FORMULIR LAMARAN KERJA

Employment Application Form

Formulir lamaran kerja ini akan saya isi dengan sejujur-jujurnya sesuai dengan kenyataan yang sebenarnya. Apabila dikemudian hari terdapat
keterangan yang tidak benar, saya bersedia ditindak sesuai dengan ketentuan perusahaan yang berlaku.
I hereby acknowledge that all information I will fill in this from are true and accurate to the best of my knowledge. Should there be any false
information. I'm willing to recaive any sanctions according to campany's regulation

Nama Lengkap (Sesuai KTP) : Photograph

Full Name (According to ID Card)

Alamat ( Sesuai KTP ) :

Addres ( to ID Card )

Kota / City :

Kode Pos / Post Code :

Nomor KTP :

ID Card Number

Posisi yang Dilamar :

Position applied

Sumber Informasi Lowongan :

Information about this vacancy

DATA PRIBADI / PERSONAL DATA

Nama Panggilan ________________________________ Agama ________________________________

Nick Name Religion

Tempat / Tgl Lahir ________________________________ Status Perkawinan ________________________________

Place / Date of Birth Marital Status

Jenis Kelamin ________________________________ Tinggi / Berat badan ______________cm / _____________kg

Gender Height / Weight

Rumah Milik Orang Tua / Pribadi / Sewa / Kredit / dll (__________________)

ALAMAT / ADDRESS

Alamat Sekarang ________________________________ Alamat Orang Tua ________________________________

Current Address Parent's Address

________________________________ ________________________________

Kota ________________________________ Kota ________________________________

City City

Kode Pos ________________________________ Kode Pos ________________________________

Post Code Post Code

No. Telephone ________________________________ No. Telephone ________________________________

Telephone Number Telephone Number

No. Hand Phone ________________________________ No. Hand Phone ________________________________

Hand Phone Number Hand Phone Number

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DATA KELUARGA / FAMILY DATA

Nama Lengkap Usia Pendidikan Pekerjaan

Full Name Age Education Occupation

Ayah : ________
Father
Ibu : ________
Mother
Saudara :
Brother / Sister 1 ________
2 ________
3 ________
4 ________

Suami / Istri : ________

Husband/Wife
Anak 1 ________
Child 2 ________
3 ________
4 ________

PENDIDIKAN FORMAL / FORMAL EDUCATION

Tingkat Nama Sekolah Jurusan Kota Periode (dari-sampai) Berijasah
Level Name of School Major City Period (from-to) Certificated

SD
Elementary School

SMP
Junior High School

SMU
Senior High School

Universitas
University

PENDIDIKAN NON FORMAL (KURSUS) / NON FORMAL EDUCATION (COURSE)

Bidang Penyelenggara Kota Periode (dari-sampai) Berijasah

Field Name of Institution City Period (from-to) Certificated

____________________________ _____________________ ________________ ________________ ________________

____________________________ _____________________ ________________ ________________ ________________

____________________________ _____________________ ________________ ________________ ________________

PENATARAN & LOKAKARYA / SEMINAR & WORKSHOP

Bidang Penyelenggara Kota Periode (dari-sampai) Berijasah
Field Name of Institution City Period (from-to) Certificated

____________________________ _____________________ ________________ ________________ __________

____________________________ _____________________ ________________ ________________ __________

KEMAMPUAN BAHASA ASING / LANGUAGE PROFICIENCY

Bahasa Menulis Berbicara Mendengarkan Membaca

Language Writing Speaking Listening Reading

__________________ __________________ ________________________ __________________ __________________

__________________ __________________ ________________________ __________________ __________________
__________________ __________________ ________________________ __________________ __________________

Isilah dengan Baik Sekali, Baik atau Cukup (Please fill with Excellent, Good or Fair)

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KETRAMPILAN KOMPUTER / COMPUTER LITERACY KETRAMPILAN LAIN / OTHER SKILL

Jenis Program Aplikasi Jenis Diskripsi

Program Type Application Type Description
__________________ _____________________ ________________________ _____________________________
__________________ _____________________ ________________________ _____________________________
Isilah dengan Baik Sekali, Baik atau Cukup (Please fill with Excellent, Good or Fair)

PENGALAMAN KERJA / WORKING EXPERIENCE

Diisi mulai dari yang terlama

1 2 3
Nama Perusahaan _____________________________ __________________________________ _____________________
Name of Company

