Colour

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EMPLOYMENT APPLICATION FORM

Please read carefully and complete all sections in this form. Completeness of your application form will be
taken into account in our decision. In case of difficulty, do not hesitate to contact us.

PERSONAL DATA
POSITION APPLIED

FULL NAME

ADDRESS
(as stated in ID
card/KTP)

RESIDENCE ADDRESS

PHONE NUMBER &

PLACE/DATE OF BIRTH

ID NUMBER (KTP)

RELIGION □ Moslem □ Catholic □ Christian □ Buddhist □ Hindu □ Others

SEX □ Male □ Female

MARITAL STATUS □ Single □ Married □ Widow/separated

Father

Mother

Brother/Sister

Brother/Sister

Brother/Sister

(Filled if you are married/separated)

1st child

2nd child

3rd child

FORMAL EDUCATION

School Name
Certification:
HIGHSCHOOL Major □ Yes
until □ No
Period (Year)

School Name
Certification:
ACADEMY Major □ Yes
until □ No
Period (Year)
UNIVERSITY School Name Certification:
Major □ Yes
GPA (IPK) □ No
 until
Period (Year)

School Name
Certification:
OTHERS Major □ Yes
until □ No
Period (Year)

TRAININGS ATTENDED
NO VENDOR TRAINING’S NAME DURATION CERTIFICATION
.

1.
□ Yes
□ No
2.
□ Yes
□ No
3.
□ Yes
□ No
4.
□ Yes
□ No
5.
□ Yes
□ No

SPECIAL SKILLS/ABILITIES
NO DESCRIPTION CERTIFICATION
.

1.
□ Yes
□ No
2.
□ Yes
□ No
3.
□ Yes
□ No
4.
□ Yes
□ No
5.
□ Yes
□ No

WORKING EXPERIENCES
(Please start from your LATEST working experience)
COMPANY NAME

COMPANY INDUSTRY
SEGMENT
COMPANY ADDRESS

JOB POSITION
until
WORKING PERIOD

JOB DESCRIPTION

PROJECTS HANDLED

LATEST SALARY
TERMINATION REASON

COMPANY NAME

COMPANY INDUSTRY
SEGMENT
COMPANY ADDRESS

JOB POSITION
until
WORKING PERIOD

JOB DESCRIPTION

PROJECTS HANDLED

LATEST SALARY
TERMINATION REASON

COMPANY NAME

COMPANY INDUSTRY
SEGMENT
 COMPANY ADDRESS

JOB POSITION
until
WORKING PERIOD

JOB DESCRIPTION

PROJECTS HANDLED

LATEST SALARY
TERMINATION REASON

REFERENCES
(Please state 2 referrer’s name who already knew you for minimum 1 year, along with their contact
details and occupation)

NAME

ADDRESS
1.
Phone :
OCCUPATION
RELATIONSHIP
(With You)
NAME

ADDRESS
2.
Phone :
OCCUPATION
RELATIONSHIP
(With You)

CONFIRMATION
Are you agree if we contact your references for our further □ Yes □ No
confirmation?
 Have you ever applied at PT. Mitratex Konsultan previously? □ Yes, ………………………………. □ No
If Yes, when?
□ Newspaper: ………………….. □ Online vacancy
Where did you know the vacancy’s information before? □ Mailing List: …….……………… □ PT. Mitratex
Konsultan’s employee
□ Others: ……………………
What kind of Compensation & Benefit details that you □ Nett
1. Basic Salary Rp
accepted on your latest employment? □ Gross

2. Commission/Bonus Rp

3. Medical Rp □ Reimburse

4. Transportation Rp

5. Other benefits
If you are considered as a qualified candidate for PT.
Mitratex Konsultan’s employee :
1. When do you available to start to work? ………………………………………………..
2. How much is your expected monthly salary? Rp ……………………………………………
3. Are you willing to work overtime? □ Yes □ No
4. Are you willing to be placed to work out of city/country? □ Yes □ No
Hereby I stated all of the information above is true and I’m fully responsible for all of the consequences if any of the
statement above is not true.

Date:
Candidate’s signature,

(Name)