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Updated Application Form - Hangry

The document is a job application form requesting personal details such as name, date of birth, contact information, education history, work experience, references, and a declaration authorizing a background check. It collects information to evaluate candidates for a position and register them for Indonesian health and employment benefits programs if applicable.

Uploaded by

Taupan Jainudin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
87 views20 pages

Updated Application Form - Hangry

The document is a job application form requesting personal details such as name, date of birth, contact information, education history, work experience, references, and a declaration authorizing a background check. It collects information to evaluate candidates for a position and register them for Indonesian health and employment benefits programs if applicable.

Uploaded by

Taupan Jainudin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Please Complete This Form Properly

Position Applied for :

Personal Data

Full Name (same with KTP/I : Taupan jainudin

Nick Name : opan

Place of Birth : Tangerang

State : WNI

Country : Indonesia

Date of Birth : 19-June-1991 dd-mmmm-yyyy

Gender : Male Female

Status : Single Married

Religion : islam

Citizenship : Indonesia Others

E-mail Address : [email protected]

Handphone Number : 89626039310

KTP/ID Card Number :


NPWP/Tax ID Number :

BPJS Ketenagakerjaan Numb: New Existing baru

Address

Original Address :

(same with KTP/ID Card)

RT : RW:
Kelurahan :

Kecamatan :

State

Phone Number :

Residential Address :

(if same with Original Address, please

RT : RW:
Kelurahan :

Kecamatan :
State

Phone Number :

Family Members & Emergency Contact

Data for main family including yourself, this data will be used for BPJS Kesehatan dan Insurance (if applicable). Maximum dependent : 1 (one) spouse
For local employee (Indonesia) Birth
No. KK No. NIK KTP Name Place Date

* Please attach copy of BPJS Kesehatan card if you have registered in BPJS Kesehatan.
Parent's Data
Birth
Name Place Date Gender Relation
Father
Mother

Emergency Contacts

Full Name :

Relation :

Handphone Number :
Reference Check ( Reference check contact will be use for applicant's background checking)

Name Phone Number Email Working Rela

Educational Background

1. High School/Diploma

Educational Degree :

Major :

College Name :

Years of Completed : until

GPA :

2. College

Educational Degree :

Major :

College Name :
Years of Completed : until

GPA :

Courses / Training

Subject

Languages

Language Read

Organisations

Organisation Name

Working Experiences
Company Name Latest Position From
(dd-mm-yy)

Others

Availability :

No. Rekening BCA :

Rekening Atas Nama :

Declaration

I hereby certify that the facts in the above employment application are true and complete to the best of my knowledge and authorize.

My data and information are subject to background check result and proper documentation including and not limited to education certificates, reference

If required by Company, I do not mind to do psychological test and medical check-up.

I understand that if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for d

Signature

Jakarta,
__________________________
Blood Type

Divorce

367112190691002
(number & street)

City

Country

(number & street)

City
Country

m dependent : 1 (one) spouse and 3 (three) children.


BPJS Keseha
Date Gender Relation Number Faskes 1
Code

Relation
Father
Mother
Working Relation

until dd-mmmm-yyyy
until dd-mmmm-yyyy

Institution

Write Speak

Position
From Until Reason for Leaving
(dd-mm-yy) (dd-mm-yy)

d authorize.

ucation certificates, reference letters and salary slips.

onsidered sufficient basis for dismissal.


Photo

Expiration Date
Zip Code

Zip Code
BPJS Kesehatan
Faskes 1 Faskes 1
Code Name
Period

Listen

Period
Latest Salary

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