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NSMP Application Form

This document is an application for employment that collects personal details, family information, education history, employment history, language skills, organizational memberships, general questions, references, expected salary and commencement date, and a declaration authorizing an investigation of the information provided. The application requests information such as the applicant's name, address, date of birth, religion, civil status, spouse, children's names and education levels, schools and degrees completed, courses/training attended, employment history including employer details and positions held, spoken and written language abilities, organizations joined, physical disabilities, previous dismissals, convictions, willingness to work overtime, and references.

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astari.astari89
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© © All Rights Reserved
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Download as DOC, PDF, TXT or read online on Scribd
20 views

NSMP Application Form

This document is an application for employment that collects personal details, family information, education history, employment history, language skills, organizational memberships, general questions, references, expected salary and commencement date, and a declaration authorizing an investigation of the information provided. The application requests information such as the applicant's name, address, date of birth, religion, civil status, spouse, children's names and education levels, schools and degrees completed, courses/training attended, employment history including employer details and positions held, spoken and written language abilities, organizations joined, physical disabilities, previous dismissals, convictions, willingness to work overtime, and references.

Uploaded by

astari.astari89
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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APPLICATION FOR EMPLOYMENT

PERSONAL DATA
Name : ____________________________ ID No. : _________________ Place/Date of issue : ___________
Place & date of birth : _____________________ Religion : ________________ Nationality : ____________
Address : _________________________________________________________________________________
City : ___________________________________________________ Postcode : ______________
Phone number: Home : ______________ Office: _______________ Cellular : ________________________
E-mail : __________________________________________________________________________________
Civil status : Single Married, date of marriage: _____________ Widowed Divorced

FAMILY DETAILS
Name Relationship Date of Birth Education / School Occupation/Employer
Father
Mother
Brother/Sister
Brother/Sister
Brother/Sister
Brother/Sister

SPOUSE & CHILDREN


Name Relationship Date of Birth Education / School Occupation/Employer
Husband/Wife
Son/Daughter
Son/Daughter
Son/Daughter

EDUCATIONAL HISTORY & OTHER QUALIFICATIONS


Formal Education
Name of School & Location Period Degree & Major Honors/Award
Senior High School -
Academy -
University -
Post Graduate -

Informal education (courses/seminar/training)


Name of Institution & Location Period Subject/Topic Honors/Award
-

Nurjadin SumonoMulyadi & Partners Page 1 of 4


-
-

Informal education (ComputerApplication)


Name of Institution & Location Period Subject/Topic Honors/Award
-
-
-

Language
Spoken Written
English Poor Fair Fluent Poor Fair Fluent
Chinese Poor Fair Fluent Poor Fair Fluent
Other, Please specify : Poor Fair Fluent Poor Fair Fluent

Membership of professional, Social or Political Activities


Name of organization Type of organization Period Activities Position
-
-
-

GENERAL
1. Have you been or are you suffering from any physical disability or disease? Yes No
If Yes, please explain: __________________________________________
2. Have you ever been dismissed or suspended by any previous employer? Yes No
If Yes, please explain: __________________________________________
3. Have you ever been charged or convicted in any Court of Law? Yes No
If Yes, please explain: __________________________________________
4. Are you willing to work overtime? Yes No
If Yes, please explain: __________________________________________

REFEREES (List three person not related to you who have known you at least one year)
Name Organization Phone Relationship No. of years known

EMPLOYEMENT HISTORY(Start with present employment, including temporary work and vocational training)
Employer _____________________________ Starting Salary Rp. __________ net gross
Nature of business _____________________________ Final Salary Rp.__________ net gross
Address _____________________________ Position Title and Work Performed:
_____________________________ ____________________________________
Phone Number _____________________________ ____________________________________

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Employment dates: ____________ -- _____________ ____________________________________
Supervisor’s name and Title: ______________________ ____________________________________
May we contact? Yes No Reason for leaving :
If No, please explain: ____________________________________
______________________________________________ ____________________________________

EMPLOYEMENT HISTORY (Start with present employment, including temporary work and vocational training)
Employer _____________________________ Starting Salary Rp.__________ net gross
Nature of business _____________________________ Final Salary Rp.__________ net gross
Address _____________________________ Position Title and Work Performed:
_____________________________ ____________________________________
Phone Number _____________________________ ____________________________________
Employment dates: ____________ -- _____________ ____________________________________
Supervisor’s name and Title: ______________________ ____________________________________
May we contact? Yes No Reason for leaving :
If No, please explain: ____________________________________
______________________________________________ ____________________________________

Employer _____________________________ Starting Salary Rp.__________ net gross


Nature of business _____________________________ Final Salary Rp.__________ net gross
Address _____________________________ Position Title and Work Performed:
_____________________________ ____________________________________
Phone Number _____________________________ ____________________________________
Employment dates: ____________ -- _____________ ____________________________________
Supervisor’s name and Title: ______________________ ____________________________________
May we contact? Yes No Reason for leaving :
If No, please explain: ____________________________________
______________________________________________ ____________________________________

COMMENCEMENT & SALARY EXPECTATION


If you are offered employment with us, when can you start work? ________________________________________
What is your salary expectation if you are offered employment with us ? ________________________________________

DECLARATION
I authorize the investigation of all information provided by me in this application for employment form except those
pertaining to my current employment. I understand that as part of recruitment process. NSMP will ask me to submit copies
of reference letter of my current and previous employers, copies of relevant certificates, last salary statement and check my
references. I also understand that a misrepresentation or omission of facts called for herein will be sufficient cause for
cancellation of consideration for employment or dismissal from the NSMP service if I have been employed.

__________________________
__________________________________

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DATE Signature of Applicant

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