Anantara Application Form

APPLICATION FORM
Date:
Personal Photograph
Position applied : Guest Service Representative - English Speaking

..................................................................................................
Salary Expectation : IDR. 4.000.000................................................
Date Available to start : Soon
PERSONAL DETAIL
Full Name : Andri Yansyah
Date of Birth : 19/05/1985 Place of Birth : Bengkuku
Address : Br. Dinas Kecicang Islam

City : Karangasem Post Code : 80861
State : Bali
Telephone (Residence) : -
(Office) : -
(Mobile) : 089654645247 / 088219141783
I.D Card Number : 5107061905850005 Date of Expiry : -

Driving License : C Type Nationality : Indonesia
Marital Status : Marries Religion : Moslem

Height / Weight : 70Kg Blood Group : A
EDUCATION AND TRAINING

Name of School, University or other Training Years Major Course or Study
Institution (From – To)
STIBA SARASWATI DENPASAR 2010 - 2018 English Literature
Pandan College 2010 - 2010 Japanese course

RECORD OF PREVIOUS EMPLOYMENT
1. Company Name : Bali Sanitya Sejahtera_______________________

Address : Tukad Yeh Aye street, Renon, Denpasae
Position : Supervisor Period From : october 2022 To : January 2023
Telephone : 0361 4722984________________________________
Nature of Business : Work Training Organization Supervisor’s Name : Ms. Nyoman Juniati
Duties : Managing Office Staff
Last Salary : IDR 4.000.000
Reason for leaving : Salary was not given full without a good reason
2. Company Name : PT. Graha Anugrah Pratama (SMARTFREN)

Address : BEC Teuku Umar
Position : Team Leader Period From : May 2018 To : June 2020
Telephone : 0361 255089
Nature of Business : Smartfren Sim Cards Distributir Supervisor's Name : Ms. Nyoman Juniati
Duties : Managing Direct Selling Team
Reason for leaving : Contract Expired and Corona Pandemic
3. Company Name : The Bali Gateway ( Karma Group)

Address : Bypass Ngurah Rai Kuta
Position : Telemarketing Period From : January 2017 To : July 2017
Telephone : 0361 762131
Nature of Business : Karma Hotel Telemarketing Divison Supervisor’s Name : Mr. Marcel
Duties : Promoting Hotel Promotions trough phone
Reason for leaving : Contract Expired
4. Company Name : PT. Cakrawala Dewata Indah (CDI Tours and TRAVEL)
Address : Tukad Pakerisan 85B
Position : Operational Period From : 2015 To : 2017
Telephone : 0361 722818
Nature of Business : Tours and Travek for chinese Tourists Supervisor’s Name : Ms. Sylvia
Duties : Managing Tour's schedules, diver, vehicles, and vehicles contracts
_______________________________________________________________________________________
Last Salary : IDR. 1.800.000
Reason for leaving : Salary was to small
REFERENCES (Non – Relatives)
1. Name : Telephone Number :

Occupation : Years known :
Address :
Address :

Address :
LANGUAGE PROFICIENCY
Language Skill (Language Spoken)
Language Speaking Reading Writing
English Excellent Excellent Excellent
Mandarin Poor Good Excellent Poor Good Excellent Poor Good Excellent
Others Poor Poor Poor

Japanese
FAMILY RECORD
Father’s Name : Anwar Musyadat Age : 60 Occupation : Retired
Mother’s Name : Meri Yanti Age : 58 Occupation : Teacher
Permanent Address : P. Natadirja street
City : Bengkulu State : Indonesia
Telephone : +62 813-6896-6410
Partner’s Name : Eva Yanti Birth of Date : 15/07/1984 Occupation : Civil Servant
Children :
1. Name : Yuuki Fachriyansyah Birth of Date : 29 September 2011 Male
2. Name : Devania Az Zahra Birth of Date : 26 October 2013 Female
3. Name : _______________________ Birth of Date : __________ Male / Female
GENERAL INFORMATION
Are you presently employed ? No

Have you ever been discharged from employment ? If yes, Please explain
NO
Have you any objection to our contacting your previous employers ? No

Have you had any serious illnesses, injuries or operations within the last (5) years? If so, please
describe
NO
Have you ever suffered from any of the following illnesses?

Tuberculosis ___ No ___ Heart Disease ___ No ___
Hypertension ___ No ___ Diabetes ___ No ___
Venereal Disease ___ No ___ Epilepsy ___ No ___
Hepatitis ___ No ___ HIV / AIDS Virus ___ No ___
Do you have any immediate family members, i.e. husband, wife, parents, child, brother, sister,
working within the company ? No
If yes, who ?
DECLARATION
I certify that all statements made on this application are true and complete to the best of my knowledge.
I understand that misrepresentation or omission when discovered, will subject me to discharge and I
hereby authorize any investigation relating to my work experience, education or reputation for the
purpose of my application for employment.
Applicant’s Signature ANDRI YANSYAH Date February 14th 2023
INTERVIEW ASSESSMENT
CODE : 1. Poor 2. Need Improvement 3. Good 4. Very Good 5. Excellent
Subject HRD Comment USER Comment GM Comment
Attitude
Verbal
Language
Interpersonal
Technical Skills
Knowledge
Leadership
Motivation
Stability
Grooming
OVERALL
Interviewer’s Name
Date
Conclusion
For Human Resources Department Only

Position : __________________________________
Starting Date : __________________________________
Grade : __________________________________
 Basic Salary : __________________________________
 Meal Allowance : __________________________________
 Service Charge : __________________________________
 Incentive/ Bonus : __________________________________
 Housing Allowance : __________________________________
 Others : __________________________________
 Gross Salary : __________________________________
APPROVED FOR HIRE

Department Head Sign/Date :
_______________________________________________
Human Resources Manager Sign/Date : _______________________________________________
General Manager Sign/Date : _______________________________________________

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APPLICATION FORM

Position applied : Guest Service Representative - English Speaking

Address : Br. Dinas Kecicang Islam

I.D Card Number : 5107061905850005 Date of Expiry : -

Marital Status : Marries Religion : Moslem

EDUCATION AND TRAINING

Pandan College 2010 - 2010 Japanese course

1. Company Name : Bali Sanitya Sejahtera_______________________

2. Company Name : PT. Graha Anugrah Pratama (SMARTFREN)

3. Company Name : The Bali Gateway ( Karma Group)

1. Name : Telephone Number :

3. Name : Telephone Number :

Language Speaking Reading Writing

English Excellent Excellent Excellent

Others Poor Poor Poor

Are you presently employed ? No

Have you any objection to our contacting your previous employers ? No

Have you ever suffered from any of the following illnesses?

Applicant’s Signature ANDRI YANSYAH Date February 14th 2023

For Human Resources Department Only

APPROVED FOR HIRE

Human Resources Manager Sign/Date : _______________________________________________

General Manager Sign/Date : _______________________________________________

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