PT. KASANA TEKNINDO GEMILANG Head Office: Jl. Lingkar Luar Barat No. 9, Rawa Buaya, Cengkareng, Jakarta Barat 11740 – Indonesia. Tel. (62-21) 5435 9999. Fax. (62-21) 5437 9999 www.kasana.co.id
APPLICATION FORM
Photo 3x4
Posisi yang dilamar Position to be applied
: __________________________________________________________________________________________________________________
Nama lengkap Full Name
: __________________________________________________________________________________________________________________
Jenis kelamin Gender
:
Tempat / Tanggal Lahir Place / Date of Birth
: _________________________________
Kewarganegaraan :_______________________ Citizenship
Nomor KTP Identity Card Number
:_______________________
Nomor SIM :_______________________ (A/B1/B2/B3/C) Driving License Number (lingkari yang dipilih / circle your option)
NPWP NPWP
:_______________________
Nomor Jamsostek :_______________________ Jamsostek Number
Agama Religion
:_______________________
Golongan Darah Blood Type
Pria(Male)
Wanita (Female)
Tinggi Badan dan Berat Badan :_________cm ________kg Height and Weight Alamat lengkap sesuai KTP Address based on ID Card
:_______________________
Ukuran Pakaian : S / M / L / XL / XXL Cloth Size (lingkari yang dipilih / circle your option)
: _________________________________________________________________________________________________________________
____________________________________________________________________________
Alamat tempat tinggal saat ini Current address
: _________________________________________________________________________________________________________________
____________________________________________________________________________ Status tempat tinggal Residence Status
: ( ) Rumah sendiri
Alamat surat elektronik Email address
: _________________________________________________________________________________________________________________
No. telephone rumah Phone (Home) number
: _________________________________________________________________________________________________________________
No. Telephone genggam (HP) Handphone number
: _________________________________________________________________________________________________________________
Status Perkawinan Marital Status
: Bujangan
( own house)
Single
( ) Sewa ( rent house)
( ) Orang tua
/ Bertunangan* / Menikah* / Bercerai*
/ Engaged *
* Sejak tanggal / Since :
/ Married *
( ) Kost
(parents' house)
/ Divorced*
(lodging)
( ) Lain-lain (others)
(lingkari yang dipilih / circle your option)
PENDIDIKAN FORMAL / EDUCATIONAL BACKGROUND No. 1.
Tingkat Pendidikan/ Education Level SMU / Senior High School
Nama Sekolah/ School Name
Tempat/Kota/ Place/City
Jurusan/ Major
Periode Pendidikan/ Period of Education s/d
2.
Akademi / Academy
s/d
3.
Universitas / University
s/d
4.
Pasca sarjana / Postgraduate
s/d
IPK/ GPA
Judul skripsi (Title of thesis) :_________________________________________________________________________________ PENDIDIKAN TIDAK FORMAL / INFORMAL EDUCATION No.
Kursus Course
Penyelenggara Organizer
Durasi Duration
Tahun Penyelenggaraan Year of Conducting
Disponsori Oleh Sponsored By
KELUARGA / FAMILY No.
Hubungan Keluarga Family Relation
1.
Ayah / Father
2.
Ibu / Mother
3.
Saudara Kandung 1. (termasuk Anda) Siblings (including you)
2. 3. 4. 5. 6.
4.
Suami/ Istri Husband / Wife
5.
Anak
1.
Children
2. 3.
Nama Name
L/P M/F
Tempat/Tgl Lahir Place/Date of Birth
Pendidikan Education
Pekerjaan Occupation
Posisi Position
Perusahaan Company
No.
Bahasa Asing Foreign Language
Membaca / Reading Baik Good
No.
Kegiatan Sosial / Social Activities
Cukup Fair
Menulis / Writing Kurang Poor
Baik Good
Tempat / Place
Cukup Fair
Berbicara / Speaking Kurang Poor
Jabatan / Title
Baik Good
Cukup Fair
Kurang Poor
Periode / Period s/d s/d s/d
Hobi / Hobby
:_________________________________________________________________________________________
PENGALAMAN KERJA (2 PEKERJAAN TERAKHIR) / WORKING EXPERIENCE ( 2 Last Job ) 1. Nama Perusahaan Company's name
:_________________________ Bergerak di bidang Type of business
Periode bekerja (Bulan & Tahun) :__________ s/d___________ Jabatan Period of employment (Month & Year) Title
:____________________________
:____________________________
Tugas dan tanggung jawab anda pada jabatan terakhir / assignment & responsible in your last job : _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________
Atasan (Superior)
:___________________
Gaji Pokok (Salary)
:___________________(Gross/Nett)
Fasilitas (Facility)
:____________________
Transportasi / Transportation :___________________
Uang Makan / Meals
:____________________
Bonus / Bonus
:___________________
Tunj. Kshtn/Health Ins.
