DATA PRIBADI (PERSONAL DATA) Nama Lengkap
Full Name
Nama Panggilan Agama
Nickname Religion FOTO
Jenis Kelamin Pria (Male) Suku Bangsa
Gender Wanita (Female) Race
Tempat Lahir Tanggal Lahir Golongan Darah
Place of Birth Birth Date Blood Type
Nomor Kartu Identitas Jenis Kartu Identitas KTP (Recidential Identity Card)
Identification Card Number Type of Identity Card SIM A/ B/ C
Alamat Permanen Alamat Permanen
Permanent Address Permanent Address
Telepon Rumah Telepon Selular Email
Home Phone Celullar Phone Email
Status Perkawinan Lajang (Single) Cerai (Divorced) Golongan Darah
Marital Status Menikah (Married) Janda/ Duda Meninggal (Widow) Blood Type
Ahli Waris Ukuran Baju Ukuran Celana Ukuran Sepatu
Beneficiary Shirt Size Pants Size Shoe Size
SUSUNAN KELUARGA SEBELUM MENIKAH (FAMILY STRUCTURE BEFORE MARRIAGE)
Tuliskan termasuk Diri Anda Sendiri/ Including Yourself Jenis Kelamin (Gender ) Usia (Age ) Pendidikan Akhir (Last Education)
Hubungan (Relationship ) Nama (Name ) (Last Job Experience )Pekerjaan Terakhir
Ayah (Father) P/M
Ibu (Mother) W/F
Saudara 1 (Sister/ Brother) Saudara 2 (Sister/ Brother) Saudara 3 (Sister/ Brother) Saudara 4 (Sister/ Brother) Saudara 5 (Sister/ Brother) Saudara 6 (Sister/ Brother) Saudara 7 (Sister/ Brother) Saudara 8 (Sister/ Brother) Saudara 9 (Sister/ Brother) Saudara 10 (Sister/ Brother)
SUSUNAN KELUARGA SETELAH MENIKAH (FAMILY STRUCTURE AFTER MARRIAGE) Hubungan (Relationship ) Nama (Name )
Jenis Kelamin (Gender )
Tempat Lahir, dan Tgl. Lahir (Place of Birth, and Birthday)
Pekerjaan Terakhir (Last Job Experience) Suami/ Istri (Husband/ Wife)*
Anak 1 (Son/ Daughter 1)* Anak 2 (Son/ Daughter 2)* Anak 3 (Son/ Daughter 3)* Anak 4 (Son/ Daughter 4)* Anak 5 (Son/ Daughter 5)*
Rev. : 1
Tanggal Efektif : 21 April 2014
PT. ANDALAN FURNINDO
FORMULIR APLIKASI CALON KARYAWAN
Nama (Name) :
DATA PENDIDIKAN (EDUCATION)
No. Nama Sekolah Kota Jurusan Tahun Masuk Tahun Lulus Keterangan
Num. Name of School City Major Starting Year Graduate Year Remarks
Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus *
PELATIHAN (TRAINING/ COURSE) PENGHARGAAN (ACHIEVEMENT)
No. Nama Pelatihan/ Kursus Tahun No. Nama Penghargaan Tahun
Num. Name of Course Year Num. Name of Achievement Year
PENGALAMAN ORGANISASI (EXPERIENCES IN ORGANIZATIONS)
No. Nama Organisasi Jabatan Masa Kerja Keterangan
Num. Name of Organization Position Length of Service Remarks
RIWAYAT PEKERJAAN (JOB EXPERIENCES ) Dari pekerjaan terakhir (from the latest job experienced)
1 Nama Perusahaan Awal Bekerja
Name of Company Started to Work on
Jenis Industri Akhir Bekerja
Industry Finished Work on
Jabatan Awal Gaji Awal
First Job Title First Salary
Jabatan Akhir Gaji Akhir
Last Job Title Last Salary
Nama Atasan Langsung Alasan Berhenti
Name of Superior Reason for Resignation
Uraikan Tugas Pokok Anda di Perusahaan Terakhir Anda Bekerja Please Explain Your Main Job or Responsibility in your Last Company you Worked For
Gambarkan Struktur Organisasi di Tempat Terakhir Anda Bekerja serta Gambarkan Posisi Anda pada Struktur Tersebut Please Draw the Organization Structure of your Latest Company that Explained your Latest Position
RIWAYAT PEKERJAAN (JOB EXPERIENCES ) Dari pekerjaan terakhir (from the latest job experienced)
2 Nama Perusahaan Awal Bekerja
Name of Company Started to Work on
Jenis Industri Akhir Bekerja
Industry Finished Work on
Jabatan Awal Gaji Awal
First Job Title First Salary
Jabatan Akhir Gaji Akhir
