EVERSEZKD

ATTACH
APPLICATION FOR EMPLOYMENf flotl .'iLamaran Kerja)
PSOTO

Position Sought \posi si ydnq Di tdn o r)

Please Fill ln With Your Own Handwriting (ln Block Black/Blue lnk)(voton Diisi Menssunakan Huruf Kapital (DensanTinta Hitam/Biru) FORMr ESAE02/R/16

PERSONAL INFORMATION (tnformsi Pribadi)

Name (Nama) Nationality lD No.
MR/MRS/MISS (No. KTP)

Place Of Birth Date Of Birth Age

(Tempat tahir) (TangEal Lahir) (Us a)

Hergnr Weight Sex (Male/Female) :

{Tlnesl Badar) (Berr Badan) (l€nis Ke amin : Lak'Laki/Peremp!an)
Marital Status Name of Spouse No of children
(status Pern kahan)

Permanent Add. :

(A amat Tetap)

Home Tel No Handphone No : Religion :

(No Tel Rumah) (No Hp)

DrivingLicence{NoslM)Yes/No l{vaTraatllClasslcoongunl tAl C lBl lB.2 NPWP NO:

EMERGENCY CONTACT (Kontak Darurat)

Name (Nama) Handphone No (Nomor HP) Address (Alamat)

Put An "X" ln The Correct Response Box {Berikan Tanda "X" Pada Kotak Jawaban Anda) Yes (Ya) No (ridak) Remark (Keterangan)

1. Own A House (Memiliki Rumah)?

2. Own A Plot Of Land (Memil ki Sebidang Tanah)?

3. Own A Car (Memiliki Mobi )?

4. Own A Motorcycle (Memiliki Motor)?

5. Rent A House (Menyewa Rumah)?

6. Reside ln A House Owned EyThe Company ( Tinggal Dirumah Milik Perusahaan)?

7. Use A Car Owned By The Company (Menggunakan Mobil Mllik Perusahaan)?

FAMILY EACKGROUND (Latar Belakang Keluarga)

Age
Relationship (Hubungan) Name (Nama) Occupation (Pekerjaan) Company Name (Nama Perusahaan)
( Usia) (Pendidikan Terakhlr)

Father (Ayah)

Mother (lbu)

Spouse (Pasangan)

children (Anak)

EDUCATION (pendidikan) / TRAINING OR COURSES (pelatihan Khusus)

From (Mulai) ro -rirssa) | -",:,31,t:1,"".i/)H*,,,i::#:iff"-, School Level (T ngkat Pendid kan) Area Of Specialization llurusan / spesialisasi)

TANGUAGE KNOWLEDGE {
pensuasaan Bahasa)

Fair - Able To Speak &

Read Simple Words 6ood - Able To Speak & Read Sentences Excellent - Able To Speak, Read and Written
Language (Bahasa)
{cukup - Mampu Membaca Dan B€rbicara Densan Kal mat Sederhana) (Baik Mampu Membaca &Berbicara Dengan Baik) (sangat Baik- Mampu Berbicara, Membacb & Menuiis)
EVE=SEzKa
FoRM: EsAE02/R/16

COMPUTER SOFTWARE KNOWLEDGE inpa sala software Komputer yang dapat anda operasikan)

Name (Nama) Beginner (Pemula) lntermedite (Menengah) Advance (Mahir)

Put An "X" ln The Correct Response Box (Berikan Tanda "x" Pada Kotak Jawaban Anda)

YES {Ya) NO illdak) REMARKS {(eteranFtr)

QUESTIONS (pen"nyaan)
1. HM you pre^/'@siy applied to our company? lf yes, please explain when and tor what position?
(Apakah anda sebelumnya pernah mensaiukan lamaran di perusahaan kami? Jika va, kapan dan untuk jabataf apa?)

2. AreVoualsoapplyingforajobtoothercompanies?lfyes,pleasementioncompany'snameandposition'
(Apakah anda juga mensal!kan tamaran ke perusahaan lain? lika ya mohon disebutkan nama per!5ahaan dan iabatan yanC anda ajukan)

3. Are you under any contract agreement with other companies?

(Apakah ande terikat perjanjian kontrak dengan perusahaan lain saat ini)
4. Do yru have any part time job? Please specify the company's name and position you held.
(Apakah anda mem tikt pekeqaan samp nsan/paruh waktu? Mohon sebutkan nama perusahaan dan posisilabatan yans anda pesans.)

5. Doyou haveanyobjectionifwecontactedyourpreviousemployerlorreferencecheckint?
(Apakah anda keberatan apabi a kam menghubungi peru$haan tempat anda bekerja sebelumnya !ntuk memverinka5 relelsO
6i. Hive you ever suffered serious illness, accident or undergo any sutgery? When you had it?
(Apakah Anda pernah menderita Penyak t S€r !s, Pernah Menga ami Ke.elakaan, Ataup!n Pe.nah Menta ar Operasi? Kapan Anda Menga aminya?

