PT MAJU BERSAMA GEMILANG

Factory :
Kawasan Industri Kendal, Jl. Tanjung Anom No. 93, Desa Wonorejo, Kec. Kaliwungu, Kab. Kendal, Jawa Tengah 51372, Indonesia
Executive Office :
Menara Kary 3rd Floor, Suite D Jl. H. R. Rasuna Said Block X-5 Kav, 1-2 Jakarta 12950. Tel (62-21) 5794 4649

FORM APLIKASI KANDIDAT KARYAWAN

Application Form
(Isilah Form ini dengan lengkap dan data yang benar. Isilah dengan huruf balok.
Please fill the form completely with valid data & use the capital)

I. DATA DIRI KANDIDAT KARYAWAN ( PERSONAL DATA )

Faiz Abyantoro Ramadhan

Nama Lengkap (Full Name)

Tempat / Tgl & thn Lahir Karanganyar / 01 January 1999

(Place & Date of Birth)
Sanggir Utara 02/06 Paulan Colomadu Karanganyar
Alamat sekarang & Kode Pos Kode Pos. 57172
(Permanent Address)

081238855169
Telepon & HP (Phone)
Abyan977@gmail.com
Alamat E-mail (E-mail Address)
Sanggir Utara 02/06 Paulan Colomadu Karanganyar
Alamat Tinggal Orang Tua& Kode Pos Kode Pos. 57172
(Parents Permanent Address)

Islam
Agama (Religion)

No KTP/SIM/Passport 3313120101990003
(ID/Driving License/Passport Number)
Indonesia
Kewarganegaraan (Nationality)
Unmarried
Status Pernikahan (Marital Status)
O
Golongan Darah (Blood Type)
Climb, Adventure
Hobby/Minat (Hobby)
Ig. Abyan Faiz
Akun Sosial Media (Social Media
account)
 PT MAJU BERSAMA GEMILANG
Factory :
Kawasan Industri Kendal, Jl. Tanjung Anom No. 93, Desa Wonorejo, Kec. Kaliwungu, Kab. Kendal, Jawa Tengah 51372, Indonesia
Executive Office :
Menara Kary 3rd Floor, Suite D Jl. H. R. Rasuna Said Block X-5 Kav, 1-2 Jakarta 12950. Tel (62-21) 5794 4649

II. DATA KELUARGA ( FAMILY DATA )

Data tanggungan ( Suami/istri jika sudah menikah) / Dependent Data)

Hubungan Keluarga Tempat/ Tgl Lahir Pendidikan Pekerjaan

Nama (Name) L/P
(Relationship) (Place/Date of Birth) (Education) (Occupation)
Suami / Istri (Spouse)
Anak ke 1(Children 1)
Anak ke 2 (Children 2)
Anak ke 3 (Children 3)
Anak ke 4 (Children 4)
Anak ke 5 (Children 5)

Anggota keluarga yang dapat dihubungi dalam keadaan darurat (Emergency Information Data) :

Nama ( Name ) : Ningsih Setiyani Hubungan (Relationship) : IBU

Alamat (Adress) : Sanggir Utara 02/06 Paulan Colomadu Karanganyar
Kode Pos. 57172

Telp (Phone Number) : 082132475770

Susunan keluarga , termasuk Anda ( please describe your family member include yourself )

Hubungan Keluarga Tempat/ Tgl Lahir Pendidikan Pekerjaan

Nama / No. Telp. L/P
(Relationship) (Place/Date of Birth) (Education) (Occupation)
(Name/Telp Numb)
Alm. Agus Suyono L
Ayah (Father)
Ningsih Setiyani P Karanganyar/12 July S1 Teacher
Ibu (Mother ) 1982
Anak kandung ke 1
(Siblings number 1)
Anak kandung ke 2
(Siblings number 2)
Anak kandung ke 3
(Siblings number 3)
Anak kandung ke 4
(Siblings number 4)
Anak kandung ke 5
(Siblings number 5)
 PT MAJU BERSAMA GEMILANG
Factory :
Kawasan Industri Kendal, Jl. Tanjung Anom No. 93, Desa Wonorejo, Kec. Kaliwungu, Kab. Kendal, Jawa Tengah 51372, Indonesia
Executive Office :
Menara Kary 3rd Floor, Suite D Jl. H. R. Rasuna Said Block X-5 Kav, 1-2 Jakarta 12950. Tel (62-21) 5794 4649

Sebutkan nama 3 anggota keluarga dan 2 teman anda yang dapat kami hubungi ( Please mention
Name 3 of family members and 2 of your friends that we can contact)

