RAHASIA

CONFIDENTIAL

FORMULIR LAMARAN
APPLICATION FOR EMPLOYMENT

Nama Jabatan yang diinginkan

: HRD OFFICER
Position Applied For
Dapat Mulai Bekerja pada
: SECEPATNYA
When available for work

Catatan:
Anda diminta untuk mengisi seluruh bagian dari formulir lamaran ini yang akan digunakan sebagai bagian dari proses seleksi.
Jika ada pertanyaan yang tidak sesuai, mohon diisi dengan N/A.

Note:
Please complete all sections of the application form as the information provided on this form will be used as part of this
selection process. Do not leave any item blank. If it is not applicable, please indicate with N/A

DATA PRIBADI
PERSONAL DATA

Nama Lengkap / Nama Panggilan

: Siti khafizah/fizah
Full Name / Nick name
Jenis Kelamin Laki-laki/Perempuan*
:
Sex Male/Female
Tempat & Tanggal Lahir
: Jakarta, 26 Mei 1999
Place & Date of Birth
Alamat saat ini
: Jl. Pendongkelan Belakang Rt 22/16, Cengkareng, Jakarta Barat
Present Address
Telepon Rumah / HP
: 085740218402
Phone Number / Mobile
E-Mail
: Sitikhafizah26@gmail.com
E-Mail
Kewarganegaraan
: Indonesia
Citizenship
Kartu Pengenal No. (KTP/SIM) / Berlaku s/d 3173016605990015/ Seumur hidup
:
Identify Card No. / Valid until
Status Perkawinan Lajang / Berkeluarga / Duda / Janda *
:
Marital Status Single / Married / Widower / Widow
Tanggal menikah :
Date of Married
Agama Islam / Kristen / Katolik / Budha / Hindu / . . . . . . . . . . . .. . *
:
Religion Moslem / Christian / Catholic / Buddhist / Hindu / . . . . . . . . .
Golongan Darah
: A / B / O / AB / . . . . . . .*
Blood Type
Tinggi dan berat badan
: 158 cm / 42 kg
Height and weight
Hobi
: Membaca Jurnal and Issue Social
Hobbies
Media sosial yang dimiliki IG / FB / Twitter / Linked in/. . . . . . .*
:
Social Media Sebutkan nama link media sosial : Siti Khafizah
* Lingkari yang benar / Please sign the correct one

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DATA KELUARGA (termasuk Anda / including you)

FAMILY DATA

Hubungan Nama L/P Tempat/Tanggal Lahir Pendidikan Pekerjaan

Relation Name M/F Place/Date of Birth Education Occupation

Ayah Ahmad Fauzie M Jakarta, 20 April 1969 SMA private

Father entrepreneur
Ibu Anah Suhanah F Pandenggelang, 11 SMA Housewife
Mother September 1970
Saudara Kandung
Brother/Sister
Siti Khafifah F Jakarta, 26 Mei 1999 S1 private sector
#1
employee
#2
#3
#4

Suami/Istri
Spouse

Anak
Child
#1
#2
#3
#4

PENDIDIKAN FORMAL
FORMAL EDUCATION
Diisi dari pendidikan terakhir, bila perlu dapat dilanjutkan pada lembaran yang berbeda
(start with the your most recent education, continuing on a separate sheet if necessary)

Tahun Lulus
Jenis Sekolah Nama Sekolah Lokasi (Kota) Jurusan / Fakultas Dates Attended Graduated Gelar
Type of School Name of School Location (City) Major Course/ Subject Dari Sampai Ya Tidak Degree
From To Yes No
SD Madasrah dawatul Jakarta Barat 2007 2012 Yes
SMP Islam
Islamic education Jakarta Barat 2012 2015 Yes
SMK Center: Alhoeda
Kesehatan Banten Tanggerang 2015 2018 Yes
D3

S1 Universitas Pancasila 2018 2022 Yes S.Psi

S2

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PENDIDIKAN NON FORMAL / PELATIHAN

COURSES / TRAININGS

Jenis Pelatihan Penyelenggara Lokasi (Kota) Tahun / Dates Attended Lisensi/ Sertifikat
Training Type Provider Location (City) From To Lisence/ Certificate
HRD PT. MSDM Indonesia E-training 27 oktober 27 oktober
Bisa 2022 2022

