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Application Form - PMG

The document is an employee application form for Putra Mas Group, requiring personal, educational, and employment information from applicants. It includes sections for personal data, previous employment records, references, language proficiency, family records, and general information regarding health and prior applications. Applicants must also sign a declaration confirming the accuracy of their provided information.

Uploaded by

Wahyu Candra
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
11 views

Application Form - PMG

The document is an employee application form for Putra Mas Group, requiring personal, educational, and employment information from applicants. It includes sections for personal data, previous employment records, references, language proficiency, family records, and general information regarding health and prior applications. Applicants must also sign a declaration confirming the accuracy of their provided information.

Uploaded by

Wahyu Candra
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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EMPLOYEE APPLICATION FORM

The following information will help us assess your employment opportunity with Putra Mas Group (hereinafter called
the “Employer”). All portions of this application pertaining to you must be completed. We appreciate the time you spend
in c--ompleting this application form.

Position applied for : _______________________________


Recent
Other position(s) you would like to be considered for : ___________________ photograph
3 X 4 cm
Salary expectation : _______________________________
Available starting date : _______________________________

PERSONAL DATA
Full name :  Male  Female
Place / Date of Birth :
Temporary Address :

City : Post code: Telephone/ HP :


Permanent Address :

City : Post code: Telephone/ HP :


I.D. Card Number : Date of Expiry :
Marital Status : Religion : Blood Group :
Height / Weight : Hobby :
Distinguishing Marks : Email :

EDUCATION AND TRAINING


Name and address of school, University or From To Degree or
Major Course or Study
other Training Institutions. (MM/YY) (MM/YY) Certificate

OTHER ACTIVITIES
Name of Organisation From date To date Status

RECORD OF PREVIOUS EMPLOYMENT


1. Company Name : ____________________________________________ Telephone : _____________________
Address : _________________________________________________ Position : _____________________
Duties : _________________________________________________________________________________
_________________________________________________________________________________
Nature of Business : _____________________________________
Employment dates : from ____________ to ____________ Supervisor’s Name : ______________________
Salary : _________________________________
Reason for leaving : _________________________________________________________________________

2. Company Name : ____________________________________________ Telephone : _____________________


Address : _________________________________________________ Position : _____________________
Duties : _________________________________________________________________________________
_________________________________________________________________________________
Nature of Business : _____________________________________
Employment dates : from ____________ to ____________ Supervisor’s Name : ______________________
Salary : _________________________________
Reason for leaving : _________________________________________________________________________

3. Company Name : ____________________________________________ Telephone : _____________________


Address : _________________________________________________ Position : _____________________
Duties : _________________________________________________________________________________
_________________________________________________________________________________
Nature of Business : _____________________________________
Employment dates : from ____________ to ____________ Supervisor’s Name : ______________________
Salary : _________________________________
Reason for leaving : _________________________________________________________________________

REFERENCES (Non – Relatives)


1. Name : ______________________ Telp/Mobile: _________________ Company : ______________________
E-Mail : __________________________________________________ Years Known : __________________

2. Name : ______________________ Telp/Mobile: _________________ Company : ______________________


E-Mail : __________________________________________________ Years Known : __________________

3. Name : ______________________ Telp/Mobile: _________________ Company : ______________________


E-Mail : __________________________________________________ Years Known : __________________

LANGUAGE PROFICIENCY
Language skills (Language spoken) :
Language Speaking Reading Writing
English Poor Good Excellent Poor Good Excellent Poor Good Excellent
..................................... Poor Good Excellent Poor Good Excellent Poor Good Excellent
..................................... Poor Good Excellent Poor Good Excellent Poor Good Excellent

FAMILY RECORD
Father’s Name : ______________________________ Age : _____ Occupation : _________________
Mother’s Name : ______________________________ Age : _____ Occupation : _________________
Permanent address : ______________________________________________________________________
City : __________________________ Telephone : _________________
Husband/Wife’s name: ____________________________ Age : _____ Occupation : _________________
First child : __________________________________ Age : _____  Male  Female
Second child : __________________________________ Age : _____  Male  Female
Third child : __________________________________ Age : _____  Male  Female

Contact person in case of emergencies : _____________________________ HP : ______________________

2
GENERAL INFORMATION
Have you ever applied to Putra Mas Group ?  Yes  No
If yes, when _____________________
Are you presently employed?  Yes  No
Have you ever been discharged from employment? If yes, please explain
______________________________________________________________________________________________
______________________________________________________________________________________________

Have you any objection to our contacting your previous employers? Yes  No
Have you had any serious illnesses, injuries or operations within the last five (5) years? If so, please describe
______________________________________________________________________________________________
______________________________________________________________________________________________

Do you have any immediate family members, i.e. husband, wife, parents, child, brother, sister, working within Putra
Mas Group? Yes No

If yes, who and in which department/ position?


(1) _______________________________________________
(2) _______________________________________________
(3) _______________________________________________

Have you ever suffered from any of the following illnesses?


Tuberculosis  Yes  No Heart Disease  Yes  No
Hypertension  Yes  No Diabetes  Yes  No
Venereal Disease  Yes  No Epilepsy  Yes  No
Hepatitis  Yes  No HIV/AIDS Virus  Yes  No

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' signature Date

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