EMPLOYMENT APPLICATION FORM

Please read carefully and complete all sections in this form. Completeness of your application form will be
taken into account in our decision. In case of difficulty, do not hesitate to contact us.

PERSONAL DATA
POSITION APPLIED ITSM Consultant
FULL NAME Arrazaq Zakaria M.S
ADDRESS
(as stated in ID Kapundung Kinali Pasaman Barat, Sumatera Barat
card/KTP)
RESIDENCE ADDRESS Jalan Musyawarah No.26G Raguanan, Pasar Minggu Jakarta Selatan
PHONE NUMBER & 085314183235
MOBILE
PLACE/DATE OF BIRTH Padang, 13 October 1993
ID NUMBER (KTP) 131205131093002
RELIGION □ Moslem □ Catholic □ Christian □ Buddhist □ Hindu □ Others

SEX □ Male □ Female

□ High school □ Diploma □ Undergraduate (S1) □ Graduate (S2) □ Postgraduate
LATEST EDUCATION (S3)

MARITAL STATUS □ Single □ Married □ Widow/separated

FAMILY DATA
RELATION FULL NAME SEX PLACE/DATE OF EDUCATION OCCUPATION
BIRTH
Sumardan Male Undergraduate
Father (S1)
Syamsilas Male Undergraduate
Mother
(S1)

Brother/Sister

Brother/Sister

Brother/Sister

(Filled if you are married/separated)

Husband/Wif
e
1st child

2nd child

3rd child

FORMAL EDUCATION
School Name
Certification:
HIGHSCHOOL Major □ Yes
until □ No
Period (Year)

School Name
Certification:
ACADEMY Major □ Yes
until □ No
Period (Year)

School Name Telkom University

Major Information System Certification:
UNIVERSITY GPA (IPK) 3.14 □ Yes
2011 until 2015 □ No
Period (Year)

School Name
Certification:
OTHERS Major □ Yes
until □ No
Period (Year)

TRAININGS ATTENDED
NO VENDOR TRAINING’S NAME DURATION CERTIFICATION
.

1.
□ Yes
□ No
2.
□ Yes
□ No
3.
□ Yes
□ No
 4.
□ Yes
□ No
5.
□ Yes
□ No

SPECIAL SKILLS/ABILITIES
NO DESCRIPTION CERTIFICATION
.

1.
IT Stategic □ Yes
□ No
2.
IT Governance □ Yes
□ No
3.
IT Service Management □ Yes
□ No
4.
IT Security Management □ Yes
□ No
5.
□ Yes
□ No

WORKING EXPERIENCES
(Please start from your LATEST working experience)

COMPANY NAME Smartpro Solusi Asia

COMPANY INDUSTRY IT Consultant

SEGMENT
COMPANY ADDRESS
Mampang Prapatan, Jakarta Selatan
Senior Consultant
JOB POSITION
January 2017 until December 2019
WORKING PERIOD

JOB DESCRIPTION Manage Project IT Master Plan, IT Governance, IT Security Management

PROJECTS HANDLED
 1. IT Master Plan Polri
2. IT Master Plan Kementerian Pariwisata
3. IT Master Plan Badan Siber Sandi Negara
4. IT Governance Polri
5. IT Governance Badan Siber Sandi Negara
6. IT Security Management Sistem Pemerintahan Berbasis Elektronik
LATEST SALARY Rp. 8.500.000
I want to learn lots of new stuffs and experience many things
TERMINATION REASON

COMPANY NAME Genesis

COMPANY INDUSTRY IT Consultant

SEGMENT
COMPANY ADDRESS
JOB POSITION Senior Consultant-Freelance
July 2019 until December 2019
WORKING PERIOD

IT Security Management Base On ISO 27000-1

JOB DESCRIPTION

1. IT Security Management in Perpusnas

PROJECTS HANDLED 2. IT Security Management in Kominfo
3. IT Security Management in LPSE Bangka Belitung

LATEST SALARY Rp. 5.000.000

TERMINATION REASON Project end

COMPANY NAME Pindad (persero)

COMPANY INDUSTRY
SEGMENT Manucfacture
COMPANY ADDRESS
Bandung
IT Governance Analyst
JOB POSITION
July 2016 until December 2016
WORKING PERIOD

JOB DESCRIPTION Manage IT Governance

PROJECTS HANDLED
 LATEST SALARY Rp.5.000.000
TERMINATION REASON

REFERENCES
(Please state 2 referrer’s name who already knew you for minimum 1 year, along with their contact
details and occupation)

NAME
Reza Febrian Alexandra

ADDRESS
Mampang Prapatan, Jakarta Selatan
1.
Phone : 081259567874
OCCUPATION
XL Axiata
RELATIONSHIP
(With You) Colleague at Smartpro Solusi Asia
Galih Fathoni
NAME

Grogol Jakarta Selatan,

ADDRESS
2.
Phone : 081324738190
OCCUPATION
RELATIONSHIP
(With You) Colleague at Smartpro Solusi Asia

CONFIRMATION
Are you agree if we contact your references for our further □ Yes □ No
confirmation?
Have you ever applied at PT. Mitratex Konsultan previously? □ Yes, ………………………………. □ No
If Yes, when?
□ Newspaper: ………………….. □ Online vacancy
Where did you know the vacancy’s information before? □ Mailing List: …….……………… □ PT. Mitratex
Konsultan’s employee
□ Others: ……………………
What kind of Compensation & Benefit details that you □ Nett
1. Basic Salary Rp 8.500.000
accepted on your latest employment? □ Gross

2. Commission/Bonus Rp 8.500.000
 3. Medical Rp □ Reimburse

4. Transportation Rp 1.500.000

5. Other benefits
If you are considered as a qualified candidate for PT.
Mitratex Konsultan’s employee :
1. When do you available to start to work? Any Time
2. How much is your expected monthly salary? Rp. 12.000.000
3. Are you willing to work overtime? □ Yes □ No
4. Are you willing to be placed to work out of city/country? □ Yes □ No
Hereby I stated all of the information above is true and I’m fully responsible for all of the consequences if any of the
statement above is not true.

Date: March 9, 2020

Candidate’s signature,

(Arrazaq Zakaria M.S)