PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005

GRAHA SAPTAINDRA
Jl. TB. Simatupang Kav. 18 Cilandak Barat, Jakarta 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3379 & 81

PERSONAL DATA OF APPLICANT

Please Note: Employment is subject to applicant's satisfactorily passing physical examination

POSITION APPLIED FOR : To be complete in

capital writing
FULL NAME
PRESENT ADDRESS (COMPLETE)

Postal Code :
Email Address : Phone.*) PHOTOGRAPH
PERMANENT ADDRESS

Postal Code : Phone.*)

Male Height Weight Religion Citizenship/Origin ID Card NO.

Female
Born Marital Status Driving A:
Place Date Month Year Single Widow/ WidowerLicense B:
Since :
Marriage Divorce
Date Date
House / home stay Glasses Car/ Motorcycle Blood Type:
Own Contract Cylinder : . Type/ Mark/ Year A
Parents Rent Right : . Owner Own Parent B
Others:. Left : . Office Others AB
Cost of Contract: O

LIST OF FAMILY / Include yourself

Family Last Last Occupation
Name M/F Age Remark
Realationship Education Title Company
Father
Mother
1 st Brother/ Sister
2 nd Brother/ Sister
3 rd Brother/ Sister
4 th Brother/ Sister
5 th Brother/ Sister
6 th Brother/ Sister
7 th Brother/ Sister
8 th Brother/ Sister
Wife/ Husband
1 st Child
2 nd Child
3 rd Child
4 th Child
5 th Child
* Use family/ relative phone numbers for communication during selection Revisi : 1

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PT SAPTAINDRA SEJATI
Graha Saptaindra
Jl. TB Simatupang Kav.18, Cilandak Barat Jakarta Selatan 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3381

JOB DESCRIPTION AND RESPONSIBILITY OF YOUR LAST POSITION

PLEASE GRAPH ORGANIZATION STRUCTURE OF YOUR LAST POSITION

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 PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005
GRAHA SAPTAINDRA
Jl. TB. Simatupang Kav. 18 Cilandak Barat, Jakarta 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3379 & 81

HISTORY OF FORMAL / INFORMAL EDUCATION

YEAR
LEVEL SCHOOL NAME MAJORITY PLACE/CITY
FROM UNTIL
BASIC SCHOOL
JUNIOR SCHOOL
HIGH SCHOOL
D1 / D3
COLLEGE / UNIVERSITY
S1 / S2

COURSE / TRAINING
AREA / TYPE CONDUCTED BY PLACE/CITY LENGTH OF COURSE YEAR

LANGUAGE KNOWLEDGE : (Fill with: Best, Good, Enough)

TYPE OF LANGUAGE LISTENING READING TALKING

AWARD : (Because of performance of participation)

SOCIAL ACTIVITY
ORGANIZATION KIND OF ACTIVITY POSITION YEAR

HOBBY AND ACTIVITY DURING LEISURE

READING HABITS BASIC POINT OF TOPIC YOU READ / ENJOY:

INTERMEDIATE
ADVANCE

What newspaper / magazine do you read ?

Newspaper :
Magazine :

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 PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005
Graha Saptaindra
Jl. TB Simatupang Kav.18, Cilandak Barat Jakarta Selatan 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3381

ANSWER
QUESTIONS
YES NO REMARKS
Have you ever applied before ? When and what position ?
Besides this application where to have you applied for and as what ?
Are you contracted with your present employee ?
Are employed to any part time job ?
If yes please specify ?
Are there any relatives of yours working for this organization. If yes please state ?
Have you ever been taken ill for a serious illness. When and why ?
Do you have any physical abnormalities that trouble you ?
Are there any family members that are constantly falling ill ?
Have you ever been treated by a psychologist or phsyciatric ?
Please state when, where and what for ?
Have you ever been convicted by police for criminal activities ?
If employed are eligible for assignment else where ?
If the company needs you, are you willing to work on extended hours during
working days or holiday ?
Are you willing to work on shift, if the company asked you ?
What criteria of work type do you desire to work in ?
What type of work do you like ?
a). Planning b). Organize c). Research d). Technics e). Marketing
f). Human Resources g). Production h). Finance I). Accounting j). General
Do you have any obligation if we refer to you past / present organization ?
Why do you want to work for this organization ?
What are you strengths ?
What are you weakness?
Have you ever been overseas ? When and why ?
What type of character are you most pleased with ?
What type of character are you most disturbed by ?
What sort of matters do you feel difficult to make a decision ?
Work familiarization that you most welcome ( manufacturing, laboratory, site )
Revisi : 1

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 PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005
GRAHA SAPTAINDRA
Jl. TB. Simatupang Kav. 18 Cilandak Barat, Jakarta 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3379 & 81

OCCUPATION HISTORY : Start from current occupation

A MONTH YEAR NAME/ ADDRESS/ COMPANY TELP POSITION

From : First :
Until :
Kind of Business : Total Employee : Last :
Name of Direct Supervisor : Name of Director :
Reason to leave : Salary :
Summary of duties :

B MONTH YEAR NAME/ ADDRESS/ COMPANY TELP POSITION

From : First :
Until :
Kind of Business : Total Employee : Last :
Name of Direct Supervisor : Name of Director :
Reason to leave : Salary :
Summary of duties :

C MONTH YEAR NAME/ ADDRESS/ COMPANY TELP POSITION

From : First :
Until :
Kind of Business : Total Employee : Last :
Name of Direct Supervisor : Name of Director :
Reason to leave : Salary :
Summary of duties :

D MONTH YEAR NAME/ ADDRESS/ COMPANY TELP POSITION

From : First :
Until :
Kind of Business : Total Employee : Last :
Name of Direct Supervisor : Name of Director :
Reason to leave : Salary :
Summary of duties :

REFERENCE
NAME ADDRESS OCCUPATION RELATIONSHIP

CONTACT PERSON IN AN EMERGENCY

NAME ADDRESS OCCUPATION RELATIONSHIP

Revisi : 1

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 PT SAPTAINDRA SEJATI Form No : HRD / 07 / F-005
Graha Saptaindra
Jl. TB Simatupang Kav.18, Cilandak Barat Jakarta Selatan 12430
Phone: (62-21) 769 3378 Fax.: (62-21) 769 3381

QUESTIONS ANSWER

What is your net salary at present ?

What facilities and benefits do you obtain from your present employee ?
How many of your family members do you have to support ?
If you are offered a job, when are you ready to start work ?
Expected salary ?

This above statements have been understood by me and furbished with sincerity.
I solely take responsibility on the false information if any is stated.

Note : Do not enclose the original of your certificates, testimonials or other document ; but typed, non returnable copies will
suffice. The original will be checked when you are accepted.

20.

Applicant

Management Decision PT SAPTAINDRA SEJATI

1 Salary on probation : Rp.
2 Salary upon confirmation : Rp.
3 Employee status : Permanent / Contract / Daily / Daily Rated.
4 Start at :
5 Remarks :

Revisi : 1

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