Employee Name

Gender

Male    Female   

Place / Birth Date

/

Status

Single    Married   

Religion

Moslem    Catholic    Christian    Hindu    Buddhist   

Nationality

Email address

Tax ID / NPWP No.

Phone

Jamsostek No.

Cell Phone

Current Address

City

Postal Code

ID Card No.

Driver Licence No.

ID Card Address

City

Postal Code

Father Name

Job Occupation

Private    State of Employee    Entrepreneur    Professional    Pension   

Others   

Mother Name

Job Occupation

Private    State of Employee    Entrepreneur    Professional    Pension   

Others   

Spouse Name

Place / Date of Birth

/

Married Date

Job Occupation

Private    State of Employee    Entrepreneur    Professional    Pension   

Others   

Name

Place / Date of Birth

1st

/

2nd

/

3rd

/

4th

/

School Name

City

Major

GPA

Year (from/to)

Certificate (Y/N)

-

-

-

-

Course Type

Conducted By

Year (from/to)

Certificate (Y/N)

-

-

-

-

Language

Written*

Conversation*

* Fill in with:

Excellent / Good / Average

-- select option -- Excellent Good Average

-- select option -- Excellent Good Average

-- select option -- Excellent Good Average

-- select option -- Excellent Good Average

Month & Year

Company's Name &

Location

Industry

Type

Position

Salary

Moving

Reason

From

To

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

-- month -- January February March April May June July August September October November December

a. Current Position

Number of employee in the Company

Number of staff under your supervision

Your job and responsibility

Direct supervisor

Your achievement

Others benefit exclude salary

b. Please describe your position in your current organization structure :

c. Describe about one problem that happen in your current job, and how you fix the problem :

d. Describe about your career ambition and your plan to reach the ambition :

6. EMPLOYEE SCREENING QUESTIONAIRES

YES

NO

1. Do you have a medical problem / physical defect, which might prevent your mobilization or restrict your assignment? If yes, please give details

2. Are you currently being treated by a doctor? If yes, please give details

3. Have you ever used alcohol or any illegal drugs? If yes, please give details

4. Have you ever pled guilty ,no contest, been convicted, been placed probation, given probation, given community supervision, or given any deferred adjudication for a crime? If yes, please give details

5. Are you the subject of any current criminal or civil proceedings? If yes, please give details

Name

Company

Relationship

Contact No.

Expected Salary

Expected Join Date

Willingness to be placed out of town

Yes     No

Reason :

Your CV (format: .doc or .docx or .pdf)

I declare that the statement above is true. If Company found that my statement above is invalid, Company has the right to terminate my employment and free of any legal charge dispute in the future.