addition to this Company?
As what?
Are you binded by a contract by other company?
Do you mind if you work in a contract base in this Company?

Do you have a side job? Where and what?

Do you mind if we ask for a reference in your previous company?

YES

Do you have a family/friend who works in this company?

Please mention!
Do you ever have a psychological test before?
Where and for what purpose?

If you're accepted, do you mind if the company send you out of town for duties?

What kind of job/position do you like the most?

10
11

What kind of job/position you do not like the most?

How much is your expected salary and what kind of facilities do you expected?
Please mention!

12

If you are accepted, when can you start working?

13

Do you ever have or in suffer of these below diseases?

TBC
Bronchitis
Hepatitis
HIV /AIDS
Malaria
Leprosy
Migrain
Typhoid
Cancer
Type :
Cardiovascular / Heart Disease
High Blood Pressure
Diabetes
Anemia
Epilepsy
Eye disorder/ dysfunction:
minus / plus
Asthma
Hyperuricemia (Asam Urat)
Ulcer
Others:
Mention :

14

Do you smoke ?

15

Do you drink alcohol?

16

For Female candidates : a. In Pregnancy

17

Do you agree to work on contract basis?

18

Do you agree to obey all rules and regulation of AHG if accepted?

b. Ever Pregnant

c. Single

I declare that all the statements above are true. If there is any untrue statement/in
full responsibilities.

Jakarta,
(

NO

ANSWER
REMARKS

there is any untrue statement/information, I am ready to take

esponsibilities.

Jakarta,
(