Last Job Title Last Salary
Nama Atasan Langsung Alasan Berhenti
Name of Superior Reason for Resignation
3 Nama Perusahaan Awal Bekerja
Name of Company Started to Work on
Jenis Industri Akhir Bekerja
Industry Finished Work on
Jabatan Awal Gaji Awal
First Job Title First Salary
Jabatan Akhir Gaji Akhir
Last Job Title Last Salary
Nama Atasan Langsung Alasan Berhenti
Name of Superior Reason for Resignation
4 Nama Perusahaan Awal Bekerja
Name of Company Started to Work on
Jenis Industri Akhir Bekerja
Industry Finished Work on
Jabatan Awal Gaji Awal
First Job Title First Salary
Jabatan Akhir Gaji Akhir
Last Job Title Last Salary
Nama Atasan Langsung Alasan Berhenti
Name of Superior Reason for Resignation
REFERENSI (REFFERENCE)
No. Nama Alamat/ Telepon Jabatan Hubungan
Num. Name Address/ Phone Number Job Title Relationship
NAMA KELUARGA DAN/ ATAU TEMAN YANG BISA DIHUBUNGI DALAM KEADAAN DARURAT (NAME OF FAMILIES AND/OR FRIENDS THAT CAN BE CONTACTED IN EMERGENCY SITUATION)
Hubungan Nama KelaminJenis Alamat Telepon
Rev. : 1
Tanggal Efektif : 21 April 2014
PT. ANDALAN FURNINDO
FORMULIR APLIKASI CALON KARYAWAN
Nama (Name) :
PERTANYAAN TAMBAHAN (ADDITIONAL QUESTION)
Apakah anda terikat kontrak dengan perusahaan tempat kerja anda saat ini? (Are you engaged contract to your current company that you work now?)
Uraian (Explanantion) : Ya/ Yes Tidak/ No
Apakah anda mempunyai teman/ sanak saudara yang bekerja di group /perusahaan ini? Jika Ya, sebutkan nama dan jabatan ybs. (Do you have friend or family that work in this group company/ company? If yes, please mention his/her name and job title.)
Uraian (Explanantion) : Ya/ Yes Tidak/ No
Apakah anda pernah menderita sakit keras/ kronis/ kecelakaan berat/ operasi? Jika Ya, sebutkan. (Have you ever had a serious/ chronic disease/ accident? If yes, please mention.)
Uraian (Explanantion) : Ya/ Yes Tidak/ No
Apakah Anda sedang mengikuti proses rekrutmen dan seleksi di Perusahaan lain? Jika ya, sebutkan nama Perusahaannya. (Are you in the middle of recruitment and selection process for other company? If yes, please mention.)
Uraian (Explanantion) :
Apakah Anda pernah mengikuti proses psikotes/ asesmen psikologis? Jika ya, apa tujuan proses tersebut dan kapan terkahir Anda mengikuti proses tersebut? (have you ever took the psychotest or psychological assessment before? If yes, please mention its purpose and when was the last time you took that test?)
Uraian (Explanantion) :
Berapa besarkah penghasilan anda per bulan dan fasilitas apa saja yang anda peroleh saat ini? (How much is your current salary and what are the facilities or allowances that you got in your current company that you worked per month?)
Uraian (Explanantion) :
Bila diterima, berapa besar gaji dan fasilitas apa yang anda harapkan?
(How much is your expected salary, and/ or facilities?) Uraian (Explanantion) :
Bila diterima, kapankah anda bisa mulai bekerja? (When is your availability time if you accepted to work in this group company/ company?)
Uraian (Explanantion) :
PERNYATAAN (ACKNOWLEDGEMENT)
Dengan ini saya menyatakan bahwa keterangan yang saya berikan di atas, adalah benar isinya. Bilamana ternyata terdapat ketidakbenaran, saya bertanggung jawab penuh atas akibatnya.
I hereby acknowledge that the data I stated above, are true and/or not aginst law or any provisions. If somehow the data prove otherwise, I will have full obligation regarding my statement.