Latihan keterampilan Dikti Jakarta E-training 30 Juni 2020 2 Juli 2020

management
mahasiswa

Latihan Ketrampilan Universitas Pancasila Jagakarsa

Management
mahasiswa

PENGUASAAN BAHASA PENGUASAAN KOMPUTER

LANGUAGE PROFICIENCY COMPUTER LITERACY

*Please indicate (Poor , Fair, Good, Excellent) Apakah anda terbiasa mengoperasikan komputer ? Ya/ Tidak *
Are you familiar in operating a computer ? Yes/No
* Written * Spoken
Tuliskan PC Software yang biasa anda gunakan
List of PC Software that you are familiar with
Bahasa Indonesia
Excellent Excellent
Indonesian
Microsoft Office: Word, Excel, Powerpoint
Bahasa Inggris
Fair Poor
English
Lainnya KETERAMPILAN LAINNYA
Others OTHER SKILLS

Canva, SPSS, tools test psikologi, teamwork, problem solving

AKTIVITAS / PENGALAMAN ORGANISASI

ORGANIZATION ACTIVITIES / EXPERIENCES

Nama Organisasi Tahun Kota Jabatan

Organization Year City Position
Bidang III Senat Keluarga Mahasiswa 2020/2021 South Jakarta secretary
Universitas Pancasila
Rumah Peran Indonesia 2021 South Jakarta member

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Bidang II Senat Keluarga Mahasiswa 2019/2020 South Jakarta staff

Universitas Pancasila
Pengenal kehidupan kampus 2019/2021 South Jakarta staff
mahasiswa baru (PKKMB) tingkat
fakultas and University

HASIL KARYA ILMIAH / PUBLIKASI (Skripsi, Karya Tulis, Artikel, Buku, dll)
SCIENTIFIC WRITING / PUBLISHED WORK (Thesis, Papers, Articles, Books, etc)

Judul Keterangan
Title Remarks
Hubungan antara big five personality dengan agresifitas pada Skripsi
remaja pengguna game online mobile legend bang bang

Sebutkan prestasi/penghargaan yang pernah Anda diperoleh!

Please mention your achievement!

Bidang Keterangan
Field Remarks
1. niversity-level LKMM best participant
* Lingkari yang benar / Please sign the correct one

PENGALAMAN KERJA
WORK EXPERIENCES
Diisi mulai dari pengalaman kerja saat ini atau yang paling akhir, cantumkan semua perusahaan tempat bekerja yang
sebelumnya, termasuk pekerjaan paruh waktu dan wiraswasta. Bila halaman ini tidak mencukupi dapat dilanjutkan di kertas
terpisah. Anda boleh melampirkan resume, namun lengkapi pula aplikasi ini.
Start with present or most recent, list all previous employers. Include self-employement and part time jobs. If more space is
required, please continue on a separete sheet. You may attach a resume but complete the application as well.

Nama Perusahaan/ Name of employer : PT. Derma Lab Nama atasan/ Name Periode kerja/ Gaji/ Pay or
Asia of last supervisor Employment dates salary
Novianti Handayani Dari/ From Awal/ Start
Alamat/ Address : Jl. Arjuna, Kebun Jeruk Mei 2022 2.400.000
Sampai/ To Akhir/ Final
Okrober 2022
Kota/ City: Jakarta Barat Jabatan terakhir/ Your last job title

Nomor Telepon / Phone number: 085692994211 Freelance trial

Alasan keluar (secara spesifik)/ Reason for leaving (be spesific)

The reason I left the previous company was because my working period was over (Contract)
Tuliskan pekerjaan yang Anda lakukan, tugas-tugas, keahlian-keahlian, kesempatan promosi selama bekerja di perusahaan ini.
List the jobs you held, duties performed, skills used to learned, advancements or promotions while you worked at this
company

I was given responsibility, namely as a pharmacist assistant, I was assigned to give drugs to patients, to do informed consent

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Nama atasan/ Periode kerja/ Gaji/ Pay or salary

Nama Perusahaan/ Name of employer; Name of last Employment dates
Madani Mental Health Care – MMHC supervisor
Surya Dari/ From Awal/ Start
Alamat/ Address: Jl. Pancawarga III, Juli 2021 1.000.000
Cipinang Besar Sel., Kecamatan Sampai/ To Akhir/ Final
Jatinegara Oktober 2021
Jabatan terakhir/ Your last job title

Kota/ City : Jakarta Timur Psychologist assistant

Nomor Telepon / Phone number:

087877515510

Alasan keluar (secara spesifik)/ Reason for leaving (be spesific)

the reason for leaving was because I was only an intern assigned for 3 months

Tuliskan pekerjaan yang Anda lakukan, tugas-tugas, keahlian-keahlian, kesempatan promosi selama bekerja di perusahaan ini.
List the jobs you held, duties performed, skills used to learned, advancements or promotions while you worked at this company

I was given responsibility as a psychological assistant, who was assigned to provide psychological assessments such as
interviews, observations, and conducting test kits, not only that I did psychotherapy and I made patient data using excel.

