FM.01.00.03.

EMPLOYMENT
APPLICATION FORM
Date:

July, 23th 2014

Position you applying for: Surveyor Petrochemical

A. PERSONAL INFORMATION
Full name: DIKKY TRI PRATANA HARAHAP
Place & Date of Birth: SUKANALU, JANUARY 28th 1992
Religion: MOSLEM
Nationality: INDONESIA
Height:

173

Marital status: SINGLE

cm,

Weight

: 67

Kg

Home Address: JL. DESA KETAREN, GG. MAJU, KABANJAHE, KAB. KARO, NORTH
SUMATERA
Phone: 081361178180

HP:08887632606

Email: dikkytripratana92@gmail.com
Emergency Contact: 085261237055

B. FAMILY
1. Direct Family
Ag
e

Occupation
Company
Name

50

POLICE

HIGH

HARAHAP
AGUSTINA br

CIVIL

SCHOOL
BACHELOR

08216569533

GINTING S.Pd

GOVERNMENT

DEGREE

Name
AGUS
Father

Mother

KARYONO

Education
SENIOR

Telp No.
08137564949
9

Husband/Wi
fe
Children
No.1
Children
No.2
Children
No.3

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2. Siblings: Brothers/Sisters
No.

Name
MHD. SYAFII ZAIN

HARAHAP
RINDY MITA JULIAND

HARAHAP

Age

M/F

26

24

Telp No.
BACHELOR

Email Address

DEGREE
SENIOR HIGH
SCHOOL

Please answer this below question

Why do you apply for this position/reply to the advertisement?

ANSWER: BECAUSE I WANT TO JOIN IN THIS COMPANY
How would you describe yourself?
ANSWER: IM HARD WORKING, DICILIPLINE,EASY ADAPTATION,CAN
WORK PERSONALLY OR TEAM.
Please describe your 3 strengths and 3 weakness

Strength
1. HIGH-MINDED
2. GOOD SPEAKING
3. HARD WORKING

Weakness
1. TALK IF NECESSARY
2. LITTLE REST
3. LITTLE FORGET

Criminal Convictions

Do you have any criminal record?

If yes, please describe:

Yes [ ]

No [ ]

See this picture carefully, focus on the nose! Which part is more dominance, women or the
man?

ANSWER : WOMEN
2

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C. EDUCATION, WORKSHOP, TRAINING

1. Education
EDUCATION

Name & Place

Education Institute

PRIMAY SCHOOL

SDN 6 Kabanjahe

ELEMENTARY
SCHOOL
SENIOR HIGH
SCHOOL
UNIVERSITY

SMP N 3 Berastagi
SMA N 1 Kabanjahe
Faculty of Pharmacy,
North Sumatera University
(Diploma)

Dates

Remarks

19982004
20042007
20072010
20102013

2. Training
TRAINING
ENGLISH
MARTIAL ART
PHYSIC
SWAFT (Studi
Wisata Analis
Farmasi Terpadu

Name & Place

Education Institute
Standford English
Course
Kei Shin Kan Karate Dojo

Dates

Remarks

20052007
2005-

The Team SMANSAKA of

2010
2008-

Physic Olympiade

2010

PHARMACY FACULTY,
UNIVERSITY OF NORTH
SUMATERA

20102013

3. Please provide at least 2 professional references from your previous job.

Company

Name

Title

Phone

HP

If you need additional space please write on the back of this form.

4. What languages do you speak and are proficient in?

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Language

Speaking

Listening

Writing

INDONESIA

VG

VG

VG

ENGLISH

Remarks
Please use the following abbreviation above
VG: Very Good
G: Good
F: Fair
D. WORKING EXPERIENCE
Dates
(From-To)

Title

Company Name

P: Poor

Reason for
Leaving

EMPLOYMENT DETAILS
Date of Employment :
Company
Company Address
Business Line
Latest Position
Report directly
(Name/Position)
Number of Sub-Ordinates
Job Description

Achievement

Date Employment Ended :

How did you get

employed
Reason for leaving
Last Drawn Salary

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ORGANIZATION STRUCTURE
*) Please draw your position within current/latest organization (including two levels up &
below)

GOVERNOOR

VICE
GOVERNOOR

LEADER
SPORT (ME)

L.PUBLICATION

L. INFRASTUCTUR FACILITIES

STAFF

STAFF

STAFF

Etc.

STAFF

MEMBER
Date of Employment :
Company
Company Address
Business Line
Latest Position
Report directly
(Name/Position)
Number of Sub-Ordinates
Job Description

Date Employment Ended :

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Achievement

How did you get

employed
Reason for leaving
Last Drawn Salary

Date of Employment :
Company
Company Address
Business Line
Latest Position
Report directly
(Name/Position)
Number of Sub-Ordinates
Job Description

Achievement

Date Employment Ended :

How did you get

employed
Reason for leaving
Last Drawn Salary
E. COMPENSATION & BENEFIT DETAIL
No.
1.
2.
3.
4.

5.
6.

Detail Compensation & Benefit

Salary Nett/Gross (monthly)
THR
Incentive Bonus
Allowance
a.
b.
c.

Current

Remark

d.
e.
Car Ownership Program
House Ownership Program

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What is your expected salary?_____IDR 3.250.000

4.500.000_______________________

F. ABOUT PT. CARSURIN

1. What do you know about Carsurin?__CARSURIN is the big company along 40
years has been serving many people about coal and minerals, agriculture,
oil and gas, and many others.
2. Are you willing to place in any Carsurin Branches? Yes I WILL
3. Do you know anybody working for Carsurin? NO
If yes, who is he/she?
4. Are you open for other position you are applying for?
YES. LABORATORY QUALITY MANAGER
What is your passion in life?

MY PASSHION IN LIFE IS SHARING HAPPYNES AROUND US. AND LIKE A CHALLENGE

TO GET SUCCES
What is the 3 most important thing in your life?
1. MY SELF
2. MY FAMILY
3. PEOPLE AROUND ME

I confirm that the information in this application form is true and honest.

Jakarta .

JULY, 23th 2014

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__DIKKY TRI PRATANA HARAHAP__

Applicant

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