PT.

HEXING TECHNOLOGY
Jl. Mitra Timur II Blok D-24, Kawasan Industri Mitrakarawang, Desa Parungmulya,
Kec. Ciampel, Karawang. Jawa Barat
Telp./Fax. (0267) 8610077 / 8610078

APPLICATION FOR EMPLOYMENT

POSITION APPLIED FOR

(PLEASE FILL IN BLOCK LETTERS)

Mr/Ms
PERSONAL DETAILS

Address

Telephone No (Office) (Home)

Date of Birth Age Place of Birth

Date Month Year

Race Citizenship
Religion KTP No
Jamsostek No
NPWP No
Income Tax Branch Sex (Please tick [Ö])
M F

Height Weight Sight Hearing

Present State of Health
Physical Disabilities or Handicap if any

Major Liness or Accident (if any) Suffered

Date
HEALTH

INCASE OF EMERGENCY, NOTIFY:

Name Relationship
Address Telephone No

Name Relationship
Address Telephone No

F-HRD-004

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Material Status Wife's/ Husband's Name

Wife's/ Husband's Occupation

Wife's/ Husband's Employer

Father's Name

Father's Occupation

Mother's Name

Mother's Occupation
FAMILY DETAILS

No of Children No of Sisters No of Brothers

Name of Children Age Sex

Name of Brother and Sisters Age Sex

(i) Name of School/College/University From To Examination Passed

(ii) Professional Qualification

(iii) Are you pursing any course? If so. Please state detail :
EDUCATION DETAILS

(iv) Languages (State whether Excellent. Good. Fair. Weak)

Language Written Spoken

(v) Recreational Activities

in School/Collage

At Present

F-HRD-004

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PRESENT EMPLOYMENT

(i) Employer Position Held

From Remuneration

(ii) Description of work

(iii) Reason for Leaving

(iv) if offered when can you start work?

EMPLOYMENT HISTORY

(v) State salary expected

(vi) Have you any objections to the company referring to your present employer

Before an offer is made ?

PAST EMPLOYMENT

(i) Employer Position Held

Reasons for Leaving

Remuneration From To

(i) Employer Position Held

Reasons for Leaving

Remuneration From To

(i) Employer Position Held

Reasons for Leaving

Remuneration From To

F-HRD-004

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OTHER INFORMATION

1. Have you applied for any position in this company before ?

If so please give date and position applied for

Position date

2. Have you ever been convicted or charged in court of law ?

(If so please give details)

REFEREES (SHOULD NOT BE YOUR FAMILY MEMBERS)

Name

Occupation Period Known

DECLARATION

I hereby declare that particulars given in this application are to the best of my knowledge

and belief, true and corect. This declaration shall if I am employed. Constitute an integral

part of any contract of service beetwen the Company and myself. I agree and accept

that if this declaration is in any part false or incorrect the Company reserve the right to

terminate my service instantly.

Date Signature of Applicant

FOR OFFICE USE ONLY

Salary offered Allowance Offred

Date of Employment Employee Category

Number

Report To Outlet/Branch/Department

Contractual OR Permanent

Name of Interviewer Appoved By

Signature of Interviewer Signature

Other Remarks

F-HRD-004

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