Application for Employment Form

FO-HR-02

Position applied for

Date : __________________

1. Personal data
Last name

First name

Middle Name

Date of birth

Place of birth

Gender

2. Present address
Zip Code:
E-mail Add

Telephone (include area code)

Mobile Phone

3. Permanent address

ZIP Code

Telephone (include area code)

Present Address
Married

4. Where should we contact you?

5. Civil Status

Single

Permanent Address

Any/Both

Number of Children:

Spouse/parents name:

Occupation:

Address:

Telephone:

6. Personal ID
ID Card No: _________________________

7. Blood Type

NPWP No : ______________________

AB

8. Family
Name

Relationship

Date Birth

Address

9. Emergency Contact
Name: _______________________

Phone: _______________________

Addres: _____________________________________________________

_____________________________________
10. Religion

11. Health

Are you under long-term medical treatment for

ailments? (If yes, please describe nature of illness.)

Vision (if any)

Physical Disability (if any)

12. Academic qualification

Year (from to)

Mental History (if any)

(Graduate course first down to high school diploma)

Institution/school

Degree/certificate

Specialization

Average grade

13. Professional Qualification

Year passed

14. Language
Language

(Most relevant licenses, competency courses, aptitude tests)

Institution/school

Certificate/level

Specialization

Average grade

Proficiency: E = Excellent, G = Good,C = Communicative, F = Fair, NA = No Applicable

1.

2.

3.

4.

5.

Read
Write
Speak

15. For applicants to technical positions

Type

(Indicate your proficiency using scale 1-5, 5 being expert)

Rating
Type
Rating
Type

Rating

Operating systems
Languages
RDBMS
System programming
Client-server
Mainframe
Hardware platforms
Others, describe

16. Employment details

From To

(Present/Latest first)

Position

Employers name & address

(mm/yy)

17. Describe your current/latest assignment

Reasons for Leaving

Take Home Pay /

month

(Give details of your responsibilities, your contribution, indicate person you report to and
persons reporting to you.)

18. Compensation Details

Monthly base pay

IDR

Monthly allowance

IDR

Monthly gross pay

IDR

Monthly net pay

IDR

(Based on current or last monthly salary)

List other benefits

Monthly Take Home

Pay :

19. Expected Take Home Pay

IDR

Benefits :

20. When can you start working for IT Group Indonesia.?

Date:

Are you under bond with your present employer? If yes, give details.

21. Reasons for joining IT Group Indonesia.

Briefly describe why you want to join IT Group Indonesia. and your expectations.

22. Relatives in IT Group Indonesia.

State whether you have any relative working with IT Group Indonesia.

23. References

State where do you know this vacation.

24. Previous Applications

State whether you have applied before for any position at IT Group Indonesia. and give details.

Declaration
I certify that the foregoing information are true and correct and hereby authorize the company to verify any of the
above given information.
If found incorrect after selection for employment, I understand that my services may be terminated.
Signature of Applicant:

Date Signed:

For HR use
Date
Psychotest Result (by HR)

Recommended

Considered

Rejected

Interview 1 Result

Recommended

Considered

Rejected

Interview 2 Result

Recommended

Considered

Rejected

Interview 3 Result

Recommended

Considered

Rejected

Hired

Keep for Reference

Rejected

Final Result (by User)

Join Date (If Hired)

Position

Processor

Signature: