Employee Information Database

I. PERSONAL IDENTITY ( IDENTITAS PRIBADI )

Full Name : Nick Name :

Nama Lengkap First ( Given Name ) / Depan Middle / Tengah Last / Surname / Marga Nama Panggilan

Previous Name :
( Nama sebelum Ganti Nama ) First / Depan Middle / Tengah Last / Akhir / Marga
Place of Birth : Date Of Birth :
Kota Tempat Kelahiran Tanggal, Bulan & Tahun
Lahir
: Male Female
Gender Religion :
Jenis Kelamin Laki – Laki Perempuan Agama / Kepercayaan

Nationality : Height :
Kewarganegaraan Tinggi Badan
Blood Type : E-mail Address :
Golongan Darah A B O AB
Alamat E-mail

N.I.K (KTP) No. : N.I.K. Valid Date :

Nomor N.I.K ( KTP ) Masa Berlaku KTP sampai
dengan
: Single Engagement, Date : / / Married, Date : / /
Marital Status
Status Perkawinan Lajang Bertunangan, Tanggal Menikah, Tanggal
: Divorced, Date : / / Widow / Widower, Date : / /
Bercerai, Tanggal Duda / Janda Tanggal
: A No. :
Driving Liscence : C No. : Valid Date :
SIM Kendaraan
: B-1 No. : Valid Date :
Valid Date :

Fixed Address
Alamat Tetap ( KTP )

RT / RW : / City : ZIP Code

Kota Kode Pos
Home Phone-1 :( ) Home Phone-2 :( )
Cell Phone/HP-1 :( ) Cell Phone/HP-2 :( )
CDMA-1 No. :( ) CDMA-2 No. :( )
Home Fax. No. :( ) Other Number :( )

CURRENT
ADDRESS
Alamat Tinggal Sekarang

RT / RW : / City : ZIP Code

Kota Kode Pos
Home Phone-1 :( ) Home Phone-2 :( )
Cell Phone/HP-1 :( ) Cell Phone/HP-2 :( )
CDMA-1 No. :( ) CDMA-2 No. :( )
Home Fax. No. :( ) Other Number :( )
House Ownership : Milik Pribadi Milik Keluarga Rumah Kontrakan Pondokan / Kos ( )
Status
Status Kepemilikan Rumah Private Owned Family Owned Rent House Boarding Lain-Lain

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II. FAMILY IDENTITY ( IDENTITAS KELUARGA )

Spouse’s Name :
Nama Istri / Suami First ( Given Name ) / Depan Middle / Tengah Last ( Surname ) / Marga
Place of Birth : Date Of Birth
Kota Tempat Kelahiran Tanggal, Bulan & Tahun Lahir
Current Spouse’s
Occupation : City :
Perusahaan Tempat Sekarang Istri / Suami Bekerja Kota
Spouse’s Work
Place Phone :( ) Spouse’s Cell Phone :( )
Nomor Telp. Tempat Kerja Suami / Istri Nomor HPSuami / Istri
: Yes, ( ) No Not Yet
Religion : Have Kids ?
Agama / Kepercayaan Punya Anak ? Ya Tidak Belum
Do you have other dependent other than your spouse & kids ? Yes, ( ____ ), How much ( Rp. ____________________ ,- ) No
Apakah anda mempunyai tanggungan lain selain istri / suami dan anak2 ? Ya, berapa orang? Berapa jumlah tanggungan per bulan ? Tidak ada

KID’S NAME PLACE, DATE OF BIRTH EDUCATION

NO Tempat, Tanggal Lahir Pendidikan
Nama Anak

1.

2.
3.
4.
5.

FULL NAME RELATION DATE OF BIRTH LAST EDUCATION OCCUPATION

NO Nama Lengkap Hubungan Pendidikan Terakhir Pekerjaan
Tanggal Lahir

1. Father
Ayah
2. Mother
Ibu
3. Guardian
Org Tua Wali
4. Guardian
Org Tua Wali
THE NEXT OF KIN ( SAUDARA KANDUNG ) Notes : K = Kakak ( Elder Brother / Sister ) ; A = Adik ( Younger Brother / Sister )

1. K / A

2. K / A

3. K / A

4. K / A

5. K / A

6. K / A

7. K / A

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III. EMERGENCY CONTACT INFORMATION ( INFORMASI KONTAK DARURAT )

Full Name : Nick Name :
Nama Lengkap First ( Given Name ) / Depan Middle / Tengah Last ( Surname ) / Akhir / Marga Nama Panggilan

