PT.

Intra Asia Worl

APPLICATION FORM

Wisma Kosgor
18th Floor
Jl. MH. Thamrin Ka
Jakarta 10350 Indo
Telephone : +6221

HR Recruitment Use only

HR Interview Date

User Interview Date

PHOTO
3X4

Personal

POSITION APPLIED
:
INSTRUCTIONS:
for
1.Please accomplish this form by fill up all blanks. Write N/A if
not applicable.
2.Use separate of paper if needed
3.Use CAPITAL LETTER

Full Name

Nick Name

Permanent
Address
(As stated on
ID/KTP)
Area
Code

Telephone Number
/ Handphone

Email Address

ID/KTP Number

District/City/Provi
nce

Date & City of

Issued

Date of Birth
(dd/mm/yy)

Civil Status
(Put X in the Selected
Box)

Place

Single

Sex

Religion

Nationalit
y

Divorce
Widower/Widow
Married (Date of Wedding
(dd/mm/yy)

Do you live in
(Put X in the Selected
Box)

Own House
Rented House
With Parents
Others

Language Skills
(Put X in the Selected

English

Baha
sa

Chines
e

Other 1

Other 2

Other 3

WQA-APAC 63 issue 4
WQA-APAC Sep 2014

Box)

Spoken
Written
Do you have own car/motor cycle? (Put X in

Yes

No

the Selected Box)

Do you have Driving Licence? (Put X in the

Yes

No

Family

Selected Box)

Name Of
Wife/Husban
d
Full Name

Birthday
(dd/mm/yy)

Place

Religio

Occupation
of Spouse
Company/Place
Employed

Details of
Living
Children
(Eldest First)

Position Held

Telephone No

Sex
M/F

Full Name

Place & Date of Birth

(dd/mm/yy

1.
2.
3.
4.
5.

Father
Full Name

Place & Date of Birth

(dd/mm/yy)

Occupation & Position

Full Name

Place & Date of Birth

(dd/mm/yy)

Occupation & Position

Full Name

Place & Date of Birth

(dd/mm/yy)

Occupation & Position

Full Name

Place & Date of Birth

(dd/mm/yy)

Occupation & Position

Full Name

Place & Date of Birth

(dd/mm/yy)

Occupation & Position

Mother

Brother/Sist
er

1.

2.

3.

4.
Full Name

Place & Date of Birth

(dd/mm/yy)

Occupation & Position

WQA-APAC 63 issue 4
WQA-APAC Sep 2014

5.
Place & Date of Birth
(dd/mm/yy)

Full Name

Occupation & Position

WQA-APAC 63 issue 4
WQA-APAC Sep 2014

Education & Professional Qualifcation

Formal Education
Name of Elementary / High School Location
(City, Country)

Majo
r

Years Attended
From

Name of College/Graduate School & Location

(City & Country)

Majo
r

Scholastic Standing
(Highest Grade
Possible)

To

Date of Entry

Date of
Graduated

GPA

Informal Education
Write down your Informal activities, incl. Participations in Course, Workshop, Training, etc.
Name of Training/Intitution

City/Country

Subject

Duration
From

To

1
2
3
4
5

Other Activities

Write down your extracurricular activities, Incl. Participations in Organization, Society, Proffesional, Sport,
Etc.
Name Of Organization
Type of
Position Held
Time Period
Activity
and
Responsibilities

Write down your Name your hobbies, interests & activities

1
2
3
4

WQA-APAC 63 issue 4
WQA-APAC Sep 2014

Experience & Company

Please indicate the functions/business you are interested to: (Put X in the selected box)
Human Resources
Mineral & Environment
Industrial Services
Services
Finance & Accounting

Oil, Gas, & Chemical

System & Services

Certifcation

Information Technology

Agricultural Services

Government & Intitution

Services

Quality Health Safety

Environment

Consumer Testing
Services

Othe
r

Please give detailed description current or last employment

Company Name

Position

Working
Period
From
Until

Reason for Leaving

Please describe your strengths.

Please describe your weakness.

Please tell about your best achievement based on your experience.

Please explain your reason interested in this position.

Please explain your reason join with WQA.

WQA-APAC 63 issue 4
WQA-APAC Sep 2014

Please explain what do you know about WQA.

Are you willing to be assigned anywhere the company

operates?

Yes

No,
Why?
Are you comfortable work with

Alone,
Why?

Other Information

Team,
Why?

Channel of Application
Job Fair/Campus
Recruitment

WQA Website

Classifed Ads

Walk In

Other Website

Referral (Specify
Name)

Letter / e-mail

Executive
Search

Jobstreet

Have you ever applied with WQA before?

Yes
,

When?

For What
Position?
No
Do you have relatives and/or friends who have worked with us at one time or another or are presently in our
employ? If so state name(s) and relationship(s)
Name
Relationship

Please write date & name of companies with thich you have pending application for employment
Name
Date (dd/mm/yyyy)

WQA-APAC 63 issue 4
WQA-APAC Sep 2014

How soon can you start working with

us?
Date (DD/MM/YYYY)

WQA-APAC 63 issue 4
WQA-APAC Sep 2014

Renumeration Information

Please detail your last or present renumeration package as follows:

Basic Salary

(Nett)

Transportatio
n

(If any)

Medical

(If any)

Other
Benefts

(If any)

Please inform your salary

expectation

Rp.

I hereby confrm all the above details to be true and correct. Should untruths be discovered during
my employment in any position in this company, I fully agree to being immediately dismissed for
just cause.

Date:

Applicant
Signature

WQA-APAC 63 issue 4
WQA-APAC Sep 2014