CONFIDENTIAL

APPLICATION FORM

Recent Photograph

NAME : Novita Debora

POSITION : Account Executive

INTERVIEW DATE : Friday, 10-03-2017

Bring along your updated Resume and related documents for the interview
NB: For Creative position please bring your portfolio

NAVA+ Group
Gd. BRI Agro 2nd Floor, Jl. Mampang Prapatan Raya No. 139B, Jakarta Selatan 12740
T. (+6221) 7919 4560 F.(+6221) 7919 4561
Web: www.irisnation.com
Email: [email protected]
 1. Personal Details

Name / Mr/Mrs/Miss) Nick Name Marital Status Number of Children

Novita Debora Novita Single 2

Current Address Tel (Local) Mobile Tel Place / Date of Birth

Jeruk 12 no 271 Perumnas 1 Bekasi Barat 081295944960 Bekasi, 26 November 1990

Other Address (If any) Other Mobile Fax Sex Height/Weight

Female 58
Religion Citizenship Ethnic Group Email Mode of Transport

Kristen [email protected] Public Transportation

2. Family (Included Father, Mother, Wife/Husband, Siblings, Children, If Any)

Name Relationship Place & Date of Birth Occupation Company / Institution

Sahala Sinaga Father 11/7/1953 PNS Mabes ABRI

Risma Simorangkir Mother 5/8/1953

Enny Sinaga Sister 18-02-1984 Nurse MRCC SILOAM

Desi Sinaga Sister 20-12-1991 Nurse Hermina Hospital

3. Education / Professional Qualifications

School/College/Tertiary
From To Qualification Attained Location
Institution Attended

SDN Kranji X 1997 2003 Bekasi

SMP Negeri 4 2003 2006 Bekasi

SMAN 12 2006 2009 Bekasi

Universitas Kristen Indonesia 2009 2013 Jakarta

4. Employment History (in chronological order beginning with the most recent position)

Employer / Company Date (dd/mm/yy) Last Drawn Reason(s) For

Position Main Responsibilities
Name Phone No. From To Salary Leaving

The British Institute /9/2013 /4/2014 Student Advisor 2jt Marketing and Accounting
Want to having a new exper

Agung Sedayu
/7/2014 /4/2015 Marketing Executive 15jt with commision Selling property
Get a better offering in other co
Group

Prioritas Land
/5/2015 2016 Marketing Consultant 9jt with commision Selling property The Project doesn't worked
Indonesia

2016 2017 Customer Relationship 3.5jt Interior design dll

Nata Ruang
5. Achievements and Awards

5. Languages Spoken and Written (Please tick on the appropriate box)

Written Spoken
Language
Good Fair Poor Good Fair Poor

English

Others

6. Computer Skill 7. Others Skill Related to the Job you Apply (Please mention):

Microsoft Office Good Fair Poor

Word
Excel
Power Point
Others

8. Personal reference (Professional)

Name Occupation / Company Relationship Contact Number Years Known

Charles Manager 081293981403 2thn

9. Do You Have Any Relatives / Friends Employee in this company: Yes

Name Relationship Contact Number Years Known

10. Courses and Seminar

11. Personal Question

a). What are your hobbies? b). Are you active in any organizations? If yes, please describe
12. Social Media
How often do you use social media and what do you think about your level? (V)
Name Number of Friends
Daily/Advanced Daily/Intermediate Weekly/Intermediate Weekly/Beginner Monthly/Beginner
Instagram
Path
Twitter
Facebook
Youtube

13. Others

a) What is your salary expectation? 5juta

b) If offered employment, when can you begin to work? 20 march, 2017

14. Declarations

No Yes If Yes, Please Give Details

a) Have you ever been discharged from any positions?

Have you ever had any serious illness and / or having an

b)
existing illness requiring long-term medication?

c) Do you have any eyesight or hearing problem?

d) Have you ever beed convicted?

e) Do you have any physical impairment or deformity?

f) Have you applied previously to this company for employment?

I certify that answers given here in are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquiries of my personal, employment or medical history, and other related matters as may be necessary in
arriving at an employment decision.

I understand that false or misleading information given in my application or interview(s) be sufficient cause for cancellation of consideration for employment or
dismisal from company's service.

Date ### Applicant's signature Novita Debora

 2

er 1990

tion

pany / Institution

Mabes ABRI

RCC SILOAM

mina Hospital

Location

Bekasi

Bekasi

Bekasi

Jakarta

Reason(s) For
Leaving

ant to having a new experience

a better offering in other company

he Project doesn't worked well

 Poor

y (Please mention):

Years Known

2thn

Years Known
 (V)
Monthly/Beginner

ls

may be necessary in

ion for employment or