Name	Address/Phone	Occupation	Relationship

Relationship	Name	Gender	Age	Latest Education	Occupation		Information
					Position	Company
Father
Father
Mother
Sibling 1
Sibling 2

Level	Name Of School	City	Major	Period		Pass/Fail
				From	To
Primary
Junior High
Senior High
Academy
University

Name of Course	Organizer	City	Period	Year	Certificate

Skills	Listening	Reading	Speaking	Writing
	Excellent Good Fair Average	Excellent Good Fair Average	Excellent Good Fair Average	Excellent Good Fair Average
	Excellent Good Fair Average	Excellent Good Fair Average	Excellent Good Fair Average	Excellent Good Fair Average

Name of organization	Kind of Organization	Position	Period

A

B

Name	Address/Phone	Occupation	Relationship

Question	Answer
	Yes/No	Explanation
Have you ever apply in this Company before? When and for what position?	Yes No
Are you currently applying in another company?	Yes No
Do you have any side job? In what position and where?	Yes No
Do you have a contract with current employer? If yes, when does it expire?	Yes No
Do you object if we request a reference from your previous companies?	Yes No
Do you have friends/family who works at this Company? Named them!	Yes No
Do you have chronic illness/ Surgery before? When and what kind is it?	Yes No
Have you ever been investigated by the police for criminal act? When, where, and why?	Yes No
If you are accepted, are you willing to travel?	Yes No
How much is your current monthly salary? State your Basic & THP amount!
Currently what facilities/benefits do you get? Mention them in details!
What is your salary and facility expectation at the least?
If you are accepted, when can you join?

• In the interest of the Company’s performance, the Company may require me to be moved to another position or location of work within the organization by taking into account my education, experience and ability, without any reduction of my formerly salary and facility.
  Untuk kepentingan kinerja Perusahaan, saya bersedia untuk dipindahkan ke bagian lain atau lokasi lain dalam organisasi Perusahaan, dengan memperhitungkan pendidikan, pengalaman serta kemampuan yang saya miliki, tanpa mengurangi gaji dan fasilitas semula.
• I further declare that I am not a relative, (directly or indirectly) to any existing employees/members of PT. ABHIMATA PERSADA
  Saya lebih lanjut menyatakan bahwa saya tidak memiliki saudara/ kerabat (secara langsung atau tidak langsung) yang bekerja di PT. ABHIMATA PERSADA
• I certify that the statements made in this application form are true and complete, I understand that any misrepresentation or omission will be considered sufficient reason for withdrawal of an offer or dismissal if employed.
  Saya menyatakan bahwa pernyataan-pernyataan yang dibuat dalam lamaran ini adalah benar dan lengkap, saya mengerti bahwa bila ada pernyataan palsu dapat dipakai sebagai alasan yang kuat untuk penolakan penerimaan kerja atau pemecatan bila sudah bekerja.

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