PT.

REERACOEN INDONESIA,
Trivium Square No. 18
Jl. MH. Thamrin, Lippo Cikarang

JOB APPLICATION FORM

Thank you for coming today.

Before we start the interview, please answer the following questions.
Do you declare that your CV and experiences are true? Yes / No

Are you eager to change your job? Yes / Not really / No

Are you in any forms of work contract with your current job? Yes (there will be a penalty ) / No / others

When you receive an offer will you be able to decide it by yourself? Yes / No (My wife / My husband /My parents / others)

When are you available to have an interview with our client? Need to ask for permission /any time (exact date: )

For Japanese speaker, do you have JLPT certification? Yes / No

Have you ever been interview with Reeracoen before? Yes / No

If possible, please bring the following documents.

☐1. Photocopy of Transcript of Record from University or College graduated in

☐2. Photocopy of PRC License Certificates for Professionals or Certificate for passing a language test or any test

☐3. Photocopy of Employment Certificate from previous employer

☐4. Copy of their updated Resume ☐5.NPWP Copy ☐6. BPJS Copy ☐7. Last pay slip ☐8. SKCK (Clearance)

*If it is proven that there are any incorrect information in the data you have provided, you will be charged for
compensation as much as 3 times your current monthly salary.
(For example: Providing false University name, current salary amount, etc.)

“I hereby declare that the provided statements and information above is true and correct.”
“I hereby consent to the provision of my personal information and entrust your company services.”

Name GUNAWAN ADAM

Signature ______TTD_________________

Thank you for your co-operation.

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PT. REERACOEN INDONESIA,
Trivium Square No. 18
Jl. MH. Thamrin, Lippo Cikarang

Date: MARCH 13RD 2018

MECH FACILITY ENGINEER/ MECH SURVEYING

Position applied for: Expected Salary: 16.500.000
ENGINEER / OPERATION ENGINEER

PERSONAL INFORMATION

Name: GUNAWAN ADAM

Surname Given Name Middle Name

Birthdate: OCT 27-1989 Age: 28 Gender: MALE

Driving
Status: MARRIED Religion: ISLAM A/C
license:

ID Card No.: NEXT STEP I WILL GIVE BPJS No: NEXT STEP I WILL GIVE

NPWP No.: NEXT STEP I WILL GIVE E-mail.: GUNAWANADAM08@GMAIL.COM

Address: PERUMAHAN TAMAN KRAKATAU BLOK F3 NO 7, KEC WARINGINKURUNG, KAB SERANG

Phone Phone
① 085263006896 ②
No.: No.:

ACADEMIC QUALIFICATIONS

Year Qualifications Obtained

Schools/Institutions Attended Major/GPA
From To (Level, Degree, Diploma)
2008 2013 ANDALAS UNIVERSITY DEGREE 3.12
INSTITUT TEKNOLOGI 10
2010 2011 EXCHANGE -
NOVEMBER
2018 NOW MERCUBUANA UNIVERSITY MASTER -

OTHER QUALIFICATIONS/COURSES ATTENDED/AWARDS ATTAINED

Year
Qualifications and Awards Obtained Achievements
From To
2018 - Certified in Fall Protection Technician
Familiar with Theodolite.

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PT. REERACOEN INDONESIA,
Trivium Square No. 18
Jl. MH. Thamrin, Lippo Cikarang

Familiar with Leica TCA 1800

Familiar with Laser Tracker TDRA6000

DETAILS OF PREVIOUS EMPLOYMENT

Employer: KRAKATAU POSCO Position: SPV

Monthly Salary: 10.700.000 (THP) Incentives:

Key Responsibilities:

Report to: TEAM LEADER MECHANICAL Employee Status: PERMANENT

Duration: JUNE-2013 - NOW Reason for leaving: BETTER OPPORTUNITY AND BETTER LIFE
Date start – Date End

Employer: Position:

Monthly Salary: Incentives:

Key Responsibilities:

