MidPlaza I Building, 19th Floor

PERSONAL DATA
I. PERSONALITY
FULL NAME * PLACE / DATE OF BIRTH * CONTACT ADDRESS E-MAIL * TELEPHONE NUMBER * *(Mobile)

Jl. Jend. Sudirman Kav. 10 - 11 Jakarta 10220 E-mail: recruitment@selnajaya.com Url: www.selnajayarecruitment.com

Photo

(M/F)

*(Home) *(Emergency)

EMERGENCY CONTACT NO. STATUS OCCUPATION JOB APPLICATION IDENTITY NUMBER DRIVER LICENCE NATIONALITY BLOOD TYPE CHARACTER COMPUTER SKILLS LANGUAGES ABILITY EXPECTING SALARY (THP) English Rp Allowances : AVAILABILITY EXPECTING LOCATION Your wishes / expectations / notes towards your new job : Japanese Indonesian A / B1 / B2 / C OWN VEHICLE ETHNICITY RELIGION HOBBIES OTHER SKILLS Mandarin (Gross/Net) Others (..) Negotiable Yes No Car / Motorcycle Married Single / (Present position) Divorced / Widowed

* Required Fields (H: Home, M: Mobile, O: Office)

I. LIST OF REFERENCES
(Your professional contact references for recommendation) NAME RELATION OCCUPATION / LOCATION PHONE

II. EDUCATION, SEMINAR & LICENCES

FORMAL EDUCATION (Last Education & High School) PERIOD * NAME of SCHOOL / PLACE MAJOR START - END
(DD/MM/YY DD/MM/YY)

DEGREE**

GRADUATE (Y/N)

** SMA/U, STM, SMEA, D1, D2, D3, D4, S1, S2, S3, etc. INFORMAL EDUCATION NAME of SCHOOL / PLACE MAJOR PERIOD * (YEAR) CERTIFICATE GRADUATE (Y/N)

ATTENDED SEMINAR NAME of SEMINAR ORGANIZATION / PLACE PERIOD * (YEAR) CERTIFICATE (Y/N)

CERTIFICATIONS ***NAME of CERTIFICATIONS ORGANIZATION / PLACE / YEAR LEVEL

*** Brevet A & B, CPA, CCNA, TOEFL, TOEIC, Japanese Proficiency Test, Etc

III. WORKING EXPERIENCE

(Fill in the following form based on the number of job changes youve had, starting with your current or most recent job) A. COMPANY NAME * COMPANY ADDRESS * INDUSTRY * COMPANY CATEGORY LAST POSITION * POSITION LEVEL * PERIOD * (DD/MM/YY DD/MM/YY) JOB DESCRIPTIONS *

LOCAL

PMA

Joint Venture

(Company Origin) : EMPLOYMENT STATUS : Contract JOB FUNCTION * : Permanent

NO. OF SUBORDINATES DIRECT REPORT TO SALARY * Gross OTHER BENEFITS REASON FOR LEAVING PREVIOUS POSITION PERIOD JOB DESCRIPTIONS Net All In POSITION : ALLOWANCE : (Meals & Transportation)

PREVIOUS POSITION PERIOD JOB DESCRIPTIONS

B.

COMPANY NAME COMPANY ADDRESS INDUSTRY COMPANY CATEGORY LAST POSITION POSITION LEVEL PERIOD (DD/MM/YY DD/MM/YY) JOB DESCRIPTIONS

LOCAL

PMA

Joint Venture

(Company Origin) : EMPLOYMENT STATUS : Contract JOB FUNCTION : Permanent

NO. OF SUBORDINATES DIRECT REPORT TO SALARY Gross OTHER BENEFITS REASON FOR LEAVING PREVIOUS POSITION PERIOD JOB DESCRIPTIONS Net All In POSITION : ALLOWANCE : (Meals & Transportation)

PREVIOUS POSITION PERIOD JOB DESCRIPTIONS

C.

COMPANY NAME COMPANY ADDRESS INDUSTRY COMPANY CATEGORY LAST POSITION POSITION LEVEL PERIOD (DD/MM/YY DD/MM/YY) JOB DESCRIPTIONS

LOCAL

PMA

Joint Venture

(Company Origin) : EMPLOYMENT STATUS : Contract JOB FUNCTION : Permanent

NO. OF SUBORDINATES DIRECT REPORT TO SALARY Gross OTHER BENEFITS REASON FOR LEAVING PREVIOUS POSITION PERIOD JOB DESCRIPTIONS Net All In POSITION : ALLOWANCE : (Meals & Transportation)

PREVIOUS POSITION PERIOD

JOB DESCRIPTIONS

D.

COMPANY NAME COMPANY ADDRESS INDUSTRY COMPANY CATEGORY LAST POSITION POSITION LEVEL PERIOD (DD/MM/YY DD/MM/YY) JOB DESCRIPTIONS

LOCAL

PMA

Joint Venture

(Company Origin) : EMPLOYMENT STATUS : Contract JOB FUNCTION : Permanent

NO. OF SUBORDINATES DIRECT REPORT TO SALARY Gross OTHER BENEFITS REASON FOR LEAVING PREVIOUS POSITION PERIOD JOB DESCRIPTIONS Net All In POSITION : ALLOWANCE : (Meals & Transportation)

PREVIOUS POSITION PERIOD JOB DESCRIPTIONS

What other agencies have you registered with? _________________________________________________ Declaration:

Herewith I certify that the information given above is true to the best of my knowledge. I undertake to furnish any further information or documents required by the company in the processing of the application. Moreover, I do agree to follow all the conditions below: a) I have / have never been convicted of any criminal charge. b) c) d) e) f) g) I have / have never been taken and am presently not taking drugs. I shall not conduct any direct transaction with the client introduced by PT. Selnajaya Prima unless instructed to do so. I shall not provide any personal contact number to the client. I shall be punctual and not be late or absent for the entire interview/test appointments. (Except with prior notice with acceptable reason). I shall be neat and wear formal dress during the interview and working days. I shall not forget to contact PT. Selnajaya Prima after I have been interviewed.

Date: __________________

____________________ Signature of applicant