EMPLOYEE DATA FORM

Recent Photograph

Position Discusse AUTOMATION ENGINEER

Personal Information

Form of Address Full Name Known As Chinese Character (if applicable) Gender
(Mr/Mdm/Ms, etc.) (As indicated in ID/Passport/NPWP (Indonesia). Pls underline surname/family name.)
Mr Suroyo Sugeng Wahyudi Sugeng --- Male

Race/Enthnic Date of Birth Place of Birth Country of Birth Nationality Marital Status Religion
(dd/mm/yyyy)
Java 04/02/1974 Jakarta Indonesia Indonesia Married Moeslem

Personal ID

Type ID Number Date of Issue Date of Expiry Place of Issue Country of Issue
(dd/mm/yyyy) (dd/mm/yyyy)
Identity Card 3172020402740003 4/02//2017 02/04/2021 Tanjung Priok, North Jakarta Indonesia
Passport A5114028 03/04/2013 30/04/2018 Kelapa Gading, North Jakarta Indonesia
Permanent Residence 121 A North Jakarta Indonesia

Others (please specify): No BPJS Ketenagakerjaan : No BPJS Kesehatan: Size (Shoe): NPWP :
16010397343000 0001637644735 42 59.494.048.8.042.000

Contact Details

Address Type Address Postal Code Country Telephone Numbers

Jl. Samudra VIII No. 121A Rt.09 / 14 Volker, Tanjung Priok North Jakarta, DKI Jakarta 14310 Indonesia Home: 62214372653
Current Mobile: 6281295473939

Home:
Home
(if different from Mobile:
current address)

Jl. Samudra VIII No. 122 Rt.09 / 14 Volker, Tanjung Priok North Jakarta, DKI Jakarta 14310 Indonesia Home:
Emergency Mobile: 81294528919
(if different from
current address)
Contact Person: Brother

Email Address sswahyudi@gmail.com

Family Details

Family Full Name I/C or Passport No. Gender Date of Birth Place of Birth Country of Birth Nationality Job Title Employer Is this person currently
Members (As in ID/Passport. Pls underline (* Compulsory for Singapore (dd/mm/yyyy) in the same country as
Hires)
(Relationship) surname / family name) you?

1 Putri Dari Dewi - F 10/01/1981 Makassar Indonesia Indonesia Housewife - Yes / No

2 Aisyah Syawal Fitriah Qurani - F 14/11/2004 Jakarta Indonesia Indonesia Student - Yes / No
3 Fathimah Azzahrah - F 18/01/2010 Jakarta Indonesia Indonesia Student - Yes / No
4 Hasna Nabila Rahma - F 29/12/2013 Jakarta Indonesia Indonesia - - Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
13 Yes / No
Yes / No
Yes / No
Yes / No
Yes / No

Education - Formal and Professional

Start Date End Date Duration Education Institution Country Qualification Major
(dd/mm/yyyy) (dd/mm/yyyy) (Bachelor, Masters, CPA, etc) (Business Administration, Accountancy,
Mechanical Engineering, etc)
08/07/1993 09/05/1998 4 Years Polytechnic Trisila Dharma Jakarta Indonesia Diploma Engineering Degree Electro Engineering

Language Skills
Language Read Write Speak
English Average ✘ Good Excellent Average ✘ Good Excellent ✘ Average ✘ Good Excellent
Mandarin Average Good Excellent Average Good Excellent Average Good Excellent
Indonesian / Malay Average Good Excellent Average Good Excellent Average Good Excellent
Others: ____________ Average Good Excellent Average Good Excellent Average Good Excellent
Others: ____________ Average Good Excellent Average Good Excellent Average Good Excellent
Working History

Start Date End Date Company City/Country Last Position Held Name of Superior Designation of Superior Last Drawn Reason for leaving
(dd/mm/yyyy) (dd/mm/yyyy) Salary
08/12/2014 31/12/2017 PT. Ostrada Indonesia Jakarta / Indonesia Lead IC Engineer Danang Wijayanto Engineering Manager 15.000,000 Contract Project Base

04/05/2013 31/10/2017 PT. Tebodin Indonesia Jakarta / Indonesia IC Engineer Denny Kurniaawan Departement Manager 13.000,000 Temporary

02/07/2011 30/03/2013 PT. Bintang Persada Abadi Jakarta / Indonesia Senior IC Engineer Mansur Ahmad Project Manager 12.500,000 Contract Project Base
01/05/2009 30/07/2011 PT. Indo Electric Instruments Jakarta / Indonesia E/IC Engineer Suryadi Project Manager 11.500,000 Temporary

07/07/2007 30/04/2009 PT. Gracia Invensys Jakarta / Indonesia E/IC Engineer Rudiyanto General Manager 9.500,000 Temporary