Bolehkan kami menghubungi Perusahaan yang mempekerjakan anda sekarang? Ya/ Tidak *
May we contact your present employer? Yes/ No *

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JABATAN SAAT INI / TERAKHIR

CURRENT / LAST JOB

1. Gambarkan jabatan Anda dalam sebuah struktur organisasi sederhana di mana Anda bekerja saat ini atau di mana Anda
bekerja terakhir kalinya sehingga terlihat jelas posisi atasan dan atau bawahan Anda !
Define the structure of your current or last employer which explain the position of your superior and or subordinate

Head Ofiicer

Apoteker

Saya

Jenis pekerjaan apa yang Anda sukai? Mengapa?
What kind of job do you like? Why?
I like a job that encourages me to always improve my skills,
including experimenting and exploring new design
techniques. An environment like this can make me always
enthusiastic in expressing creativity.
Jenis perkerjaan pekerjaan apa yang Anda tidak sukai?
Mengapa
What kind of job do you dislike? Why?
Actually it's not a big problem that makes me not like it, it's
just a work environment that is different from the vision that
makes me uncomfortable.

Ceritakan pengalaman kerja yang paling berharga bagi Anda dari pekerjaan-pekerjaan sebelumnya.
Please state your most valuable experience in your previous jobs.

The valuable experience I got from my previous job was when I worked with a team and talked with patients, it made
me have new knowledge and new habits. knowledge and habits that make me better in the future

Berikan penjelasan singkat mengapa Anda tertarik melamar di perusahaan ini.

Please state the reasons why you are interested in applying in our company.

I am interested in applying for a job at this company, because this company has a good reputation. Apart from that, I see
that your company has survived and developed even during a pandemic because it has innovative and solutive products
for its users. Because of that, I am sure to have a career in this company.

Tambahkan satu hal yang menurut Anda penting dan dapat membantu kami dalam menilai kecakapan Anda atas posisi yang
Anda lamar.
Add any facts here which you consider important and helpful to us in assessing your suitability for the position you have
applied for.
I read on the company's website that your company's mission is to create humanist elements that are safe and of
guaranteed quality. I am a Bachelor of Psychology graduate, have internship experience. With my educational
background and experience, I can help companies create and develop quality humanist elements.

Sesuai dengan pendidikan dan pengalaman Anda, apa yang Anda harapkan dengan pekerjaan Anda ?
Based on your education and experiences, what do you expect from your future job ?

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The reason for applying for the job, this job position in particular, can help me pave the way for a
long-term career development plan, which is by far the most important thing in my life as a working individual.

Sebutkan berapa gaji yang Anda harapkan.

Please state your expected salary.
My salary requirements are flexible, but given that I have significant experience in this field, I hope that HRD ladies and
gentlemen can discuss in more detail about my responsibilities in this company in the future. From there, I can
determine a fair salary for my position.

Apakah anda pernah diberhentikan atau diminta untuk mengundurkan diri ? Apabila Ya, oleh siapa dan kapan?
Have you ever been discharged or asked to leave your job? If yes, by whom and when?
I have never been laid off or to resign

Apakah anda pernah melamar atau bekerja untuk perusahaan ini atau salah satu unit bisnis Kompas Gramedia ?
Apabila Ya , dimana dan kapan?
Have you ever applied or to work for this company, or one of Kompas Gramedia Business unit?
If Yes, where and when?
I have never work this company

Apakah anda mempunyai keluarga atau kawan yang bekerja dalam perusahaan ini atau pada unit bisnis Kompas Gramedia?
Apabila Ya, Cantumkan nama dan jabatannya!
Do you have any relatives or friends working in this company or any other Kompas Gramedia Business Unit ? If Yes, please
state his/her name and current position!
none of my relatives or family work here

Ceritakan rencana hidup Anda untuk 3-5 tahun mendatang? Bagaimana Anda mewujudkan rencana Anda?
Please tell your life plans in the 3-5 year to come. How are you going to make your plan happen?
First of all, I want to learn as much as possible to be more familiar with this line of work. After working for 1 year,
maybe I will start attending training to broaden my knowledge and gain experience. If I have gone through many
phases, the hope is that I can at least be considered to fill my dream position in the future.

LAIN-LAIN
OTHERS

Sebutkan referensi yang dapat dihubungi. Tidak termasuk sanak keluarga atau bekas atasan
Please state your references who is able to be contacted. Exclude relative or former employer

Nama Jabatan Perusahaan Telepone

Name Position Company Phone Number
1.
2.

Apa yang Anda rasakan sebagai kelebihan Anda? Apa yang Anda rasakan sebagai kelemahan Anda?
What do you consider as your strengths? What do you consider as your waeaknesses?