Telepon Hubungan
Keterangan L/ Pekerjaan
Nama (Name) Alamat ( Address ) (Phone (Relationship)
( Notes) P (Occupation)
number )
Keluarga 1 Ningsih setiyan P Sanggir Utara 02/06 0821324757 Mother Teacher
( family 1) Paulan Colomadu
70
Karanganyar
Keluarga 2 Dzaky Mubarok L Sanggir Utara 02/06 085171732908 Younger sibling Students
( family 2) Paulan Colomadu
Karanganyar
Keluarga 3 Muhammad Marzuki Rifa’i L Fajar Indah 081364635632 Uncle Swasta
( family 3)
Teman 1 Hery Swtiyawan L Karanganyar 088216688452 Friend Swasta
( friend 1)
Teman 2 Ilham Setyoko L Klaten 081215658411 Friend Swata
( friend 2)

III. RIWAYAT PENDIDIKAN / EDUCATIONAL BACKGROUND

Jenjang Pendidikan Nama Sekolah Kota Periode Jurusan Peringkat Nilai

( level of Education ) (Institution) (City) (period) (Major) (Grade) (Score)
Bachelor Muhammadiyah Surakarta 2017-2021 Electrical 3.22
University of Surakarta Engineering

- Uraikan secara singkat dan jelas mengapa Anda memilih jurusan tersebut
( Please describe why do choose your major )

I chose Electrical engineering because in every aspect many use electrically powered equipment and I
am interested in being able to understand and learn so that later it can be useful to looking for a job as
well as in everyday life.

- Jelaskan karya ilmiah yang pernah Anda buat ( skripsi, artikel, karya tulis, dll )
( Please describe one of the thesis, article, essay, etc)

I made a Final Project entitled Panel Automatic Transfer Switch (Ats) Hybrid PLN And PLTS With Two
Choices of Relay-Based Mode MK2P-I is a tool for households that makes it easier to use two sources
of electricity in supplying these household appliances. This tool has worked as expected, using two
modes that have been provided, namely supplying household needs with the priority of the SOLAR
system and supplying household needs with PLN priorities
 PT MAJU BERSAMA GEMILANG
Factory :
Kawasan Industri Kendal, Jl. Tanjung Anom No. 93, Desa Wonorejo, Kec. Kaliwungu, Kab. Kendal, Jawa Tengah 51372, Indonesia
Executive Office :
Menara Kary 3rd Floor, Suite D Jl. H. R. Rasuna Said Block X-5 Kav, 1-2 Jakarta 12950. Tel (62-21) 5794 4649

IV. PENGALAMAN ORGANISASI / ORGANIZATIONAL EXPERIENCE

Nama Organisasi Jabatan di dalam Organisasi Periode Menjabat

( Organization) ( Title in Organization ) ( Period )
KMTE (Keluarga Mahasiswa Member 2017-2020
Teknik Elektri)

V. PENGALAMAN KURSUS & TRAINING / TRAINING & COURSES EXPERIENCE

No Nama Trainning Tahun Penyelenggara Peringkat

(Training & Course) ( Year ) ( Held by ) (Grade)
1.
2.
3.

VI. BAHASA ASING YANG DIKUASAI ( Baik Sekali, Baik, Cukup, Kurang )
LANGUAGE ( Excellent, Good, Poor )

No Jenis Bahasa Mendengar Membaca Berbicara Menulis

(Language) ( Listening) ( Reading ) ( Speaking ) ( Written )
1. English Good Good Less Good
2.
3.

VII. PENGALAMAN KERJA / WORKING EXPERIENCE

Tulislah pengalaman kerja Anda mulai dari pengalaman kerja yang terakhir

Nama Perusahaan (Company)

Periode kerja (dari s/d) (period)
Alamat perusahaan
(company address)

No Telp Perusahaan
(company phone number)
Jabatan awal (First role title
Jabatan terakhir (Last role title)
Nama atasan langsung
(Name of direct supervisor )
Alasan berhenti
(Resignation reason)
Gaji Terakhir
(Last salary)
 PT MAJU BERSAMA GEMILANG
Factory :
Kawasan Industri Kendal, Jl. Tanjung Anom No. 93, Desa Wonorejo, Kec. Kaliwungu, Kab. Kendal, Jawa Tengah 51372, Indonesia
Executive Office :
Menara Kary 3rd Floor, Suite D Jl. H. R. Rasuna Said Block X-5 Kav, 1-2 Jakarta 12950. Tel (62-21) 5794 4649

Nama Perusahaan (Company)

Periode kerja (dari s/d) (period)
Alamat perusahaan
(company address)

No Telp Perusahaan
(company phone number)
Jabatan awal (First role title
Jabatan terakhir (Last role title)
Nama atasan langsung
(Name of direct supervisor )
Alasan berhenti
(Resignation reason)

Gaji Terakhir
(Last salary)

Nama Perusahaan (Company)

Periode kerja (dari s/d) (period)
Alamat perusahaan
(company address)

No Telp Perusahaan
(company phone number)
Jabatan awal (First role title
Jabatan terakhir (Last role title)
Nama atasan langsung
(Name of direct supervisor )
Alasan berhenti
(Resignation reason)

Gaji Terakhir
(Last salary)

