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G.

O APPLICATION
Pas Photo
4x6
Representative Office
Club Med Jakarta – PT Bali Holiday Village - One Wolter Place, 7th Floor
Jl. Wolter Monginsidi No 63B, Kebayoran Baru, Jakarta Selatan 12180
Phone: (62) 21 724 8087
Website: http://clubmed.com EMail: velina.widyastuti@clubmed.com

Department :
Position Applied For :

PERSONAL INFORMATION
NAME :
DATE OF BIRTH : PLACE OF BIRTH :
SEX : NATIONALITY :
MARITAL STATUS : RELIGION :
ID NO. / PASSPORT NO. :
CURRENT ADDRESS :
ZIP CODE / POSTAL CODE :
HOME PHONE / FAX :
PERMANENT ADDRESS :
HOME PHONE / FAX :
MOBILE PHONE :
E-MAIL :
EDUCATION
SCHOOL MAJOR YEAR GRADUATE/NOT
HIGH SCHOOL
DIPLOMA ( D3 )
UNIVERSITY ( S1 )
UNIVERSITY ( S2 )
FAMILY INFORMATION ( Father, Mother, Siblings, including yourself )
NAME DATE OF BIRTH EDUCATION JOB
FATHER
MOTHER
Child 1
Child 2
Child 3
Child 4
Child 5
SPOUSE INFORMATION
(If Legally Married)
Child 1
Child 2
Child 3

PERSON TO BE CONTACT IN CASE OF EMERGENCY


NAME :
RELATION :
ADDRESS :
CONTACT NO :
PASSPORT
PASSPORT NO :
VALID FROM :
VALID TILL :
ISSUED AT :
COURSE/TRAINING
TYPE OF COURSE NAME OF THE COURSE/TRAINING PERIODE COMPLETED/FAIL

LANGUAGE PROFICIENCY ( put X )


ORAL WRITTEN
LANGUAGE
BEGINNER CONVERSATIONAL FLUENT BEGINNERCONVERSATIONAL FLUENT

PREVIOUS EMPLOYMENT (Start with last position held)


COMPANY NAME : COMPANY BUSINESS:
ADDRESS :
WORKING PERIOD (FROM/UNTIL) :
FIRST JOB TITLE : ENDING JOB TITLE :
SKILLS :
REASON OF RESIGN :
FIRST SALARY :
COMPANY NAME : COMPANY BUSINESS:
ADDRESS :
WORKING PERIOD (FROM/UNTIL) :
FIRST JOB TITLE : ENDING JOB TITLE :
SKILLS :
REASON OF RESIGN :
FIRST SALARY :
COMPANY NAME : COMPANY BUSINESS
ADDRESS :
WORKING PERIOD (FROM/UNTIL) :
FIRST JOB TITLE : ENDING JOB TITLE :
SKILLS :
REASON OF RESIGN :
FIRST SALARY :
REASON WHY YOU WANT TO JOIN CLUB MED
:
RESORTS
SALARY EXPECTATION :
FACILITY EXPECTATION :
WHEN WILL YOU BE READY TO START TO WORK :

JOB DESCRIPTION
TO WHOM ARE YOU RESPONSIBLE

WHO AND HOW MANY PEOPLE THAT ARE


RESPONSIBLE TO YOU

EXPLAIN BRIEFLY YOUR TASKS


AND RESPONSIBILITIES
OTHERS
HOBBIES

ORGANISATION, YEAR AND POSITION

HAVE YOU ALREADY WORKED IN CLUB MED RESORTS,


POSITION,
WRITE ANYWHEN,
MAJOR WHY YOU RESIGN
ILLNESSES THATAND YOUSKILL
HAVE SUFFERED,
SURGERIES, AND DISABILITIES (if any)
LAST MEDICAL CHECK-UP, WHEN AND WHERE
ARE YOU WILLING TO BE PLACED IN OTHER CITIES OR
OTHER COUNTIRIES
FAMILY MEMBER THAT WORKS IN CLUB MED RESORTS
NAME
POSITION
DEPARTMENT
RELATION
OTHER INFORMATION THAT SUPPORTING YOUR
APPLICATION

REFERENCES
NAME COMPANY POSITION PHONE

I, THE UNDERSIGNED, HEREBY UNDERSTAND THAT ANY RELEVANT INFORMATION THAT I HAVE
WILFULLY WITHHELD OR FALSIFIED WILL RESULT IN THE IMMEDIATE DISMISSAL OR EMPLOYMENT IF I
AM HIRED.

Jakarta ,

( ………………………………. )

FILLED BY THE RECRUITER


TEST TEST

NOTES

RECRUITER RESULT SIGNATURE

RESULT : ACCEPTED / REJECTED / CONSIDERED