Fixed Address
Alamat Tetap ( KTP )

RT / W : / City : ZIP Code

Kota Kode Pos
Home Phone-1 :( ) Home Phone-2 :( )
Cell Phone/HP-1 :( ) Cell Phone/HP-2 :( )
CDMA-1 No. :( ) CDMA-2 No. :( )
Home Fax. No. :( ) Other Number :( )
: Family / The Next of Kin Relatives Friend Guardian Other : ( )
Relationship
Hubungan Keluarga / Saudara Kandung Kerabat Teman Wali Lain-Lain

IV. FORMAL EDUCATION ATTAINTMENT ( RIWAYAT PENDIDIKAN FORMAL )

GRADU
NO FROM UNTIL NAME OF SCHOOL / ACADEMIC / UNIVERSITY MAJORITY CITY / COUNTRY
Dari Sampai Nama Sekolah / Akademi / Universitas Jurusan Kota / Negara ATE
Lulus / Tidak

1.
2.

3.

4.

5.

6.

7.

V. NON - FORMAL EDUCATION ATTAINTMENT ( RIWAYAT PENDIDIKAN NON – FORMAL / KURSUS )

CERTIFI
NO NAME OF COURSE / TRAINING INSTITUTE TRAINING PERIOD CITY / COUNTRY
Judul / Tema Pelatihan ( Training ) / Kursus yg diikuti Badan Institusi / Badan Pelatihan Lamanya Pelatihan / Kursus Kota / Negara CATE
Ada / Tidak

1.
2.

3.

4.

5.

6.

7.

8.

9.

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VI. FOREIGN LANGUAGE & MOTHER TONGUE ( PENGUASAAN BAHASA ASING, DAERAH & IBU )
LANGUAGE EXCELLENT GOOD / ACTIVE AVERAGE / PASSIVE INSUFFICIENT
NO Bahasa
Spoken & Written Active Spoken Active, Written adequate Spoken & Written Sufficient / Adequate Spoken & Written insufficient
Sangat Baik ( Lisan & Tulisan ) Lancar Lisan, Tulisan Sedang Lisan & Tulisan sedang Tidak menguasai lisan & tulisan

1.
2.

3.

4.

5.

VII. EMPLOYMENT HISTORY ( RIWAYAT PEKERJAAN )

WORK PERIOD PLACE / LAST SALARY
NO COMPANY NAME JOB TITLE REASON
Nama Perusahaan
Lama Bekerja ( dari sampai
Jabatan / Posisi CITY Gaji Terakhir ( Take
Alasan Pindah
dengan ) Tempat / Kota Home Pay / Nett )

1.

2.

3.

4.

5.

6.

7.

8.

VIII. TESTIMONIAL / REFERENCE ( REFERENSI )

NO NAME COMPANY JOB TITLE TELP. NO RELATIONSHIP NOTES
Nama Nama Perusahaan Jabatan / Posisi Nomor telepon Hubungan dgn anda Catatan

1.
2.

3.

4.

5.

6.

7.

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1. Describe your job’s function / responsibility in your last position :

Uraikan pokok-pokok tugas / tanggung-jawab dari jabatan terakhir saudara / saudari

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________

2. Describe the number of your sub-ordinates within the last 2 ( two ) years :
Sebutkan berapa jumlah bawahan yang pernah saudara / saudari pimpin dalam 2 tahun terakhir

_____________________________________________________________________________________________
_____________________________________________________________________________________________
________

3. Describe your achievement or improvement you have been made in your former employments :
Uraikan prestasi atau perubahan / perbaikan / pembaharuan yang pernah anda lakukan di perusahaan-perusahaan sebelumnya
No / Tidak pernah Yes / Ya ( Describe / Uraikan )

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________

4. What position or title you applied for in this company? Give your reason to apply this position / title.
Posisi atau jabatan apa yang saudara / saudari lamar di perusahaan ini ? Berikan alasan mengapa saudara / saudari melamar posisi / jabatan tersebut

_____________________________________________________________________________________________
_____________________________________________________________________________________________
________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
________

5. Describe what do you know about the task & responsibility of the above position.
Uraikan apa yang saudara / saudari ketahui tentang tugas dan tanggung jawab jabatan tersebut

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

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_____________________________________________________________________________________________
_____________________________________________________________________________________________