Jenis Usaha _____________________________ __________________________________ _____________________

Nature of Business

Alamat Perusahaan _____________________________ __________________________________ _____________________

Company's Address

Jabatan _____________________________ __________________________________ _____________________

Position

Uraian Tugas _____________________________ __________________________________ _____________________

Job Description
_____________________________ __________________________________ _____________________

_____________________________ __________________________________ _____________________

_____________________________ __________________________________ _____________________

Masa Kerja (dari-sampai) _____________________________ __________________________________ _____________________

Length of Employment(from-to)

Pendapatan / bulan _____________________________ __________________________________ _____________________

Salary / month

Alasan Berhenti _____________________________ __________________________________ _____________________

Reason for Leaving

Gambarkan posisi anda ;

dlm struktur organisasi
Organization Structure

REFERENSI / REFERENCE

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Nama Jabatan/Pekerjaan Nama Perusahaan / Lembaga Alamat & No. Telephone Hubungan
Name Position/Occupation Name of Company / Institution Address & Phone Number Relationship

__________________ __________________ ________________________ ___________________ ____________________

__________________ __________________ ________________________ ___________________ ____________________

Pernah saudara / saudari melamar di perusahaan ini? 1. Ya ( Kapan________________) 2. Tidak Pernah

Sebutkan kenalan anda / Family yang bekerja di Perusahaan ini?

Nama Jabatan / Pekerjaan Alamat & No. Telephone Hubungan
Name Position/Occupation Address & Phone Number Relationship

__________________ __________________ ________________________ ___________________

__________________ __________________ ________________________ ___________________

Sebutkan no dan jenis SIM pyang anda punya : SIM ________ No SIM __________________________________________
SIM ________ No SIM __________________________________________

Informasi keluarga / orang terdekat yang dapat dihubungi saat Emergency :

Nama Hubungan No Telp / HP
____________________ ____________________ _________________________

____________________ ____________________ _________________________

LAIN-LAIN / MISCELLANEOUS

Jenis Pekerjaan yang saudara sukai _________________________________________________________

Type of job your prefer

Bila diterima, kapan saudara dapat mulai bekerja ? _________________________________________________________

If accepted, when are you ready to start working ?

Besar gaji yang diinginkan _________________________________________________________

Expected salary

Fasilitas yang diharapkan _________________________________________________________

Expected facility

Beberapa kelebihan yang saudara miliki _________________________________________________________

Some of your strengths

Beberapa kelemahan yang saudara miliki _________________________________________________________

Some of your weakness

Penyakit berat yang pernah diderita & kapan ? _________________________________________________________

Any serious illness contracted and when ?

Keterlibatan perkara pidana, kapan & masalah apa ? _________________________________________________________

Court offense, when and what case ?

Orang-orang yang anda kenal dlm perusahaan ini ? _________________________________________________________

Persons you know to be working in this company ?

Bila anda sedang dalam proses seleksi di perusahaan lain, sebutkan nama perusahaan tsb, posisi yang anda lamar dan seberapa jauh proses tersebut
If you are being processed at others company, please mention the company's name, your applied position and how far is the process

Tuliskan keterangan lain yang ingin Saudara sampaikan dan perlu untuk diketahui
Please write any additional explanation you need to inform and need to be know

Jakarta,………..,………..,………..

Tanda tangan Pelamar

(_________________)
LAPORAN HASIL INTERVIEW

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HASIL INTERVIEW / RESULTS INTERVIEW
Penilaian Pribadi Calon :
personal assessment of job candidates
Penilaian Penguasaan dalam bekerja

Penilaian terhadap :
dan cara bicara calon karyawan

PENILAIAN / HASIL INTERVIEW

Penilaian Pribadi Calon Karyawan
Penilaian Penguasaan dalam
Pengalaman Bekerja
Penilaian terhadap Penampilan,
dan cara bicara calon karyawan
Gaji masa Percobaan/Kontrak
: ______________________________________________________________________________________________
: ______________________________________________________________________________________________
______________________________________________________________________________________________
: ______________________________________________________________________________________________
: ______________________________________________________________________________________________

Decision: Rejected KIV Selected •

Hasil Interview

PEWAWANCARA Tanda Tangan HRD

(_________________)
1. ( ) ( )

2. ( )

Approved By :
Full Name Signature

Line / Departmental Manager

Human Resources Department

Director

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