Uraikan singkat dan jelas tugas dan tanggung jawab anda pada jabatan yang terakhir
( Please describe duties and responsibility in your current or last position )
 PT MAJU BERSAMA GEMILANG
Factory :
Kawasan Industri Kendal, Jl. Tanjung Anom No. 93, Desa Wonorejo, Kec. Kaliwungu, Kab. Kendal, Jawa Tengah 51372, Indonesia
Executive Office :
Menara Kary 3rd Floor, Suite D Jl. H. R. Rasuna Said Block X-5 Kav, 1-2 Jakarta 12950. Tel (62-21) 5794 4649

Gambarlah struktur organisasi pada posisi jabatn pekerjaan Anda yang terakhir
( Please describe the structure organization which shown your current last position)
 PT MAJU BERSAMA GEMILANG
Factory :
Kawasan Industri Kendal, Jl. Tanjung Anom No. 93, Desa Wonorejo, Kec. Kaliwungu, Kab. Kendal, Jawa Tengah 51372, Indonesia
Executive Office :
Menara Kary 3rd Floor, Suite D Jl. H. R. Rasuna Said Block X-5 Kav, 1-2 Jakarta 12950. Tel (62-21) 5794 4649

VIII. LAIN-LAIN ( OTHERS)

No Pertanyaan ( Question ) Ya ( Yes ) Tidak ( No ) Penjelasan ( Remarks )

Jawaban (Answer)
Apakah saat ini anda pernah di perusahaanini sebelumnya? Kapan & sebagai apa? No
1
(Have you previously applied to this company / group? If so when & what position?)
Apakah saat ini anda melamar di perusahaan lain? Sebagai posisi apa? (Are you also Yes As Engineer
2
aply to other company? If yes please mention the company & in what position?)
Apakah anda terikat kontrak dengan perusahaan tempat bekerja anda saat ini? (Are No
3
you under any contract agreement with other company ?)
Apakah anda memiliki pekerjaan part time? Dimana dan sebagai apa? (Do you have No
4
any part time job?Please specify the name of the company & position held?)
Apakah anda keberatan bila kami meminta referensi pada perusahaan anda No
5 sebelumnya? (Do you have any objection if we contact your previous employer for
background checking?
Apakah anda memiliki teman atau saudara yang bekerja di group / perusahaan ini? No
6 Sebutkan nama dan hubungan dengan anda (Do you have any acquintance or
relative employed by our company or group? Please mention your relationship)
Apakah anda memiliki teman atau saudara yang bekerja di industri kabel optic dan No
distribusi kabel optik atau sejenis? Sebutkan nama, nama perusahaan, jabatan dan
7
hubungan dengan anda? (Do you have any acquintance or relative employed by
other fiber/ cable company or group? Please mention your relationship)
Apakah anda pernah mengalami sakit keras atau menjalani perawatan yang No
8 intensif? Bila ya, kapan dan sebutkan penyakitnya (Have you ever got serious illness
or take intensive care? If yes please mention the time
Apakah anda pernah mengalamai kecelakaan? Bila ya kapan dan apa akibat yang No
9 anda rasakan sekarang?(Have you ever got accident or surgeries? If yes, when have
you had it? Is it affect to your health condition right now?)
Apakah anda pernah menjalani pemeriksaan Psikologis? Bilamana, dimana dan No
10 untuk tujuan apa? (Have you ever undergone psychological examination before? If
so, when, where, for what purpose?)
Apakah anda pernah berurusan dengan polisi karena tindakan tertentu? (Have you No
11
ever been involved in any administrative civil or criminal case?)
Bila diterima bersediakah anda bertugas ke luar kota? (If you accepted by this No
12
company do you agree to out of Jakarta assignment?)
Bila diterima apakah anda bersedia ditempatkan di seluruh daerah di Indonesia? (If No
13 you accepted by this company do you agree to be located anywhere in
Indonesia?Please mention the preferred cities or regions?)
Macam pekerjaan atau jabatan apakah yang sesuai dengan cita cita anda?(Please Work in the field
14
describe any kind of jobs that are in line with your career plan?)
Macam pekerjaan atau jabatan yang tidak sesuai dengan cita cita anda? Please Work inside the office
15
describe any kind of jobs that do not fit to you?)
Bila diterima, kapan anda dapat mulai berkerja? (If you accepted by this company A week after the notification is received
16
when can you start to work?)
17 Besar gaji yang anda harapkan? (Please mention your expected salary) Rp. 3.000.000

18 Tambahkan informasi tambahan jika ada (Additional Information?)

19 Mengapa anda ingin bekerja di PT Maju Bersama Gemilang? (Why do you want to I want to develop my ability to work in the part that I learned in
work at PT Maju Bersama Gemilang?) college

Dengan ini saya menyatakan bahwa keterangan yang saya berikan di atas adalah benar. Bilamana terdapat ketidak benaran, saya bertanggung jawab
penuh atas akibatnya. (Thereby certify the information given above is true & if under any circumstances any misreprensentation of omission of
information is tound, I understand that I shall fully be held responsible )

Kendal, 11 Agustus 2022

Faiz Abyantoro Ramadhan

Pelamar ( Applicant )