FM-HRD-001.

PERSONAL DATA APPLICANT

PT. Sejahtera Karna Menggoreng

FILL THE DATA IN CAPITAL LETTER

POSITION

NAME (FULL NAME)

PERMANENT ADDRESS (COMPLETE)

PHONE NUMBER
PHOTO
EMAIL ADDRESS

IDENTITY NUMBER

NPWP NUMBER
GENDER HEIGHT WEIGHT RELIGION NATIONALITY ETHNIC
[ ] MALE [ ] FEMALE

BORN MARITAL STATUS

PLACE DATE MONTH YEAR [ ] SINGLE [ ] WIDOWED
[ ] MARRIED [ ] DIVORCED
OWNERSHIP STATUS - HOME VEHICLE
[ ] OWN [ ] LEASE TYPE
YEAR
[ ] OWN BY PARENTS [ ] BOARDING HOUSE [ ] PRIVATE [ ] PARENTS
STATUS
[ ] OFFICE [ ] OTHERS
FAMILY STRUCTURE (INCLUDING YOURSELF)
FAMILY LAST LAST WORKING EXPERIENCE
RELATION NAME M/F AGE EDUCATION REMARKS
COMPANY POSITION
FATHER

MOTHER

BROTHER /
SISTER / ME

HUSBAND

WIFE

CHILDREN
FORMAL / INFORMAL EDUCATIONAL BACKGROUND
YEAR TYPE OF
LEVEL NAME OF SCHOOL PLACE MAJOR FROM TO DIPLOMA GPA

COURSE / TRAINING
TYPE PROVIDER PLACE/CITY NAME OF COURSE YEAR SUPPORTED BY

LANGUAGE (PLEASE FILL IN WITH : GOOD, FAIR OR INSUFFICIENT)

TYPE OF LANGUAGE LISTENING READING SPEAKING WRITING

SOCIAL ACTIVITY
ORGANIZATION TYPE OF ACTIVITY POSITION YEAR

- - - -

HOBBY & ACTIVITY (DURING THE LEISURE TIME) :

HOW MUCH DO YOU READ?

[ ] LESS [ ] MEDIUM [ ] A LOT HOW MANY BOOKS DO YOU READ A YEAR?

TOPICS:

WHAT KIND OF MAGAZINE / NEWSPAPER DO YOU READ?

NEWSPAPER :

MAGAZINE :

WHAT IS THE BEST BOOK HAVE YOU EVER READ?

COMPUTER LITERACY:
CAPABILITY OF OPERATING HARDWARE : CAPABILITY OF OPERATING SOFTWARE :
o Server o Plotter o Windows NT o Power Point o Microsoft PRJT
o Workstation o Scanner o Excell o Acess o Primavera
o Printer o LAN o Winword o Autocad o COREL, E-SPT
WORKING EXPERIENCE HISTORY
MONTH YEAR ADDRESS/PHONE POSITION
FROM START
TO END
TYPE OF BUSINESS TOTAL EMPLOYEE
COMPANY NAME SALARY
NAME OF SUPERVISOR NAME OF DIRECTOR
EMAIL :
REASON FOR LEAVING

MONTH YEAR ADDRESS/PHONE POSITION

FROM START
TO END
TYPE OF BUSINESS TOTAL EMPLOYEE
COMPANY NAME SALARY
NAME OF SUPERVISOR NAME OF DIRECTOR
EMAIL :
REASON FOR LEAVING

MONTH YEAR ADDRESS/PHONE POSITION

FROM START
TO END
TYPE OF BUSINESS TOTAL EMPLOYEE
COMPANY NAME SALARY
NAME OF SUPERVISOR NAME OF DIRECTOR
EMAIL :
REASON FOR LEAVING

MONTH YEAR ADDRESS/PHONE POSITION

FROM START
TO END
TYPE OF BUSINESS TOTAL EMPLOYEE
COMPANY NAME SALARY
NAME OF SUPERVISOR NAME OF DIRECTOR
EMAIL :
REASON FOR LEAVING

REFERENCE (TO WHOM WE MAY ASK ABOUT YOURSELF?)

NAME ADDRESS/PHONE COMPANY RELATION

PERSON WE CAN CONTACT IN CASE OF EMERGENCY

NAME ADDRESS/PHONE COMPANY RELATION
 DESCRIBE YOUR DUTIES AND RESPONSIBILITIES

DRAW THE ORGANIZATION CHART TO SHOW YOUR POSITION

DESCRIBE YOUR VALUES

1 What is the most important thing in life?

2 What is the most important for your worklife?

3 What are you work values and goals?

4 What's your core value?

5 What's your competitive edge?

6 How would you want from people perceive you?
 ANSWER
NO QUESTION
YES NO REMARKS
Have you applied in this Group/Company before?
1
When and what position ?
Are you applying to other Companies in addition to this Company?
2
As what?
Are you binded by a contract by other company?
3
Do you mind if you work in a contract base in this Company?
4 Do you have a side job? Where and what?
5 Do you mind if we ask for a reference in your previous company?
Do you have a family/friend who works in this company?
6
Please mention!
Do you ever have a psychological test before?
7
Where and for what purpose?
8 If you're accepted, do you mind if the company send you out of town for duties?
9 What kind of job/position do you like the most?
10 What kind of job/position you do not like the most?
How much is your expected salary and what kind of facilities do you expected?
11
Please mention!
12 If you are accepted, when can you start working?
Are you directly or indirectly involved with any illicit organization?
13
When and what position ?
14 Do you ever have or in suffer of these below diseases?
Covid 19
TBC
Bronchitis
Hepatitis
HIV /AIDS
Malaria
Leprosy
Migrain
Typhoid
Cancer Type :
Cardiovascular / Heart Disease
High Blood Pressure
Diabetes
Anemia
Epilepsy
Eye disorder/ dysfunction: minus / plus
Asthma
Hyperuricemia (Asam Urat)
Ulcer
Others: Mention :
15 Do you smoke ?
16 Do you drink alcohol?
17 For Female candidates : a. In Pregnancy b. Ever Pregnant c. Single
18 Do you agree to work on contract basis?
19 Do you agree to obey all rules and regulation of AHG if accepted?

I declare that all the statements above are true. If there is any untrue statement/information, I am ready to take full
responsibilities.
Jakarta,

signed

( …………….. )