APPLICATION FORM

Tgl. Aplikasi: __________________________

Pelamar yth, Application Date
Kami sangat menghargai perhatian anda terhadap Perusahaan kami yang tergabung
dalam PT. Sarana Security Indonesia dan ingin mengetahui lebih banyak tentang
Untuk latar
Posisi: PHOTO
__________________________
belakang professional anda. Namun demikian, penerimaan kembali formulir ini setelah
Position Applied For 4x6
anda lengkapi bukan berarti bahwa kami wajib menerima anda bekerja. (color)
Untuk Bagian : ____________________________
Dear Applicant, For Departement
We deeply appreciate your interest in our organization and assure you that we are sincerely
interested in your qualifications. However, the acceptance of this form after your complete
filling at this form, may not be assume that we will accept you as our employee.

DATA PRIBADI PELAMAR

Applicant Personal Information

Nama : __________________________________________________ Nama

Panggilan:______________________
Full Name Nick Name

Alamat Rumah :
______________________________________________________________________________________
Home Address

Telepon : _______________ __________________ ___________________

___________________________
Telephone Kantor Rumah Handphone Alamat E-mail
Business Residence Mobile E-mail address

Tgl. Lahir Usia Laki2/Perempuan Tempat Lahir Warganegara Agama

Date of birth Age Sex Place of Birth Nationality Religion

Status Nama Istri/Suami Pekerjaan Istri/Suami Jumlah Anak

Marital Status Name of Spouse Occupation of Spouse No. of Children

Nama Usia Pendidikan Terakhir Pekerjaan

Name Age Highest Education Occupation
Posisi Perusahaan
Position Company
Ayah
Father

Ibu
Mother

ANAK-ANAK
Children
Nomor Nama Anak Usia Pendidikan Terakhir
Number Name of Child Age Highest Education
1.

2.

3.

4.

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APPLICATION FORM

LATAR BELAKANG PENDIDIKAN (isi dari tingkat tertinggi)

Educational Background (complete from higher level)
Nama Universitas / Sekolah Periode Kualifikasi
Name of University / School Period Qualification

1.

2.

3.

4.

Apakah sat ini anda sedang sekolah? Bila “Ya”, jelaskan dalam bidang apa, nama institusi dan kapan Anda akan
menyelesaikan sekolah?
Are you currently studying? If yes, please state the type of course, name of course, name of institution and when you will be completing

_________________________________________________________________________________________

ORGANISASI / ASOSIASI
Organization/Association
Nama Organisasi / Asosiasi Tipe Organisasi / Asosiasi Tahun Jabatan
Name of Organization/ Association Type of Organization/ Year Position
Association
1.

2.

3.

4.

5.

6.

7.

8.

KURSUS / PELATIHAN / SEMINAR

Course / Training / Seminar
Jenis Kursus/Pelatihan/Seminar Tahun Penyelenggara Lama Waktu Sertifikat
Type of Course/Training/Seminar Year Conducted by Duration Certificate
1.

2.

3.

4.

5.

6.

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APPLICATION FORM

STRUKTUR ORGANISASI
Organization Structure
Gambarkan Struktur Organisasi yang menerangkan jabatan anda saat ini
Please draw the Organization Structure which explaining your current position

REFERENSI
References

PT. Sarana Security Indonesia dapat Harus dengan persetujuan Pelamar sebelum menghubungi
menghubungi kapan saja To check with applicant before enquring
PT. Sarana Security Indonesia may inquire at will

Referensi Pekerjaan Jabatan Perusahaan Telepon

Business Reference Title Company Telephone
1.
2.
Referensi Pribadi Hubungan Alamat Telepon
Character / Personal Reference Relationship Address Telephone
1.
2.

ORANG YANG DAPAT DIHUBUNGI DALAM KEADAAAN DARURAT

Contact person for emergency case
Nama Alamat Nomor Telepone
Name Address Telephone Number

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APPLICATION FORM

PENGALAMAN BEKERJA
Work History

Apakah anda pernah diberhentikan atau diminta untuk berhenti dari pekerjaan? Ya Tidak
Have you ever been suspended or requested to resign from any employment? Yes No

Bila “Ya”, kapan dan apa alasannya?

