FM-HRD-REC-04

ASEAN Secretariat Jl. Sisingamangaraja 70A Jakarta 12011

EMPLOYMENT APPLICATION FORM

Position applied : Technical Officer Intellectual Property Rights ___ Application Source: ASEAN website (www.asean.org/opportunities) Online advertisement (from other website) Print advertisement Others: ____________________________________

Date: _17-7-2013____

I.PERSONAL Name : ___Pramadi_______Ditya___________________________ email address : dityapramadi@gmail.com______ Last Name First Name Middle Name Present Address : Jalan Betaka 1 No. 8, Banjar Dukuh, Desa Dalung __________________________________________________________Denapasar__Indonesia___80361__________ Street City Country Zip Code Telephone : (+62) 85737746167 (office) ___ (residence) (+62) 82147263607 ________________ (hand phone) Date/month/year of Birth : 7/9/1991_________________ Place of Birth : Surabaya __________________ Gender : Male________________________ Marital Status : Single Married Widow(er)

Citizenship : Indonesian_________________ Identification Card KTP/Passport ) No.: 5103060709910002______ Place of issue : Denpasar, Bali__ Issued by : _____________________ Issued date : ____________________ Expiration date : 7-9-2015__________

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II. FAMILY BACKGROUND a. Parents Name Edy Kusmayadi Dra. Eka Widiarti Relationship Father Mother Date Of Birth 7-8-1959 1-10-1964 Education Secondary School (SLTA) Bachelor Degree (Sarjana) Occupation Entrepreneur Entrepreneur

b. Family / Dependent Name Relationship Dea Amanda Sani Sister

Sex Female

Date of birth 8-6-2000

Education Primary School (SD)

Occupation Student

III. FORMAL EDUCATION Years attended Name of School Start 1997 2003 2006 2009 Ending 2003 2006 2009 2013 SDN Sekardangan SMPN 1 Sidoarjo SMAN 1 Sidoarjo Universitas Udayana Location Sidoarjo, East Java Sidoarjo, East Java Sidoarjo, East Java Denpasar, Bali Major Degree granted Main Subjects

Science (IPA) Bachelor Of Economics Management (SE) Management Economics

IV. EMPLOYMENT RECORD (Start from the most recent) 1. Years employed/duration From 2010 To 2011 Name of Organisation / Company CV. Chandra Kirana (Convenience Address/Phone Jalan By Pass Ngurah Rai 806 Suwung Kauh, Denpasar / (0361) Position Store Supervisor Net Salary per annum (Excluding allowances) Starting IDR 1.800.000 Final IDR 1.800.000

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Store) 7975678 Description of your work : 1. Making a sales report once a week 2. Producing regular purchase orders for products 3. Preparing work schedule s for a few employees 4. Involving in stocktaking which is done every three months 5. Maintaining good relationships between customers and business

Reason for leaving : I have to finish my essay due to get a bachelor degree

Supervisors Name : I Made Dwi Ismawan Telephone : (+62) 81558008333

2. Years employed/duration From To

Name of Organisation / Company

Address/Phone

Position

Net Salary per annum (Excluding allowances) Starting Final

Description of your work:

Reason for leaving : 3. Years employed/duration From To Name of Organisation / Company

Supervisors Name : Telephone : Address/Phone Position Net Salary per annum (Excluding allowances) Starting Final

Description of your work :

Reason for leaving : Total working experience : ____1____ years

Supervisors Name : Telephone : Salary expectation : IDR 2.300.000____________

Please note that in evaluating your candidature ASEAN Secretariat reserved the right to approach your previous employer(s) for references. It is not our policy to approach your present employer at the evaluation stage unless you expressly authorize this. Have you any objections to our making inquiries of your present employer? Yes No

Please note, however, that before making an offer of employment ASEAN Secretariat is required to contact both your present and previous employers. _______________________________________________________________________________________________ V. SKILLS Remarks Computer MAINTENANCE PC LAN

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(for computer related position)

Language English

Softwares : Microsoft Office Speak Fair Good Fluent Fair

Read /Write Good Fluent

Other VI. COURSE / TRAINING RECORD Certification/Seminar/Course Description/Type On the Job Training/Training Course English Course Training Training at Commercial Division

Institution English First PT. Angkasa Pura 1 (PERSERO)

Place/Location Sidoarjo, East Java Denpasar, Bali

Duration 3 years (2006-2009) 2 Months (September 2012- October 2012)

Have you been charged for committing to any crime? If yes, please explain. No. Are you a member of labour organization or political party? If yes, please state the name, address and your position in the organization. No. Employment by the ASEAN Secretariat may require assignment and travel to any area. Have you any disabilities or reservations that may restrict your activities in this respect? If yes, please explain. Are you under any obligation to return/stay in the service of your company in recognition of sponsored training or education? Please show your position at your current job in an organization chart.

Yes

No

Yes

No

If this space not enough, please use next page.

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Please mention three (3) references No. Name Occupation Address & Email Telephone

I hereby certify that the above information is true and correct. I agree that any misinterpretation made in this application for the purpose of securing employment shall be grounds for termination or denial of employment. Final appointment will be subject to a physical examination.

Applicants Signature : ___________________________