:____________________
Lain-lain /Others
:___________________
Gambarkan struktur organisasi departemen Anda / Please draw your position in the organization department structure:
Perbaikan yang telah Anda lakukan / Area of improvement: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Alasan berhenti Reason of resignation
: ________________________________________________________________________________________________________________________
2. Nama Perusahaan Company's name
:_________________________ Bergerak di bidang Type of business
Periode bekerja (Bulan & Tahun) :__________ s/d___________ Jabatan Period of employment (Month & Year) Title
:____________________________
:____________________________
Tugas dan tanggung jawab anda pada jabatan terakhir / assignment & responsible in your last job : _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________
Atasan (Superior)
:___________________
Gaji Pokok (Salary)
:___________________(Gross/Nett)
Fasilitas (Facility)
:____________________
Transportasi / Transportation :___________________
Uang Makan / Meals
:____________________
Bonus / Bonus
:___________________
Tunj. Kshtn/Health Ins.
:____________________
Lain-lain /Others
:___________________
Gambarkan struktur organisasi departemen Anda / Please draw your position in the organization department structure:
Perbaikan yang telah Anda lakukan / Area of improvement: ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Alasan berhenti Reason of resignation
: ________________________________________________________________________________________________________________________
Di perusahaan mana Anda paling senang bekerja: In which company you enjoyed working the most __________________________________________________________________________________________________________________ Mengapa : Why __________________________________________________________________________________________________________________ Di perusahaan mana Anda paling tidak senang bekerja: In which company you enjoyed working the least __________________________________________________________________________________________________________________ Mengapa: Why __________________________________________________________________________________________________________________
REFERENSI / REFERENCES No.
Nama / Name
Alamat & No. Telepon / Address &
Jabatan / Title
Phone Number
Perusahaan /
Hubungan /
Company
Relationsip
MINAT KERJA / WORK INTEREST Minat Anda pada pekerjaan / your point of interest : (harap lingkari /please circle) a. Marketing e. Technical i. Manufacturing m. Quality Management
q. Legal
b. Sales
f. HRD
j. Logistic
n. Training
r. lain-lain / others :
c. Finance
g. Business Development
k. Import
o. IT
d. Accounting
h. Clerical/ Administration
l. Audit
p. Purchasing
Jelaskan / please explain your reason
:_________________________________________________________________________
____________________________________________________________________________________________________________ INFORMASI LAINNYA / INFORMATION CONCERNING APPLICATION No.
Pertanyaan / Questions
1.
Pernahkah Anda melamar di perusahaan ini ? Have you ever applied in our company before ? Jika pernah, kapan dan untuk posisi apa ? If Yes, when and what did your apply for ?
2.
Apakah Anda masih terikat kontrak dengan perusahaan Anda saat ini ? Did you sign any contract with your current company ?
3.
Apakah Anda memiliki pekerjaan sampingan, dimana dan sebagai apa? Do You have any part time / free lance job, where & what is the position? Pernahkan Anda menderita sakit berat / lama sembuh atau menjalani operasi? Have you ever suffered any serious illness or any major / minor operation?
4.
5.
Apakah saat ini Anda sedang menderita sebuah penyakit ? Do you currently have any diseases or illnesses ?
6.
Apakah Anda mempunyai referensi/kenalan di perusahaan ini ? Do you have reference / relative who works for this company ?
7.
Pernahkan Anda terlibat dengan kasus kriminal ? Have you ever been involved in a criminal case?
8.
Apakah Anda siap dan bersedia ditempatkan di seluruh wilayah Indonesia ? Are you ready to be placed in other cities (troughout Indonesia)?
9.
Jenis pekerjaan apa yang Anda sukai ? What kind of job you like ?
10.
Jenis pekerjaan apa yang Anda tidak sukai ? What kind of job you don't like ?
Ya / Yes
Tidak / No
Penjelasan / Explanations
INFORMASI LAINNYA / INFORMATION CONCERNING APPLICATION No.
Pertanyaan / Questions
11.
Apakah Anda pernah mengikuti tes psikologis sebelumnya ? Have you ever joined any psychology test before?
12.
Kemampuan apakah yang Anda miliki yang berkaitan dengan pekerjaan yang dilamar ? What kind of knowledge or skill do you have, related to applied position ?
Ya / Yes
Tidak / No
Penjelasan / Explanations
1. 2. 3.
13.
Apa saja kelebihan yang Anda miliki ? What kind of strength do you have ?
1. 2. 3.
14.
Apa saja kelemahan yang Anda miliki ? What kind of weakness do you have ?
1. 2. 3.
15.
Berapa besar gaji dan fasilitas yang Anda harapkan? How much salary and other benefits / facilities do you expect ?
16.
Apakah memungkinkan bagi Anda untuk bekerja lembur? Are You available to work overtime? Kapan Anda siap untuk bergabung dengan perusahaan ini ? When are you ready to join this company?
17.
Saya menyatakan bahwa semua informasi dan data yang telah saya buat adalah benar. Bila ternyata ada keterangan yang tidak benar, saya bersedia mempertanggungjawabkannya dan diberhentikan tanpa syarat I undertake that all material and/or information I provided for this application form is true and complete to the best of my knowledge and believe. I also undertake that I am fully liable for any action if found wrong, therefore I agree to be terminated from my position.
Jakarta, _______________________
[
] Pelamar / Applicant
