No

Revisi
Tanggal
Halaman

FORMULIR
ISIAN LAMARAN KERJA

:
:
:
:

FR-HR-005
00
01-11-09
1-5

UNIT : ______________________________________
Isi dengan huruf cetak. Tanda *) coret yang tidak perlu
JENIS PEKERJAAN YANG ANDA INGINKAN: Web Programmer..............................................
Nama lengkap

: Fransiscus Tobias.........................................................................................................

Tempat / tanggal lahir

: Jakarta, 6 Juni 1989....................................................... Laki-laki/ Perempuan *)

Agama

: Kristen Protestan.................................................. Belum kawin/kawin/duda/janda *)

Kewarganegaraan

: Indonesia..............................

Suku bangsa

: Tionghoa.......................

Berat Badan

: 58........ Kg

Tinggi badan

: 165........ Cm

Alamat

: ............................................................................................................................
............................................................................................................................

Telepon

: .............................................................HP: 083870724601................................

Nomor KTP

: ................................................ Berlaku : ....................... s/d .............................

Nomor Pasport

: ................................................ Berlaku : ....................... s/d .............................

Nomor & Jenis SIM

: ................................................ Berlaku : ....................... s/d .............................

Nomor NPWP

: ............................................................................................................................

Bahasa Asing

: ................................................ Tertulis : Ya/Tidak *)

Lisan

: Ya/Tidak *)

: ................................................ Tertulis : Ya/Tidak *)

Lisan

: Ya/Tidak *)

ISTERI / SUAMI *)
Nama lengkap

: ..........................................................................................................................................

Tempat/tanggal lahir

: ..........................................................................................................................................

Pekerjaan

: ..........................................................................................................................................

Perusahaan

: ..........................................................................................................................................

Alamat Perusahaan

: ..........................................................................................................................................

ANAK
No

Nama Lengkap

L/P

Tempat / tanggal lahir

Nama/alamat
Sekolah/Perusahaan

Jenis pekerjaan
(Jika bekerja)

1
2
3
4
5
SAUDARA KANDUNG (Tidak termasuk anda)
No

Nama Lengkap

L/P

Tempat / tanggal lahir

Anda anak ke: ..............

Nama/alamat
Jika bekerja
Sekolah/Perusahaan
Jenis pekerjaan

1
2
3
4
5
AYAH KANDUNG
Nama lengkap

: ..........................................................................................................................................

Tempat/tanggal lahir

: ..........................................................................................................................................

No
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Tanggal
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FORMULIR
ISIAN LAMARAN KERJA

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:
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FR-HR-005
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01-11-09
2-5

Agama

: ..........................................................................................................................................

Pekerjaan

: ..........................................................................................................................................

Jabatan

: ..........................................................................................................................................

Alamat / telepon

: ..........................................................................................................................................

IBU KANDUNG
Nama lengkap

: ..........................................................................................................................................

Tempat/tanggal lahir

: ..........................................................................................................................................

Agama

: ..........................................................................................................................................

Pekerjaan

: ..........................................................................................................................................

Jabatan

: ..........................................................................................................................................

Alamat / telepon

: ..........................................................................................................................................

RIWAYAT PENDIDIKAN FORMAL

No

Sekolah/Universitas

Jurusan

Kota

Mulai
Tahun

Sampai
Tahun

Memiliki
Ijazah/sertifikat

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

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Ada / tidak *)

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Ada / tidak *)

..............................................................

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..............

Ada / tidak *)

RIWAYAT PENDIDIKAN NON FORMAL

No

Sekolah/Lembaga Pendidikan

Jurusan

Kota

Mulai
Tahun

Sampai
Tahun

Memiliki
Ijazah/sertifikat

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

..............................................................

...................

.......................

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..............

Ada / tidak *)

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...................

.......................

..............

..............

Ada / tidak *)

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

RIWAYAT PEKERJAAN (disusun menurut tahun masuk / keluar)

Tahun
Nama Perusahaan
Dari s/d
Alamat / telepon
.......... s/d ..........

.........................................................................
.........................................................................

Jabatan /
Pekerjaan

Alasan
Berhenti

....................................
....................................

........................................
........................................

No
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Tanggal
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FORMULIR
ISIAN LAMARAN KERJA

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.......... s/d ..........

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.......... s/d ..........

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.......... s/d ..........

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.......... s/d ..........

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Aktivitas di luar jam kerja

: ...................................................................................................................................

Hobby / olahraga

: ...................................................................................................................................

Status rumah yang ditempati

: ...................................................................................................................................

Kendaraan yang dimiliki

: ...................................................................................................................................

Penyakit yang pernah diderita

: ...................................................................................................................................

Kacamata : Ya / tidak *) Min

: ..................... Plus: .................... Contact lens: ..................... Softlens: ....................

Pernahkah anda dihukum karena kejahatan atau kriminal?

Ya / Tidak *)

Pernahkah anda melamar di Perusahaan ini sebelumnya?

Ya / Tidak *)

Jenis pekerjaan yang dilamar

: ...................................................................................................................................

Melamar melalui

: ...................................................................................................................................

Apakah anda diwawancarai

: Ya/tidak *)

Bila ya, oleh: ........................................................................

Apakah anda mempunyai kenalan/famili yang bekerja di Perusahaan/Group ini?

Ya / tidak *)
Bila ya, sebutkan:
Nama

: ..........................................................................................................................................

Hubungan

: ..........................................................................................................................................

Jabatan

: ..........................................................................................................................................

Referensi ( sebutkan dua orang yang bukan keluarga yang anda kenal di luar Perusahaan ini )
Nama

: ............................................................

Nama

: ............................................................

Perusahaan

: ............................................................

Perusahaan

: ............................................................

Jabatan

: ............................................................

Jabatan

: ............................................................

Alamat

: ............................................................

Alamat

: ............................................................

FORMULIR
ISIAN LAMARAN KERJA
Telepon

: ............................................................

Berapa lama mengenal anda

: ..................................

Telepon

No
Revisi
Tanggal
Halaman

:
:
:
:

FR-HR-005
00
01-11-09
4-5

: ............................................................

Berapa lama mengenal anda

: ..................................

Jika anda diterima:

Kapan anda bisa mulai bekerja di Perusahaan ini? ...........................................................................................................
Sebutkan keterangan-keterangan lain yang anda anggap penting yang dapat membantu penilaian kami untuk posisi
yang anda inginkan dan apa alasan anda untuk melamar di Perusahaan ini.
............................................................................................................................................................................................
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Demikianlah keterangan tersebut Saya buat dengan sebenarnya dan penuh kesadaran. Saya bersedia
menerima sanksi atau menanggung segala akibat bila dikemudian hari terbukti bahwa keterangan yang Saya berikan
tersebut ternyata tidak benar.
.............................., ................................
Hormat Saya,

Pelamar

1. Berapakah gaji terakhir anda? .............................................................................................................................

2. Fasilitas apa yang anda dapatkan?
...............................................................................................................................................................................
...............................................................................................................................................................................
...............................................................................................................................................................................
...............................................................................................................................................................................
...............................................................................................................................................................................

FORMULIR
ISIAN LAMARAN KERJA

No
Revisi
Tanggal
Halaman

:
:
:
:

FR-HR-005
00
01-11-09
5-5

...............................................................................................................................................................................
...............................................................................................................................................................................
...............................................................................................................................................................................
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3. Berapa gaji yang anda inginkan? .........................................................................................................................
___________________,________________________
Hormat Saya,

___________________________
Pelamar