No:

APPLICATION FORM Date:

Applied Division : Employment Status :

Sub-Service Line : When can you start:

Applied Position :

Full Name

(based on ID card/KTP) (First Name) (Middle Name) (Last Name)

Current Address

City Postal Code Country

Contact Mobile phone Home

Email Address Office

Where do you live ?

Permanent Address
(based on ID Card / KTP / Passport)

City Postal Code Country

Identification Card No. (KTP/Passport*) Identity Expiry Date (DD-MM-YYYY)

*) applied for expatriate employee

Sex (M / F) Age years old Blood Type

Date of Birth Place of Birth

Citizenship Religion

Civil Status :

No. of Children No. of Dependents

EDUCATION RECORD :
Inclusive Date Major Course Honors/
Education Name of School City Degree GPA Certificate No.
From To or Subject Rank
Senior High School
(SMU)
Academy

University

Postgraduate / Advance Studies

Others Courses

Computer skills
pHOTO Ph
English skills

Other language - Level

- Level
Photo

Where did you hear

about our job
vacancy?

Application Form - EY Recruitment - 03/16

B.2.1
PROFESIONAL MEMBERSHIP QUALIFICATION (CPA, CIA, CISA, Brevet etc.)

Title of Certificate Name Professional Association/Organization No of Certificate Issued by (City, Country) Dates/Year Certification

RECORD OF EMPLOYMENT

Present Employer Past Employer 1 Past Employer 2 Past Employer 3

Company Name

Address

Nature of Business

Your position/title

Period of Employment
(Start - End)
Starting monthly
Salary (gross)
Present salary/ salary
Upon leaving (gross)
Reason for
Leaving

Have you ever been dissmissed or suspended by your previous employers If so, state date

by which company and the case

FAMILY BACKGROUND:
Give names and addresses of your family background
Occupation and
Name Address / Telephone
Employer
Father
Mother

Siblings

Spouse

Child

REFERENCES:
Give names and addresses of person/ contact number, preferably those in business or profession, who have known you for at least three years.
(Do not give names of relatives)
Number of
Name Address / Telephone Email Occupation and Employer Years of
Acquaintance

Are you related to any partner or employee of this Firm ? if so, to whom?

Name referral in our employ

Were you involved in any administrative, civil or criminal case? if so, please specify

Have you taken our entrance test before? If so, when date/year

Minimum monthly salary acceptable (Gross) Rp.

Application Form - EY Recruitment - 03/16

B.2.1
Explain briefly below your reason (s) for applying with us and state why you believe you are qualified for the position:

I certify that the printed information on this form or any supplements, and supported documents to support this form is complete and accurate.

I hereby authorize EY entities to perform employment reference checks on my previous employment, verify academic checking, and conduct full background checks including
personal references. This is not limited to overseas inquiries if necessary and, I authorize to release my personal data outside of Indonesia in the course of processing.

I consent to release my personal data to a third parties for background check purpose. I also consent the recipients of such enquiries to provide the data requested.

I understand that my offer is that I may withhold my permission and that in such a case, no investigation will be done and my application for employment will not be
processed further.

Signature

Name                                                         

Date

Application Form - EY Recruitment - 03/16

B.2.1