HRD – B.01/07/2011 Date / Tgl :
Position applied for / Posisi : _______________________ Salary desired / Gaji :
PERSONAL / DATA PRIBADI
Name / Nama : __________________________ Citizen / Warga negara : __________________________ Age / Umur :
Sex (F/M) / Jenis Kelamin (P/L) : Religion / Agama :
Address / Alamat : ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Marital status / Status : Single / Lajang Married / Menikah Divorce / Cerai : Others / Lain – lain : ________________
Telephone numbers / Nomor telephone :
Home / Rumah : -‐ Handphone : -‐
Place of birth / tempat tgl lahir : ____________________ Date of birth / Tgl lahir :
Language written and spoken / Bahasa yang dikuasai (lisan/tulisan) ____________________ Language spoken only / Bahasa yang dikuasai (lisan) _________________________________
When was your latest medical check – up? / Kapan anda terakhir periksa kesehatan ? ____________ Please check which of the following were performed / Pemeriksaan yang telah dilakukan
Chect X – Ray / Rontgen
Blood Count (culture) / Periksa darah
Laboratory examination of stool, urine, etc / Pemeriksaan Laboratorium untuk kotoran, urine, dsb Electrocardiogram (EOG)
Blood pressure / Tekanan darah Others (Specify) / Lain – lain Health / Kesehatan :
Do you suffer from any serious ailment or Phisycal handicap whose effects impair your ability to handle the job you are applying for / Apakah anda menderita suatu penyakit yang serius atau cacat tubuh yang mengakibatkan kesulitan bagi anda dalam melaksanakan tugas yang sedang anda lamar ? If yes, please specify / Jika iya, mohon dijelaskan : ______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Are you employed at present ? / Apakah anda masih bekerja saat ini ? _______________________ How soon can you join MARINTUR ? / Kapan anda bisa segera bergabung di MARINTUR ? ________ If you married, name and occupation of your spouse / Bila saudara menikah, sebutkan nama dan pekerjaan pasangan saudara ______________________________________________________ Jumlah anak ____________ Jumlah tanggungan (bila ada) _______________________________ If you are head of the family, list down your dependets / Bila saudara adalah kepala keluarga, buatlah daftar tanggungan saudara :
Name / Nama P/L
F/M Tempat & Tanggal Lahir Place & Date of birth Pendidikan Education
Family / Keluarga Name / Nama Age / Umur Education / Pendidikan
Father / Ayah Mother / Ibu Brothers / Saudara laki-‐laki Sisters / Saudara perempuan
Where do you live ? Dimana anda tinggal ? -‐ In own home / Rumah sendiri
-‐ In rented home / Rumah sewa
-‐ With parents in law or in relatives home / Bersama mertua, saudara atau keluarga
Do you have any relatives in MARINTUR ? / Apakah anda mempunyai keluarga di MARINTUR ? _____ Name dan relationship / Nama dan hubungan ____________________________________________ Do you know about business or ever know about MARINTUR, if you do, please explain how far / Apakah anda sudah mengenal atau pernah tahu mengenai bisnis MARINTUR, jika iya, berilah penjelasan apa yang anda ketahui : ______________________________________________________ ____________________________________________________________________________
Do you have other sources of income besides your employment / Apakah anda mempunyai sumber penghasilan lain disamping penghasilan tetap ? ________________________________________ Are you in debt ? If yes to whom, how much and far ? what reason are you in debt ? / Apakah anda mempunyai hutang ? Bila ada, kepada siapa, berapa dan untuk keperluan apa ?
____________________________________________________________________________ Leisure interest, sports, hobbies / Hobby dalam mengisi waktu luang ________________________
PRESENT EMPLOYMENT / PEKERJAAN SAAT INI
Company / Perusahaan _______________________________________________________________ Address / Alamat ____________________________________________________________________ Business of company / Bisnis perusahaan :
Manufacturing / Pabrik : Service / Pelayanan : Trading / Perdagangan : Finance / Keuangan :
Others / Lain-‐lain ____________________________________
Products, service / Produk, layanan _____________________________________________________ Date joined / Tanggal mulai bekerja _____________________________________________________ State various position held in your present company, starting with carliest / Macam-‐macam jabatan yang anda ingin mulai dari awal :
Duration : month and year / Lama : bulan dan tahun
Position / Jabatan From / Dari To / sampai dengan
Description of current job / Penjelasan atas pekerjaan sekarang :
Report to / Melapor kepada __________________________________________________________ Supervise / Mengawasi _______________________________________________________________ Main responsibilities, significant achievements / tanggung jawab utama :
__________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
CURRENT REMUNERATION / REMUNERASI
Present annual remuneration broken down into / Perincian remunerasi tahunan : Basic Salary / Gaji pokok ___________________________________ per month / bulan Annual bonus / bonus tahunan
Transportation ( non refundable ) / Transport ________________________ month / bulan x 12 Others (specify) / Lain-‐lain (jelaskan) ____________________________________________________ __________________________________________________________________________________ Total annual remuneration / Total remunerasi tahunan ____________________________________ No of days vacation leave per year / Jumlah cuti per tahun _________________________________ No of working days per week / Jumlah hari kerja per minggu ________________________________
PAST EMPLOYMENT HISTORY / RIWAYAT PEKERJAAN
(List below the details of your work history beginning with the most recent. Attach, if available, copy of documents certifying your term of employement / Perincian riwayat pekerjaan anda, mulai dari yang terakhir. Lampirkan, bila ada, copy surat keterangan kerja anda)