If yes, when and why?
___________________________________________________________________________________________________

1. Pekerjaan terakhir / saat ini Nama Perusahaan Lokasi

Present / last employment Company Name Location

Tanggal Mulai Bekerja Jenis Usaha Jumlah Karyawan

Start Date / Period Nature of Business No of employess

Posisi Terakhir Nama dan Jabatan dari atasan langsung Jumlah Karyawan dibawah Anda
Current / last position Reporting to (name & title) No of staff you supervised

Tanggung Jawab dalam pekerjaan (Jelaskan secara terperinci)

Duties & Responsibility (please describe in details)

Kesuksesan dalam pekerjaan yang menonjol?

Significant Achievements (please highlight)

Remunerasi Awal Remunerasi saat ini:

Starting Remuneration Present / Last Remuneration

Gaji Dasar : (bersih / kotor) Gaji Dasar : (bersih / kotor)

Base Salary (net / gross) Base Salary (net / gross )

Fasilitas tambahan : Fasilitas tambahan :

Benefits Benefits

Apakah memiliki sumber pendapatan lainnya?

Please list other source of income, if any?

Apakah alasan Anda untuk mengganti pekerjaan?

What is reason for wishing to change your job?

2. Posisi Sebelumnya (Bila ada) Nama Perusahaan

Previous Position (if applicable) Company Name

Bulan Tahun Jenis Industri Jabatan Terakhir

Month Year Nature of Business Job Title (last)
Dari
From
Sampai
To
Pekerjaan dan Tanggung Jawab (jelaskan secara terperinci)
Key Duties & Responsibility (please describe in details)

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APPLICATION FORM

Keberhasilan Signifikan yang pernah dicapai

Significant Achievements (please highlight)

Alasan Meninggalkan Pekerjaan

Reason for leaving

3. Posisi Sebelumnya (Bila Ada) Nama Perusahaan

Previous Position (if applicable) Company Name

Bulan Tahun Jenis Usaha Jabatan Terakhir

Month Year Nature of Business Job Title (last)
Mulai
From

Berakhir
To
Tanggung Jawab dalam pekerjaan (jelaskan secara terperinci)
Key Duties & Responsibilities (please describe)

Keberhasilan signifikan yang pernah dicapai

Highlight Achievements (please highlight)

Alasan meninggalkan pekerjaan

Reason for leaving

PERTANYAAN
Questions

Apakah Anda pernah bekerja sebelumnya di PT. Sarana Security Indonesia /divisi Ya Tidak
perusahaannya? Yes No
Have you ever been employed by PT. Sarana Security Indonesia

Group or any of its subsidiaries or sister companies ?

Bila “Ya”, pada masa periode kapan, posisi terakhir dan nama perusahaan
If ”yes” please indicate the period, position and the Company’s name

____________________________________________________________________________________________________

Apakah Anda pernah melamar pekerjaan di PT. Sarana Security Indonesia atau anak Ya Tidak
perusahaannya? Yes No
Have you previously applied for employment with PT. Sarana Security Indonesia or any of the
subsidiaries?

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APPLICATION FORM

Bila “Ya”, Kapan dan untuk posisi apa?

If ”yes” when and for what position?

____________________________________________________________________________________________________
Bagaimana Anda mengetahui PT. Sarana Security Indonesia ?
How were you referred to PT. Sarana Security Indonesia ?

Agen Majalah Iklan Kontak langsung Karyawan Lain-lain____________

Agency Magazine Advertisement Direct Contact Employee Other

Mohon sebutkan keluarga atau teman yang saat ini bekerja di PT. Sarana Security Indonesia ?
Please name any relatives or friends currently or previously employed by the Company.

Nama ____________________________________________ Hubungan _____________________________________

Name Relationship
Nama Hubungan _____________________________________
Name Relationship

Apakah hobby dan aktivitas rekreasi Anda?

What are your recreational activities and hobbies?

Apakah Anda memiliki keahlian khusus, misalnya bahasa, berpidato/presentasi?

Do you have any special skills or aptitudes e.g. language, manual skills, public speaking etc.?

Program komputer apa yang Anda kuasai?

What software applications are you fluent with?

Apakah Anda pernah mendapatkan penghargaan, piagam, beasiswa arau sejenisnya?

Do you ever receive any reward, certification, scholarship or other recognitions?

PENGHASILAN YANG DIHARAPKAN

Berapa gaji yang Anda harapkan? (sebutkan bersih atau kotor)
What salary do you expect for this position?(mentioned nett or gross)

Tunjangan-tunjangan atau fasilitas apa saja yang anda harapkan?

What kind of allowance(s) or facilities that you desire?

