7/30/2019 Application Form AKR (Original-English)(1)

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PT. AKR CORPORINDO TBKPhoto

APPLICATION FORM

Position to be applied :

Full Name :

Sex : M/F

Place / Date of Birth :

Address :

Phone (Home) :

Handphone :

Religion :

Marital Status :

Tribe / Ethnic :

Identification number :

KTP / Passport / SIM

FAMILY

Family Relation Name M/F Education Occupation Position Company

Father

Mother

A Older Brother/ 1.

Sister 2.

3.

4.

5.

6.

B Younger 1.

Brother/Sister 2.

3.

4.

5.

6.

Place/Date of

Birth

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FAMILY

Family Relation Name M/F Education Occupation Position Company

Husband / Wife

Daughter/Son 1.

2.

3.

4.

5.

EDUCATIONAL BACKGROUND

Major In Year Graduated Diploma GPA/IPK

Primary School

Junior High School

Senior High School

Academy / University

INFORMAL EDUCATION

Course Name Organizer Period Diploma Sponsored by

Reading Writing Speaking

Foreign Language Good Fair Poor Good Fair Poor Good Fair Poor

Social Activities Place Title Period

Hobby :

You're reading : A lot of Average A little

Topic :

Place/Date of

Birth

Place/CitySchool's NameEducation Level

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WORKING EXPERIENCE (Current Job & 1 Last Job)

1 Company's Name : Type of Business: Company's Annual Sales:

Date of Employment : Title:

Sub-ordinate :

Assignment & Responsibilities in your job :

Current Basic Salary : Rp. __________ million net / gross

Benefits (please fill in for any one of them that you receive monthly besides your salary):

Meal Allowance : Rp. ________________ received per day

Transport Allowance : Rp. ____________ received per day

Gasoline Allowance : Rp. _____________ million received per month (if received in reimbursement amount, maximum amount Rp. ___________ million)

HP Allowance : Rp. _________________ received per month (if received in reimbursement amount, maximum amount Rp. ______________ )

Car Allowance : Rp. ________________ received per month

Do you get a company's car ? _____ YES _____ NO

If get company's car : Car Ownership Program (What type of car? _______________ ; Year of car manufactured? ____________ ; Years Remain? ___________

If get operational car : What type of car? ____________________ ; Year of car manufactured? _____________

Medical Coverage : ____________________________________________________________________________________________

Yearly Bonus Received : ____________________ ; Incentive Scheme : ________________________________________________

Please draw your position in the organization structure

Reason of Leaving :

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2 Company's Name : Type of Business: Company's Annual Sales:

Date of Employment : Title:

Sub-ordinate :

Assignment & Responsibilities in your job :

Current Basic Salary : Rp. __________ million net / gross

Benefits (please fill in for any one of them that you receive monthly besides your salary):

Meal Allowance : Rp. ________________ received per day

Transport Allowance : Rp. ____________ received per day

Gasoline Allowance : Rp. _____________ million received per month (if received in reimbursement amount, maximum amount Rp. ___________ million)

HP Allowance : Rp. _________________ received per month (if received in reimbursement amount, maximum amount Rp. ______________ )

Car Allowance : Rp. ________________ received per month

Do you get a company's car ? _____ YES _____ NO

If get company's car : Car Ownership Program (What type of car? _______________ ; Year of car manufactured? ____________ ; Years Remain? ___________

If get operational car : What type of car? ____________________ ; Year of car manufactured? _____________

Medical Coverage : ____________________________________________________________________________________________

Yearly Bonus Received : ____________________ ; Incentive Scheme : ________________________________________________

Reason of Leaving :

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REFERENCES

Name Contact Phone Number Title / Position Relation

No. Questions Yes No Explanations

1 Have you ever applied at our company before?

If Yes, when and what position did you apply for?

2 Are you engaged in a contract with the current working company?

3 Have you ever been hospitalized?

4 Do you smoke?

If Yes, how many cigarettes do you smoke a day?

5 Do you have a reference at PT. AKR Corporindo Tbk?

6 Have you ever been involved in a criminal case?

If Yes, what kind of criminal case?

7 Are you ready to be placed in other cities? If NO, please explain why?

8 Are you ready to be put on duty in other cities? If NO, please explain why?

9 What kind of job do you like?

10 What kind of job do you dislike?

11 What kind of duty, knowledge or skill do you have?

12 What is your strong point?

13 What is your weakness point?

14 What kind of improvement can you offer to this company ?

15 How much salary and what kind of benefits do you expect ?

16 What date are you ready to begin the job?

I hereby declare that all of the above data and information are true and correct

,

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INFORMATION CONCERNING APPLICATION

Applicant