,
Nama Lengkap & Tanda Tangan (Full Name & Signature)
DATA PRIBADI (PERSONAL DATA)
Nama Lengkap WNI Indonesian Citizen
Full Name WNA Foreign Citizen
Nama Panggilan Agama
Nickname Religion FOTO
3X4
Jenis Kelamin Pria (Male) Suku Bangsa
Gender Wanita (Female) Race
Tempat Lahir Tanggal Lahir Golongan Darah
Place of Birth Birth Date Blood Type
Nomor Kartu Identitas Jenis Kartu Identitas KTP (Recidential Identity Card)
Identification Card Number Type of Identity Card SIM A/ B/ C
Alamat Permanen Alamat Sementara
Permanent Address Temporary Address
No. Rekening Bank Mandiri No. NPWP
Bank Account No……… Tax ID
Tidak Ada (None) No. Paspor
Passport ID
Telepon Rumah Telepon Selular Email
Home Phone Celullar Phone Email
Status Perkawinan Lajang (Single) Cerai (Divorced) Golongan Darah
Marital Status Menikah (Married) Janda/ Duda Meninggal (Widow) Blood Type
Ahli Waris Ukuran Baju Ukuran Celana Ukuran Sepatu
Beneficiary Shirt Size Pants Size Shoe Size
SUSUNAN KELUARGA SEBELUM MENIKAH (FAMILY STRUCTURE BEFORE MARRIAGE)
Tuliskan termasuk Diri Anda Sendiri/ Including Yourself Jenis Kelamin (Gender ) Usia (Age ) Pendidikan Akhir (Last Education)
Hubungan (Relationship ) Nama (Name ) (Last Job Experience )Pekerjaan Terakhir
Ayah (Father) P/M
Ibu (Mother) W/F
Saudara 1 (Sister/ Brother) Saudara 2 (Sister/ Brother) Saudara 3 (Sister/ Brother) Saudara 4 (Sister/ Brother) Saudara 5 (Sister/ Brother) Saudara 6 (Sister/ Brother) Saudara 7 (Sister/ Brother)
SUSUNAN KELUARGA SETELAH MENIKAH (FAMILY STRUCTURE AFTER MARRIAGE) Hubungan (Relationship ) Nama (Name )
Jenis Kelamin (Gender )
Tempat Lahir, dan Tgl. Lahir (Place of Birth, and Birthday)
Pekerjaan Terakhir (Last Job Experience) Suami/ Istri (Husband/ Wife)*
Anak 1 (Son/ Daughter 1)* Anak 2 (Son/ Daughter 2)* Anak 3 (Son/ Daughter 3)* Anak 4 (Son/ Daughter 4)* Anak 5 (Son/ Daughter 5)*
Rev. : 2
Tanggal Efektif : 17 Juni 2014
PT. ANDALAN FURNINDO
FORMULIR APLIKASI CALON KARYAWAN
Nama (Name) :
DATA PENDIDIKAN (EDUCATION)
No. Nama Sekolah Kota Jurusan Tahun Masuk Tahun Lulus Keterangan
Num. Name of School City Major Starting Year Graduate Year Remarks
Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus * Lulus/ Tidak Lulus/ Belum Lulus *
PELATIHAN (TRAINING/ COURSE) PENGHARGAAN (ACHIEVEMENT)
No. Nama Pelatihan/ Kursus Tahun No. Nama Penghargaan Tahun
Num. Name of Course Year Num. Name of Achievement Year
PENGALAMAN ORGANISASI (EXPERIENCES IN ORGANIZATIONS)
No. Nama Organisasi Jabatan Masa Kerja Keterangan
Num. Name of Organization Position Length of Service Remarks
RIWAYAT PEKERJAAN (JOB EXPERIENCES ) Dari pekerjaan terakhir (from the latest job experienced)
1 Nama Perusahaan Awal Bekerja
Name of Company Started to Work on
Jenis Industri Akhir Bekerja
Industry Finished Work on
Jabatan Awal Gaji Awal
First Job Title First Salary
Jabatan Akhir Gaji Akhir
Last Job Title Last Salary
Nama Atasan Langsung Alasan Berhenti
Name of Superior Reason for Resignation
Uraikan Tugas Pokok Anda di Perusahaan Terakhir Anda Bekerja Please Explain Your Main Job or Responsibility in your Last Company you Worked For
Gambarkan Struktur Organisasi di Tempat Terakhir Anda Bekerja serta Gambarkan Posisi Anda pada Struktur Tersebut Please Draw the Organization Structure of your Latest Company that Explained your Latest Position
RIWAYAT PEKERJAAN (JOB EXPERIENCES ) Dari pekerjaan terakhir (from the latest job experienced)
2 Nama Perusahaan Awal Bekerja
Name of Company Started to Work on
Jenis Industri Akhir Bekerja
Industry Finished Work on
Jabatan Awal Gaji Awal
First Job Title First Salary