Kapan Anda dapat mulai bekerja?

When would you be available to take up this position?

Apakah Anda bersedia ditempatkan di luar kota?

Would you consider a position in another city in Indonesia?

Ya Tidak Bila “Ya”, Mengapa?

Yes No If yes, why?

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APPLICATION FORM

LATAR BELAKANG KESEHATAN

Medical History

Terakhir Anda melakukan Medical Check-up? Tgl : ______________ Dimana : ________________________________

When was your last medical check-up? Date: Where : ________________________________

Apabila Anda pernah melakukannya, test apa saja yang pernah dilakukan?
If you had a check-up please tick which of the following tests were performed?

X – Ray Dada Pemeriksaan laboratorium untuk tinja dan urine

Chest X – Ray Laboratory examination of stool, urine etc

Kultur Darah Pemeriksaan fisik secara lengkap

Blood count culture Complete physical examinations

Tekanan Darah Electrocardiogram (ECG)

Blood pressure

Lainnya (Jelaskan) ___________________________________________________________________________________

Others (specify)

Apakah Anda menderita penyakit atau halangan secara fisik yang dapat mempengaruhi kemampuan Anda dalam
menjalankan pekerjaan yang sedang dilamar?
Do you suffer form any ailment of physical handicap whose effects impair your ability to handle the job you are applying for?

Ya Tidak
Yes No

Bila “Ya” jelaskan :

If yes please describe__________________________________________________________________________________
___________________________________________________________________________________________________

Apakah anda pernah terlibat dalam kasus administrasi atau kriminal? Bila “Ya”, mohon jelaskan secara terperinci.
Are you involved in any administrative , civil or criminal case? If yes, please provide details of the case
________________________________________________________________________________________________
________________________________________________________________________________________________

PERNYATAAN
Certification

Dengan ini saya menyatakan bahwa saya mengerti semua pertanyaan diatas dan seluruh jawaban dan informasi yang
diberikan adalah benar sesuai dengan pengetahuan saya. Apabila saya diterima dan bekerja di perusahaan ini, saya mengerti
bahwa bila informasi yang salah yang pernah saya berikan pada waktu proses pelamaran pekerjaan ini, saya dapat
diberhentikan dari pekerjaan. Saya juga menyanggupi untuk tunduk terhadap seluruh peraturan perusahaan yang ada.
I certify that I understand the questions and the answers and information given herein are true and complete to the best of my knowledge.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in
discharge. I understand, also, that I am required to abide by all rules and regulations of the company.

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APPLICATION FORM
Tgl : _____________________ Tanda Tangan : __________________________________
Date Signature

Wawancara Pertama
First Interview

1. Apa yang membuat Anda tertarik untuk bekerja di PT. Sarana security Indonesia?
What attract you to apply to PT. Sarana Security Indonesia ?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
__________________________________________________________________________

2. Apa persepsi Anda mengenai PT. Sarana security Indonesia?

What is your perception about PT. Sarana Security Indonesia ?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
__________________________________________________________________________

3. Apa yang akan Anda lakukan dalam 6 bulan pertama bila Anda diterima bekerja di PT. Sarana
Security Indonesia besok?
What would you do in your first 6 months with PT. Sarana Security Indonesia if you were to be employed
by tomorrow?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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______________________________________________________________________________________

4. Bagaimana menurut Anda mengenai bekerja dalam tekanan, harus memenuhi target, waktu
ataupun target lainnya dalam situasi yang berubah-ubah ?
What do you think about working under pressure, meeting deadlines, and being chased to achieve a
certain target at changing circumstances?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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APPLICATION FORM
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5. Apakah tujuan karir Anda dalam 3-5 tahun mendatang ?
What are your 3 to 5 years career objectives?
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6. Jenis pekerjaan apa yang paling tidak memotivasi Anda ? (pekerjaan yang paling anda tidak suka)
What type of job role motivates you the least?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________

Mengapa?
And why?
______________________________________________________________________________________
______________________________________________________________________________________
________________________________________________________________________________

7. Apakah kesuksesan yang paling besar dalam hidup Anda ? Mohon tuliskan paling sedikit 3
kesuksesan Anda yang paling besar dengan penjelasan penuh dan dengan cara apa Anda mencapai
kesuksesan tersebut.
What are your greatest achievements in life? Please write at least 3 of your greatest achievement with full
explanation on how you achieve them.
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APPLICATION FORM
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