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EMPLOYMENT APPLICATION FORM

Position Applied :

PERSONAL DATA
Full Name
Place/Date of Birth
National ID Number
Marital Status
Email Address
Phone Number
Permanent Home Address (based on your Current Home Address (if different from
National ID Number) : Permanent Home Address) :

Phone Number : Phone Number :

FAMILY BACKGROUND
Place/Date of Gend
Name Education Occupation
Birth er
Father M/F*
Mother M/F*
1st M/F*
Child
2ndChil M/F*
d
3rd M/F*
Child
4th M/F*
Child
5th M/F*
Child

Spouse M/F*
1st M/F*
Child
2nd hild M/F*
3rd M/F*
Child
4th M/F*
Child
*mark that fit your family

Please list 3 persons that we can contact, in case of emergency

 Relationshi
Name Address Phone Number
p

EDUCATION
Formal Education
School/ Institution Start
Faculty Major Location GPA
Name Finish Year
Diploma
I/II/III*
Bachelor
Master
Doctoral
*mark that fit your education

Informal Education / Training / Course / Seminar

No Subject / Topic Duration Provider Certificat
e
1. Yes/No*
2. Yes/No*
3. Yes/No*
4. Yes/No*
5. Yes/No*
*mark that fit you

SKILLS
Language (foreign language)
Write Speak
N
Language Goo Goo
o Poor Fair Poor Fair
d d
1.
2.
3.

JOB EXPERIENCES
(Start from the latest)
Join Leave
Company Name Position Salary
Date Date

May HR
Supervisors
Supervisors Name Supervisors Email contact your
Phone Number
Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?
 Summary of Job Description Reason For Leaving

Join Leave
Company Name Position Salary
Date Date

May HR
Supervisors
Supervisors Name Supervisors Email contact your
Phone Number
Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?

Summary of Job Description Reason For Leaving

Join Leave
Company Name Position Salary
Date Date

May HR
Supervisors
Supervisors Name Supervisors Email contact your
Phone Number
Supervisor?

Were you a Supervisor in this position? Yes/No

If yes, how many people did you supervise?

Summary of Job Description Reason For Leaving

INTEREST
In which division and position are you interested for the future?

Where do you know about Veda Praxis and where you know the job vacancy from?
Please explain, why you want to work in Veda Praxis?

Are you willing to travel outside Jakarta? Yes / No (please explain)

If Yes, how often are you willing to travel? (Please select from below options)
Anytime Once a Week Twice a Month Once a Month
Are you willing to work overtime? Yes / No (please explain)

If Yes, When will be the latest time you are willing to work? (Please select from below
options)
Anytime After Midnight 23.00 21.00 19.00

Please mention the salary and benefit expectation.

Current Monthly Salary Desired Monthly Salary
Net / Gross* Net / Gross*
Current Benefit Desired Benefit
Benefit Amount Benefit Amount

SOCIAL ACTIVITY
Organization Activities
N DD-MM-YY
Organization Name Position Place
o DD-MM-YY
1.
2.
3.
4.
5.

Please mention your hobbies!

What would you do in your spare time?

OTHER INFORMATION
Have you applied to Veda Praxis before ? If yes, please mention the time and
position applied.

Do you have relatives and or friends who worked in Veda Praxis? If yes, please
mention the name(s) and relationship(s).

Do you also apply to any other company? If yes, please mention the company and
position applied.
Do you have any part-time jobs? If yes, please explain.

Have you ever had serious illness or undergone surgery or gotten into serious
accident ? If yes, please explain.

Do you have any serious illness that require specific condition for working ? If yes,
please explain.

In your opinion, what is your 5 strength ?

In your opinion, what is your 5 weakness that you need to improve ?

Please mention further information which may be helpful in considering your

qualifications.

I hereby certify that all the information given above are true and if under any
circumstances omission or misrepresentation is found, I understand that I shall be
fully held responsible.

Date :
Applicant Signature

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