Report to: Employee Status:

Duration: Reason for leaving:

Date start – Date End

Employer: Position:

Monthly Salary: Incentives:

Key Responsibilities:

Report to: Employee Status:

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PT. REERACOEN INDONESIA,
Trivium Square No. 18
Jl. MH. Thamrin, Lippo Cikarang

Duration: Reason for leaving:

Date start – Date End

PROFESSIONAL REFERENCE

MANAGER MARKETING EXECUTIVE ASIA

Name: BAYU ADAM Position:
PACIFIC

Company Name: MAERSK

Contact No.: 081310011137 Email: BAYUADAM@YAHOO.COM

PERSONAL REFERENCE

Name: Position:

Company Name:

Contact No.: Email:

CAREER PLAN

Priority while you looking for job, what’s important for you while you decided to change job.

① SALARY AND BENEFIT

② IMPROVE KNOWLEDGE

③ CAREER STAGE

Kind of Job that:

You like : ENGINEER / MARKETING/ FIELD/SUPPLY CHAIN

You don’t like : FULL BACK OFFICE

Position you prefer : ENGINEER/ MARKETING/SUPPL Y CHAIN

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PT. REERACOEN INDONESIA,
Trivium Square No. 18
Jl. MH. Thamrin, Lippo Cikarang

Career plan in 5 years MANAGER POSITION AND HAVE ANY KIND OF SERTIFICATION FROM SUPPLY CHAIN
:
ahead AND LOGISTIC

PREFERRED INDUSTRY CATEGORY

Software / Information Processing Manufacturing (Computer / Telecommunication)

IT / Telecommunications Manufacturing (Electronics / Semiconductors)
Web / Mobile / Game X Manufacturing (Automobile)
Food Services X Manufacturing (Machinery)
X Retail X Manufacturing (Chemicals / Materials)
Hospitality, Tourism, and Leisure X Manufacturing (Food)
Human Resources X Manufacturing (Pharmaceutical / Medical Equipment)
Call Center Manufacturing (Other)
Medical and Healthcare Finance (Banking)
Education Finance (Insurance)
Publishing / Printing / Advertising / Broadcasting Finance (Securities)
Trading Firm Finance (Other)
X Logistic Real Estate
Retail / Distribution (Fashion and Apparel) Civil Engineering / Architecture
Retail / Distribution (Other) X Utilities
Consulting Other

PREFERRED WORK LOCATION

X Jakarta X Tangerang X Karawang

X Bogor X Bekasi X Cibitung
X Depok X Lippo Cikarang X Any

CHARACTER REFERENCES

Strength: EASY TO LEARN, TEAM WORKERS, PROBLEM SOLVER, MARKETING SKILL

Weakness: -

Do you have pending application/s?

Yes X No

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PT. REERACOEN INDONESIA,
Trivium Square No. 18
Jl. MH. Thamrin, Lippo Cikarang

If YES, please provide the details below:

Company Name: Date of application:

Company Name: Date of application:

Have you ever been convicted for any criminal case and/or violate deny law under the Indonesian Government?
Yes X No
If YES, please explain further:

Do you allow the company to conduct background check to verify the authenticity of the information you provided?
Yes X No
If NO, kindly state the reason why: YOU DO NOT NEED TO DO IT BECAUSE I GIVE INFO THAT IS THE TRUTH

PLEASE CHECK THE FOLLOWING APPROPRIATE BOX FOR THE REQUIREMENTS THAT YOU HAVE BROUGHT WITH YOU

X Updated Curiculum Vitae Copy of ID Card Number

X Copy of university transcript Copy of NPWP Number
X Copy of professional license or language test Copy of Jamsostek / BPJS Number
Copy of reference letter from previous employer Copy of SKCK

I verify that the above information is correct to the best of my knowledge. I accept that providing false information
deliberately could result in my dismissal.

MARCH 13 RD 2018
GUNAWAN ADAM
Signature above Printed Name Date

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