I have the ability to do things related to the field of Human
Resources and also several other skills such as writing letters,
making power points, entering data into excel and editing
good videos/photos. With this ability, I can believe that the
work will go well too, coordination with team members goes
well. Work as Human Resource Development requires
psychological assessment such as interviews, observations,
assessments of psychological test kits. Therefore, this ability
is very necessary for the job.
I consider myself to be someone who is very conscientious.
However, sometimes this can lead to a tendency towards
perfectionism. At my previous job, this trait had led me to
check data in spreadsheets over and over again. I myself
have always succeeded in measuring which tasks could have
been done earlier by analyzing the level of difficulty.
However, I realize that perfectionism is not something to be
taken lightly. I have also started to improve this weakness by
appreciating more for every success I have achieved

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Apakah Anda pernah menderita sakit keras? Jika pernah, penyakit apa dan kapan?
Have you ever had any serious illnesses? If yes, what kind of illness and when?
I have never

Apakah Anda pernah mengikuti tes psikologi Ya/ Tidak *

Have you ever had a psychological testing? Yes / No *

Jika pernah, dalam 1 tahun terakhir ini sudah berapa kali, di mana, dan kapan?
If you ever had a psychological testing in last the one year, how many times, where, and when?
I did psychological tests 2 times on campus, I did it around February

* Lingkari yang benar / Please sign the correct one

Bersediakah Anda untuk mengikuti pemeriksaan kesehatan sesuai standar perusahaan (termasuk pemeriksaan Ya / Tidak*
Fisik menyeluruh)? Yes / No *
Would you be willing to take a health examination according to company standards (including a thorough physical
examination)?

Bersediakah Anda bila diperlukan dipindahkan baik di dalam 1 (satu) perusahaan maupun ke salah satu Ya / Tidak*
perusahaan/ anak perusahaan Kompas Gramedia, baik di Jakarta maupun di luar Jakarta? Yes / No *
Would you be willing to be placed within the company or to other subsidiary company of Kompas Gramedia in
Jakarta or outside Jakarta.

Bersediakah Anda bila diperlukan untuk bekerja dengan system shift? Ya / Tidak *
Would you be willing to work by shift? Yes/No *

Bersediakah Anda bila diperlukan bekerja lembur atau di luar hari/jam kerja yang sudah ditentukan? Ya / Tidak *
Would you be willing to work overtime or outside the regular work time? Yes / No *
Apabila Anda diterima, bersediakan Saudara menjalani masa kontrak/training? Ya / Tidak *
If you are accepted, would you be willing to undergo contract period? Yes / No *

Apabila dalam masa kontrak/training Anda melanggar ketentuan perusahaan dan tidak memenuhi
kinerja/prestasi yang ditentukan, bersediakan Anda diberhentikan tanpa pesangon? Ya / Tidak *
If in your contract period, you have been found to violate company rules and regulations or failed to meet the Yes / No *
set performance, would you be willing to be dismissed without any further compensation?

Apabila kemudian Anda ingin berhenti dari perusahaan ini, bersediakan Anda memberitahukan secara
tertulis sekurang-kurangnya 1 (satu) bulan dimuka (pasal 1603 KUH Perdata jo. pasal 162 UU No.13 thn
2003) Ya / Tidak *
If you plan to resign from the company, would you be willing to submit a written letter of resignation at least Yes / No *
1 month in advance? (Article 1063 KUH Perdata jo. article 162 UU No.13 thn 2003)

Apabila Anda diterima, bersediakah Anda mentaati segala peraturan dan ketentuan yang berlaku di
perusahaan ini? Ya / Tidak *
If you are accepted, Would you be willing to comply the all rules and regulations of this company? Yes / No *

Saya bersedia menjamin bahwa semua yang saya tulis di surat keterangan lamaran ini adalah benar dan lengkap. Saya
memahami bahwa adanya informasi yang tidak benar (atau penghapusan) di dalam aplikasi ini, atau dokumen
pendukungnya, merupakan bukti yang memadai untuk pembatalan penawaran kerja atau pemutusan hubungan kerja tanpa
tanpa pesangon jika saya diterima bekerja (sesuai dengan pasal 1603 O KUH Perdata)

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I certify that all facts in this application letter are true and complete. I understand that any false
information (or omissions) in this application, or its supporting documents, will be sufficient grounds for refusal to hire or
termination without any additional compensation other than for the work completed (Article 1603 O KUH Perdata)

Jakarta, 16 November 2022

(Siti Khafizah)
Tanda tangan & Nama jelas
Signature and Full Name
* Lingkari yang benar / Please sign the correct one

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