03/05/2005 30/06/2007 PT. Schneider Electric Jakarta / Indonesia Automation Project Nurcholis Wahyudi Project Manager 7.500,000 Contract Project Base
Engineer
01/02/2004 30/04/2005 PT. Pertafenikki Engineering Jakarta / Indonesia E/IC Engineer Jajat Sudrajat Project Manager 7.000,000 Contract Project Base
05/11/2000 30/01/2004 PT. Nucleus Engineerings & Suppliers Jakarta / Indonesia Automation Engineer Hiandro Virgo General Manager 6.000,000 Reformation
Management
01/11/1996 31/10/2000 PT. Mitra Info Parama Jakarta / Indonesia Syatem Engineer Harnaka General Manager 4.500,000 Restrucrisation
Management

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Please draw the latest organisation chart of your present/last job. Indicate clearly your position, your supervisor and your subordinates.

Engineering Manager

Civil Departement Piping Departement Mechanic Departement Electrical Departement Inst Ctrl Departement HSE / QA-QC Departement Document Control

Lead Engineer Lead Engineer Lead Engineer Lead Engineer Lead Engineer Lead HSE Lead Project Control
Senior Engineer Senior Engineer Senior Engineer Senior Engineer Senior Engineer Senior HSE Project Control.1
Junior Engineer.1 Junior Engineer.1 Junior Engineer.1 Junior Engineer.1 Junior Engineer.1 Junior HSE.1 Document Control.1
Junior Engineer.2 Junior Engineer.2 Junior Engineer.2 Junior Engineer.2 Junior Engineer.2 Junior HSE.2 Document Control.2
Junior Engineer.3 Junior Engineer.3 Junior Engineer.3 Junior Engineer.3 Junior Engineer.3 QA/QC Inspector.1 Document Control.3
Designer Engineer Designer Engineer Designer Engineer Designer Engineer Designer Engineer QA/QC Inspector.2 Document Control.4
Drafter.1 Drafter.1 Drafter.1 Drafter.1 Drafter.1 QA/QC Inspector.3
Drafter.2 Drafter.2 Drafter.2 Drafter.2 Drafter.2 QA/QC Inspector.4

Current And Expected Remuneration

Monthly Basic Salary 16.000,000 Other Benefits Company Standard of Regulation Structure

Fixed / Variable Bonus / Expected Salary 18.000,000

Fixed Commission / Allowances / 2.000,000 Notice Period Immediate after notice of 1 month

Involvement In Social/ Political Activities (if applicable)

Organisation/ Club From To Country Nature of Activities

Declaration

Please Tick The Appropriate Box Yes No

Do you have/ Have you ever had any immediate relative(s) or friends working in the RGE Group (RGE/ APRIL/ Asian Agri/ PEC-Tech/ PO&G/ Sateri) ?

If, so, give name(s) and position(s) held. √

Have you on any previous occasion(s) been offered a position by / employed in any capacity with the RGE Group (RGE/ APRIL/ Asian Agri/ PEC-Tech/ PO&G/ Sateri) ? √

Are/Have you been declared a bankrupt? √

Have you been convicted of any criminal charge? √

Have you been suspended or dismissed by any company/organisation/government service? √

Are you suffering/ Have you suffered from any disease/physical defects/mental illness? If so, give details.
√

Are/Have you been addicted to drugs? √

Do you have/ Have you had any involvement in any business undertakings ? If so, give details.
√

Have you signed a promissory note or an acknowledgment of indebtedness for which the amount pledged has not already been fully paid? √

Do you have other sources of income besides your salary? If so, give details.
√

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Character Referees (Names of relatives should not be given)

Name Occupation Years Known

Employer Mobile
Office
Email

Name Occupation Years Known

Employer Mobile
Office
Email

Could we conduct a reference check with your present and previous employers? If No, please state reasons. _____________________________________________________________ Yes No

Additional Information

Date available to start work (dd/mm/yyyy) 2/1/2018

Are you willing to travel in the course of your employment? Yes No

Are you willing to relocate? Yes No

Why do you wish to join this company? Having hands on experience in the same project for Engineering and Construction

What is your career objective? the current Position Lead Engineering at Project Pekerjaan Pembangunan Terminal Multi Purpose & Supporting Fasilities at Port Kuala Tanjung Asahan North Sumatra

Please furnish any additional information you consider to be helpful in your application
Strong interpersonal skills includes communicating with owner and maincontractor, subcontractor, vendor project, effectively, tactfully, & efficiently which benefited in defining business and technical requirements

How did you come to know of the RGE Group?

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DECLARATION
I hereby declare that all the information given by me in this form and the copies attached are true and correct and that I am liable to be dismissed if it is found to be otherwise, notwithstanding any provisions in my
contract of service with the Company. I acknowledge that employment is subject to my passing a medical examination.

SSW
17/10/2017
Signature of Applicant Date

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