7, Are You A Smoker ? (apakah anda seorang perokok?)

8. Have you ever been involved in any administra6ve, civil or criminal case?
(Apakah anda pernah ter ibat da am kasus admlnistratl sipi , stau krim na ?)

tt repted, do you agree to be located anywhere in indonesia? Please mendon preferred cities or regions.
(Apab a anda diterlma bekeria, apakah anda setuiu untuk ditempatkan d mana saja di ndonesia?)

10. Do you have any acquaihtance or relatives employed by our company/group? Please mention their name and
your relationship. (Apakah Anda memi tkt relas atau keluarga yans b€kerla di perushaan/grup kam ? Mohon sebutkan nama, jabatan,
dan hubungan Anda densan or.ng yang bersanEkutan)

11. Are you member oI any Social / Religion Ortanization? Please statel
(Apakah anda anggota ke ompok keagaaan tedenru? Harap d lelaskanl)

12. Describe any kind of jobs that you do not like. lMohon uraikan pekeriaan apa saia vrns k!rans anda m nat)

(Rrwayat kesehatan) (E G Mensanduns/hamil, Asma, Diabetes, Darah T nggi etc)

14, Please state your current monthly income and facilitie5.

(Mohon tu skan pendapatan bu anan dan fas itas yang anda dapatk.n saat lni)

15. State salary and facilities that you expect . (Mohon tu lskan 8aI dan fasilita, yanC anda inginkan)

16. ll a€cepted, are you willing to surrender your original education certificate to company for safe keepint in company's
safety box during Vour servi€e? When can you start workint? (Apabila anda diterima bekerla, apakah anda setuiu menyer.hk:n
setrfkat pendldikan asl anda ke perusahaan untuk d s mpan d safety box selama layanan anda? Kapan anda dapat m!lai kerja?)

[E STARTING FROM THE PRESENT TO !A5T EMPTOYMENT

( pensataman Keria -Mohon Dlist Pengalaman Kerja Anda seakuEt Dan klengkap Mungkan, Dimulai Dari P€rkeriaan AndaSaat lri HinggaPekerjaan S€belumnyll _
From To Name/Address/Company Phone No POSNOn HetO starting Salary Latest Salary Desired Reason For Leaving
(Mulal) (H nssa) (Name/Alamat/No Tel€pon Perusah,an) (labatan) (Gaji Terakh r) (Alasan Pengunduran Diri)

Total Emplovee

To Name/Address/Company Phone No Position Held Stafring Salary Latest Salary Desired Reason For Leaving
(GajiM! (Gatl Terakhlrl (Alasan Pengunduran Diri)
{Mula ) (Hinssa) {Name/A amat/No. Ie epon Perusahaan) Uabatani ar)

Total Employee
(iumlah Karyawan
From To Name/Address/company Phone No Position Held 5ramn8 )arary Latest Salary 0esired Reason For Leaving
(Mulai) (Hingsa) (Name/A amat/No. Te epon P€rusahaan) (labatan) (Gati Mu ai) lGaj Terakh r) (len 5 usaha) (Alasan Pengundunn Diri)

Total Employee
( iumlah Karyawan )

@latives), Formers Employer or Former Teacherc

(Referensi- Berikan 2 Dua {lanpa Hubunean Xelua.ga), Atasan SebelumnF atau pen8aiar Sebelunnya}

Name (Nama) Address & Contact No (a amat & No. Te epon) Occupation (Pekerjaan)
EVERffEZKD
FoRM: ESAE02/R/15

oescribe your good and bad working uperien(e (At Least 50 wordings in English)
Mohor jelatbr perta amrn keta rlda eelama rnr yalg bar< maup-r bu.uk ,-,i,-ar 50 k.ta da'am bahasa rnggls,

I hereby certify that the information given above is true and if under any circumtances any misinterpresentation or omission of information is found,
I understand that i shall fully be held responsible.
Soyo menyotokan bohwo informosi yong soyo berikon dolom formulir ini odolah benor odonyo don soyo sepenuhnyo sodar don mompu bertonqqung jowob
penuh, apobilo di kemudion hori ditemukon kesolohpohomon otoupun kekurangon dori informosi yong soyo berikon, soyo sidp bertonggunq jowob otos

informosi tersebut.

I am aware that background checks might be carried out to verify the above information.
Soyd memohomi bohwo pemeriksoon lotor belakong sayo diperlukon untuk memverit'ikosi int'ormosi yong teloh sayo berikan daldm formulir ini

SIGNATURE OF APPLICANT (Tanda Tangan Pemohon) DATE (Tanggal)

FOR OFFICE USE ONIY {Untuk Penggunaan Kantor )

Comment To Work For lnterview Bv :

PT, EVERSEIKO INDONESIA

PT. EVOSATVO

PT, ENRICH SOTUTIONS