1. Name of company / Nama perusahaan
Nature of business, products and services / bisnis, produk dan layanan
_______________________________________________________________________________ Date joined / Tanggal mulai
Date quited / Tanggal berhenti
Position on joining / Jabatan awal __________________________________ Position on lasting / Jabatan terakhir __________________________________ Monthly salary on joining / Gaji pertama
Monthly salary on lasting / Gaji terakhir
Describe briefly your job and any significant accomplishments / Jelaskan dengan singkat pekerjaan anda _____________________________________________________________ Reason for leaving, wanting to leave / Alasan berhenti _______________________________ _________________________________________________________________________ 2. Name of company / Nama perusahaan
Nature of business, products and services / bisnis, produk dan layanan
_______________________________________________________________________________ Date joined / Tanggal mulai
Position on joining / Jabatan awal __________________________________ Position on lasting / Jabatan terakhir __________________________________ Monthly salary on joining / Gaji pertama
Monthly salary on lasting / Gaji terakhir
Describe briefly your job and any significant accomplishments / Jelaskan dengan singkat pekerjaan anda _____________________________________________________________ Reason for leaving, wanting to leave / Alasan berhenti _______________________________ _________________________________________________________________________
3. Name of company / Nama perusahaan
Nature of business, products and services / bisnis, produk dan layanan
_______________________________________________________________________________ Date joined / Tanggal mulai
Date quited / Tanggal berhenti
Position on joining / Jabatan awal __________________________________ Position on lasting / Jabatan terakhir __________________________________ Monthly salary on joining / Gaji pertama
Monthly salary on lasting / Gaji terakhir
Describe briefly your job and any significant accomplishments / Jelaskan dengan singkat pekerjaan anda _____________________________________________________________ Reason for leaving, wanting to leave / Alasan berhenti _______________________________ _______________________________________________________________________________
Have you ever been suspended or asked to resign from any position ? If yes, where and why ? / Apakah anda pernah diminta untuk berhenti bekerja ? jika iya, dimana dan mengapa ?
_______________________________________________________________________________ Explain any period of unemployment / Jelaskan jangka waktu bilamana anda tidak bekerja _______________________________________________________________________________ Are you involved in any administrative, civil or criminal case ? if yes, please describe the details of the case / Apakah anda terlibat kasus administrasi, sipil atau kriminal ? Jika iya, mohon jelaskan kasus anda ______________________________________________________________________ _________________________________________________________________________
Have you applied with our company before ? If yes, give date applied / Apakah Pernah malamar di perusahaan kami sebelumnya ? Jika iya, beri tanggal melamarnya
EDUCATION, PROFESSIONAL, QUALIFICATION / KUALIFIKASI PENDIDIKAN
(Attack copies of diploma, transcipts / Lampirkan copy diploma, transkip)Inclusive dates / tahun Name & address of school / Nama & alamat
sekolah From / Dari
To / Sampai dengan Degree / Lulus Major subject/ Subjek Honors or Awards / Penghargaan Elementary/SD
Junior High School
/ SMP
Senior High School
/ SMA Academy / Akademi University / Universitas
Post Graduated or advance study / Lanjutan Others Courses / Kursus lain
Name at leat three (3) person business or in your profession who have known your for at least 5 (five) years, but who are not previous employers not your relatives / Tuliskan nama-‐ nama 3 orang yang pernah berhubingan bisnis dengan anda untuk 5 tahun terakhir tetapi bukan atasan anda sebelumnya dan bukan saudara anda :
Name / Nama Address / Alamat Occupation / pekerjaan No of years known / Lama kenal
Name some of the seminars or workshop you have attended during the last five (5) years / Seminar atau workshop yang anda ikuti selama 5 tahun terakhir :
Name of seminars or workshop / Nama seminar atau workshop
Place / Tempat Date / Tanggal Counducted by (Name of organization) / Diadakan oleh (Nama organisasi)
OTHER INFORMATION / KETERANGAN LAIN
Use this space for additional information you wish to provide concering yourself of your job responsibilities (eq.major achievements goals, personal interest, etc) / Jelaskan tambahan informasi yang ingin anda berikan sehubungan dengan diri dan tanggungjawab anda _________ __________________________________________________________________________ _________________________________________________________________________
I hereby acknowledge that all the information provided herein are to the best of my knowledge true and accurate. In the event I am selected for the job I hereby allow MARINTUR, my prospective employer, to verify indepedently the information contained herein prior to my actual employement. Any material misrepresentation or omission of information may be grounds for my prospective employer’s decision to reject my application or in the I am hired, for my immediate termination while under probation / Informasi yang saya jelaskan diatas adalah benar dan akurat dalam hal saya diterima bekerja dengan ini saya mengijinkan calon atasan saya untuk meneliti lebih jauh perihal pekerjaan saya sebelumnya. Bila ada hal-‐hal yang tidak benar, saya tidak berkeberatan bila calon atasan saya menolak lamaran saya atau memberhentikan segera selama masa percobaan.
..., ... ______________________
