APPLICANT DATA FORM

IDENTITY
KTP No. Fullname Nickname Twitter account Address Address as in KTP Phone House's owner status Place and Date of Birth Religion Marital Status : : : : ____________________ Facebook account: : : : : Parents' Own : : : Single / Married / Widowed SIM No. Sex : M/ F ______________________

Mobile phone: Rent/Lease

Nationality

MEDICAL CONDITION
Blood Type Accident experienced Ongoing health treatment : : : Allergy Smoking : Yes / No

FORMAL & INFORMAL EDUCATION

Degree Primary School Junior High School Senior High School Academy University Others Name of School Address Major School Year From To Result

Why did you choose that major in education? Write the title of your final thesis to obtain your degree.

SPECIAL ABILITY
Foreign Language that are Mastered Oral Written Ability / Skills that are mastered (sports/arts/etc) Info

PARENTS & HUSBAND/WIFE'S DATA

Relation Father Mother
Father in law

Name

DoB

Education

Address

Name of office

Address of office

Job

Phone Number

Mother in law

Husband/

Wife

SIBLINGS' Data
Relation Brother/ Brother/ Brother/ Brother/ Sister Sister Sister Sister Name DoB Education Address Name of office Address of office Job Phone Number

CHILDREN'S DATA
Name Date of Birth Address Name of School Address of School Level/ Class

WORK EXPERIENCES IN THE LAST 10 YEARS

Job length Since To Name and Address of prior workplace Phone Job/Division Job Description References

Why do you leave your last job?

Why do you apply for this job in CIKAL?

Briefly tell us what do you know about this job.

How much salary do you get in the last job?

If there's any, what kind of subsidiary do you get?

How much salary do you hope will you get from CIKAL? (must be filled)

What kind of subsidiary do you hope you get from CIKAL?

PERSONALITY
How do you solve a problem and who do you ask for opinion when you meet a problem in your job?

What kind of problems that you often face in your previous job? How do you solve it?

Do you like working with children? Yes No If the answer is yes, in what condition do you interact with children?

Are you keen in interacting with children?

Yes

No

What kind of problems that you usually face in interacting with children?

Do you have strategy in facing children?

OTHERS
Tell us your hobbies or the things you do in your spare time?

Do you like travelling? Yes No If the answers is yes, tell all the cities that you've visited (domestic and foreign)

Do you like to read? Yes / No Yes No If the answer is yes, what kind of books do you like to read : Tell the last book titles and the authors you had read or, the one you're reading right now.

Have you ever been in an organization? Yes No If the answer is yes, tell us when, name of organization, job and division in that organization.

What do you know about CIKAL and where did you get the information from?

What do you think about child and family education?

The one who signed below tells that all the information that have been written above is true. Jakarta, _________________________

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