Jabatan Akhir Gaji Akhir
Last Job Title Last Salary
Nama Atasan Langsung Alasan Berhenti
Name of Superior Reason for Resignation
3 Nama Perusahaan Awal Bekerja
Name of Company Started to Work on
Jenis Industri Akhir Bekerja
Industry Finished Work on
Jabatan Awal Gaji Awal
First Job Title First Salary
Jabatan Akhir Gaji Akhir
Last Job Title Last Salary
Nama Atasan Langsung Alasan Berhenti
Name of Superior Reason for Resignation
4 Nama Perusahaan Awal Bekerja
Name of Company Started to Work on
Jenis Industri Akhir Bekerja
Industry Finished Work on
Jabatan Awal Gaji Awal
First Job Title First Salary
Jabatan Akhir Gaji Akhir
Last Job Title Last Salary
Nama Atasan Langsung Alasan Berhenti
Name of Superior Reason for Resignation
REFERENSI (REFFERENCE)
No. Nama Alamat/ Telepon Jabatan Hubungan
Num. Name Address/ Phone Number Job Title Relationship
NAMA KELUARGA DAN/ ATAU TEMAN YANG BISA DIHUBUNGI DALAM KEADAAN DARURAT (NAME OF FAMILIES AND/OR FRIENDS THAT CAN BE CONTACTED IN EMERGENCY SITUATION)
Hubungan Nama KelaminJenis Alamat Telepon
Relationship Name Gender Address Phone Number
Rev. : 2
Tanggal Efektif : 17 Juni 2014
PT. ANDALAN FURNINDO
FORMULIR APLIKASI CALON KARYAWAN
Nama (Name) :
PERTANYAAN TAMBAHAN (ADDITIONAL QUESTION)
Apakah anda terikat kontrak dengan perusahaan tempat kerja anda saat ini? (Are you engaged contract to your current company that you work now?)
Uraian (Explanantion) : Ya/ Yes Tidak/ No
Apakah anda mempunyai teman/ sanak saudara yang bekerja di group /perusahaan ini? Jika Ya, sebutkan nama dan jabatan ybs. (Do you have friend or family that work in this group company/ company? If yes, please mention his/her name and job title.)
Uraian (Explanantion) : Ya/ Yes Tidak/ No
Apakah anda pernah menderita sakit keras/ kronis/ kecelakaan berat/ operasi? Jika Ya, sebutkan. (Have you ever had a serious/ chronic disease/ accident? If yes, please mention.)
Uraian (Explanantion) : Ya/ Yes Tidak/ No
Apakah Anda sedang mengikuti proses rekrutmen dan seleksi di Perusahaan lain? Jika ya, sebutkan nama Perusahaannya. (Are you in the middle of recruitment and selection process for other company? If yes, please mention.)
Uraian (Explanantion) :
Apakah Anda pernah mengikuti proses psikotes/ asesmen psikologis? Jika ya, apa tujuan proses tersebut dan kapan terkahir Anda mengikuti proses tersebut? (have you ever took the psychotest or psychological assessment before? If yes, please mention its purpose and when was the last time you took that test?)
Uraian (Explanantion) :
Berapa besarkah penghasilan anda per bulan dan fasilitas apa saja yang anda peroleh saat ini? (How much is your current salary and what are the facilities or allowances that you got in your current company that you worked per month?)
Uraian (Explanantion) :
Bila diterima, berapa besar gaji dan fasilitas apa yang anda harapkan?
(How much is your expected salary, and/ or facilities?) Uraian (Explanantion) :
Bila diterima, kapankah anda bisa mulai bekerja? (When is your availability time if you accepted to work in this group company/ company?)
Uraian (Explanantion) :
PERNYATAAN (ACKNOWLEDGEMENT)
Dengan ini saya menyatakan bahwa keterangan yang saya berikan di atas, adalah benar isinya. Bilamana ternyata terdapat ketidakbenaran, saya bertanggung jawab penuh atas akibatnya.
I hereby acknowledge that the data I stated above, are true and/or not aginst law or any provisions. If somehow the data prove otherwise, I will have full obligation regarding my statement.
,
Nama Lengkap & Tanda Tangan (Full Name & Signature)
