POSITION APPLIED : Safety Officer

APPLICATION FOR EMPLOYEMENT FORM

- The Content of this Form have no obligation for both parties
- This form should be completed in English

THE SOURCE OF INFORMATION FOR POSITION APPLIED (please choose)

1. Apexindo Website 4. On my own

2. Newspaper adv. 5. Apexindo Empoyee (please mention)
3. Friend/Relatives 6. Other (please mention) LinkedIn

PERSONAL DETAIL
FULL NAME : Biyan Abi Yoga
DATE OF BIRTH : February, 13th 1993
ID/PASSPORT NUMBER : 6171051302930000
ADDRESS : Dr. Abdul Rahman Saleh Street No.31
CITY : Jakarta COUNTRY: Indonesia
CONTACT NUMBER : HOME : -
EMAIL ADDRESS : biyan.abiyoga@yahoo.com
NATIONALITY : Indonesia
MARITAL STATUS : Single

FAMILY DETAILS
No. Family Relation M/F Name Place & DOB
1 Father M Siswanto Pontianak & December, 26th 1955
2 Mother F Lisyawati Nurcahyani Surakarta & February, 9th 1965
3 Spouse
4 Sibling M Rendi Tesa Hendrawan Surakarta & October, 11th 1989
5 Sibling M Reza Fahlevi Pontianak & March, 11th 1991
6 Self M Biyan Abi Yoga Surakarta & February, 13th 1993
7 Sibling F Megasari Devi Kurnilla Pontianak & February 3rd 1996
8 Sibling M Reva Dedi Delima Pontianak & October, 13th 1997

You are child number 3 from total children of 5

FORMAL EDUCATION
Formal Years
No. School/ University Name Education
 Formal
No. School/ University Name Education From To
1 SMA Negeri 01 Pontianak Sr. High School 2009 2011
2 Academy

3 Islamic University of Indonesia University 2011 2016

4 Post Graduate
5

INFORMAL EDUCATION, TRAINING, COURSE, SEMINAR

No. Institution Name Location Sucject/ Topic Month & Year
1 PT. Mitra K3 Semetsa Yogyakarta Ahli K3 Umum 01 2017
2 TOEFL Tutep Pontianak TOEFL Test 09 2017
3
4
5

FOREIGN LANGUAGES
No. Language Speaking
1 English Fair Good Excellent
2 Fair Good Excellent
3 Fair Good Excellent

No. Skill Name

1 Job Safety Analysis
2 HIRA
3 AMDAL
4 UKL - UPL
5

GENERAL INFORMATION
No. Strenght(s) Weakness(es)
1 Communication Absent Minded
2 Teamwork Not Experiences
3 Analytical Problem Forget about the time
4 Fast Learner
5

WORKING EXPERIENCES (START WITH CURRENT JOB, INCLUDING TEMPORARY WORK & VOCATIONAL TRAININ

Name & Type of

Rig (Land Rig,
No. Company Name Position Rig Location Client W/O, Jack Up, Geothermal/Oil Project
Semi, Tender)
 Environment
PT. Dinamika Teknik Consultant and
1 - - - -
Group Supervision
Engineering

PT. Kaltim Methanol HSE Officer

2 - - - -
Industri Internship

10

WORKING REFERENCES
No Name Company Name Location
1 Muhammad Slamet PT. Dinamika Teknik Group Jambi
2 Isnul Ateta PT. Len Railways Kebumen
3 Wahyu Arif PT. Bukaka Teknik Bekasi
4
5

GENERAL
Your expected salary on the position applied (Brutto / Nett) Rp. 5.000.000
Are you willing to relocate? Yes / No (if No please explain) Yes
Are you willing to travel? Yes / No (if No please explain) Yes
Have you been or are you suffering from any serious physical disability or disease? No

I declare that the above mentioned statements are true and ready for any retribution if company found impropriate data.
 Biyan Abi Yoga )
(signature of applicant)
 PT APEXINDO PRATAMA DUTA TBK.
Gedung Office 8 lantai 20-21, SCBD Lot 28
Jl. Jend Sudirman Kav 52-53 Jakarta 12190
HUMAN RESOURCES DEPARTMENT

DATE: August, 23th 2018

ENT FORM

NICKNAME: Biyan
PLACE : Surakarta

ZIP CODE : 10410

MOBILE : 082175779437

ETHNIC: Javanese
RELIGION : Islam

Education Occupation
S1 PNS
S2 PNS

D3 PNS
S1 PNS
S1 Jobseeker
S1 Student
S1 Student

Degree & Major Graduate NEM / GPA

 Degree & Major Graduate NEM / GPA
SMA IPA Yes 8,6
Yes/No

S1 Environmental Yes 3,22

Engineering

Yes/No
Yes/No

Certifacate
Certified Date Of Certificate Validity Attached
Yes 2017 Yes
Yes 2017 Yes
Yes/ No Yes/No
Yes/ No Yes/No
Yes/ No Yes/No

Written
Fair Good Good Excellent
Fair Good Good Excellent
Fair Good Good Excellent

Level
Fair Good Good Excellent
Fair Good Good Excellent
Fair Good Good Excellent
Fair Good Good Excellent
Fair Good Good Excellent

Interest/ Hobby
Football
Music
Adventure

OCATIONAL TRAINING)

Month & Years

Reason for
SALARY
From To Leaving
 Want wo work
as a Safety
March 2017 July 2018 Rp.3.000.000 Officer at
Apexindo

August 2014 November 2014 Rp.1.000.000 Part Time

Position Title
Team Leader
QHSE Supervisor
HSE Officer

Yes/No (if Yes please explain below) No

propriate data.