6. Your favorite working environment : Reason :

Lingkungan kerja yang saudara / saudari senangi : Alasan / sebab-sebabnya
Factory Field Office Laboratory
Pabrik Lapangan Perkantoran Laboratorium

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________

7. Your un-favorite working environment : Reason :

Lingkungan kerja yang tidak saudara / saudari senangi : Alasan / sebab-sebabnya
Factory Field Office Laboratory
Pabrik Lapangan Perkantoran Laboratorium

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________

8. What is your life-dream or your life’s destination ?

Apa cita-cita atau tujuan hidup saudara / saudari
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________

9. What is your hobby ?

Apa hobi saudara / saudari ?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________

10. In which circumstances you have difficulty to make decision ?

Dalam hal – hal apa saja atau dalam kondisi bagaimanakah saudara / saudari sulit mengambil keputusan ?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________

11. Describe each minimum 3, your strong and weak point ( need to be improved ) ?
Uraikan masing-masing minimum 3 yang menjadi kekuatan / kelebihan dan kelemahan ( faktor-faktor yang perlu diperbaiki / ditingkatkan ) saudara / saudari

Strong Point : Weak Point :

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

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_____________________________________________________________________________________________
____________________

12. Have you ever been abroad ? No / Tidak pernah Yes / YA, describe when, how long, in
what purpose :
Apa saudara / saudari pernah ke luar negeri ? Bila “YA”, sebutkan kapan, berapa lama, dan untuk keperluan apa ?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
________
______________________________________________________________________
___________________________
IX. ORGANIZATION ( ORGANISASI YANG PERNAH DIIKUTI )
NO ORGANIZATION NAME CITY / COUNTRY TITLE / STATUS PERIOD REMARKS
Nama Organisasi / Serikat Kota / Negara / Tempat Jabatan / Status Periode Keterangan
1.
2.
3.
4.
YANG PERNAH DIIKUTI )
X. INTERN COMPANY ( INTERNAL PERUSAHAAN )

1. What is your expectation salary ( Take Home Pay ) ? Negotiable ? No / Tidak Yes / Ya
Berapa Gaji bersih yang saudara / saudari harapkan ( Take Home Pay ) ? Dapat dirundingkan / dinegosiasi ?
___________________________________________________________________________________________________
___________________________________________________________________________________________________
______

2. What facilities you wish? ( To be noticed : Terms and Conditions will follow Company’s Policies & shall be
discuss
Fasilitias apa yang saudara / saudari harapkan ?
___________________________________________________________________________________________________
___________________________________________________________________________________________________
______
___________________________________________________________________________________________________
___

3. When you will able to joint / start to work if you hired?

Kapankah saudara / saudari dapat mulai bekerrja apabila anda diterima di perusahaan ini ?
___________________________________________________________________________________

4. Do you agree to be transferred to other unit / branch / affiliates company and / or out of town ( Jakarta ) ?
Bersediakan saudara / saudari ditempatkan di unit-unit yang lain atau di luar kota ?

Yes / Ya No / Tidak , Why / Describe your reason ? / Mengapa / sebutkan alasan anda :
___________________________________________________________________________________________________
___________________________________________________________________________________________________
______

5. Do you mind for business trip to other unit / branch / affiliates company and / or out of town ( Jakarta ) ?
Apakah anda bersedia melakukan perjalanan dinas ke unit-unit yang lain atau ke luar kota ( daerah – daerah ) ?

Yes / Ya No / Tidak , Why / Describe your reason ? / Mengapa / sebutkan alasan anda :

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___________________________________________________________________________________________________
___________________________________________________________________________________________________
______

6. Do you have any vehicle ? Yes / Ya : Car / Mobil Motorcycle / Motor No /

Tidak
Kendaraan apa yang saudara / saudari miliki saat ini ?

7. Have you ever send your resume before to this company ? When & for what position? No/Tidak
Yes/Ya
Pernahkah saudara / saudari mengirimkan lamaran ke perusahaan ini sebelumnya ? Kapan dan untuk posisi apa ?

_________________________________________________________________________________________________
_________________________________________________________________________________________________
______

8. Have you ever been hospitalized or had sick for long time ? No/Tidak Yes/Ya, Describe it
Pernahkah saudara / saudari dirawat di rumah sakit atau menderita sakit / sakit keras untuk waktu yang lama ? Jelaskan kapan, di mana & apa penyakit yang diderita

_________________________________________________________________________________________________
___

Jakarta, / / 20 ______

( )

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