Form PT INDONESIA CHEMICAL ALUMINA INSTRUCTION INSTRUKSI RECRUITMENT APPLICATION DATA Please complete the questions using capital font. Mohon dilengkapi dengan menggunakan huruf besar. Form. HRDF-5-FRM-REC-02 Record. Form Issued April 27, 2014 Date Revision 0 Page 5 APPLIED POSITION POSISI DILAMAR ALAMAT E-MAIL e-mail address PERSONAL DATA DATA PRIBADI PHOGRAPH 3 X 4 PRESENT ADDRESS ALAMAT SEKARANG PERMANENT ADDRESS ALAMAT TETAP, SESUAI KTP HP PLACE/DATE OF BIRTH TEMPAT/TGL LAHIR KTP/PASPORT KTP/PASPOR MARITAL STATUS STATUS PERKAWINAN NICK PANGGILAN BLOOD TYPE GOL. DARAH NATIONALITY KEBANGSAAN RELIGION AGAMA IN CASE OF EMERGENCY DALAM KEADAAN DARURAT CONTACT PERSON PIHAK HARUS DIHUBUNGI ADDRESS ALAMAT NOMOR TELEPON FAMILY DATA DATA KELUARGA RELATIONSHIP FATHER'S AYAH MOTHER'S IBU YOU'RE NUMBER ANDA ADALAH NOMOR DATE OF BIRTH TANGGAL LAHIR DATE OF BIRTH TANGGAL LAHIR OF BROTHERS/SISTERS BERSAUDARA HUSBAND/WIFE & CHILDREN INFORMATION INFORMASI MENGENAI SUAMI/ISTRI & ANAK S RELATIONSHIP PLACE & BIRTH DATE TEMPAT & TGL LAHIR EDUCATION PENDIDIKAN
FORMAL EDUCATION PENDIDIKAN FORMAL SCHOOL SEKOLAH LEVEL JENJANG DICIPLINE JURUSAN GRADUATE LULUS REMARK KETERANGAN INFORMAL EDUCATION PENDIDIKAN INFORMAL TYPE OF EDUCATION JENIS PENDIDIKAN ORGANIZER PENYELENGGARA DURATION LAMA REMARK KETERANGAN LANGUAGE ( Please using word "EXCELLENT" / "GOOD" / "AVERAGE" / "BELOW AVERAGE" BAHASA (MOHON GUNAKAN KATA "EXCELLENT"/"GOOD"/"AVERAGE"/"BELOW AVERAGE") LANGUAGE BAHASA LISTENING MENDENGARKAN READING MEMBACA SPEAKING BERBICARA WRITING TULISAN NOTE CATATAN WORKING EXPERIENCE [THE LAST FOUR PLACES] PENGALAMAN KERJA [DIURUTKAN TEMPAT KERJA TERAKHIR KE TIGA TEMPAT SEBELUMNYA] COMPANY (1) ATASAN DESCRIPTION OF GAMBARAN KERJA
COMPANY (2) ATASAN DESCRIPTION OF GAMBARAN KERJA COMPANY (3) ATASAN DESCRIPTION OF GAMBARAN KERJA COMPANY (4) ATASAN DESCRIPTION OF GAMBARAN KERJA
OTHER REFERENCES PEMBERI REFERENSI LAINNYA S COMPANY RELATION SOCIAL & PROFESSIONAL ACTIVITIES KEGIATAN SOSIAL DAN PROFESSIONAL ORGANIZATION ORGANISASI ACTIVITIES KEGIATAN POSITION POSISI REMARKS CATATAN PROFESSIONAL CERTIFICATION SERTIFIKAT KEAHLIAN PROFESI CERTIFICATE SERTIFIKAT PUBLISHER PENERBIT OF DURATION MASA BERLAKU VALID TROUGH BERLAKU S/D PERSONAL TERMS & CONDITION PERSYARATAN & KONDISI PRIBADI 1. Any serious illness in last 5 years? Pernah menderita sakit serius 5th terakhir? 2. Any serious injured/operated in last 5 years? Pernah menderita luka/operasi 5th terakhir? 3. Any physical defect? Anda memiliki kekurangan fisik? 4. Are you willing to travel out of town? Maukah anda melakukan perjalanan luar kota? 5. Are you willing to relocated to other town? Bersediakah anda untuk direlokasi ke luar kota? 6. Have you ever been convicted of a crime? Anda pernah terbukti melakukan tindak kriminal? 7. Do you have any relatives who work in PT. ICA? Apakah anda mempunyai kenalan di PT. ICA? 8. Would you be interested to be... Apakah anda tertarik untuk menjadi karyawan... Permanent Tetap Contract Kontrak On Call Basis Sesuai panggilan 9. Would you be interested to be employed... Apakah anda tertarik untuk bekerja... Full Time Penuh Waktu Part Time Waktu Sesaat Shift Kerja bergilir 10. What the position you are applying in PT. ICA? Anda melamar ke PT. ICA sebagai apa? 11. Please explain why you wish to join PT. ICA? Mohon dijelaskan kenapa anda berminat untuk bergabung dengan PT. ICA?
CONFIDENTIAL RAHASIA COMPENSATION & BENEFIT DATA DATA PRIBADI APPLIED POSITION POSISI DILAMAR EXPECTED SALARY GAJI DIHARAPKAN EXPECTED BENEFIT TUNJANGAN DIHARAPKAN NICK PANGGILAN EXP. CAREER PLAN RENCANA KARIR DIHARAP LAST COMPANY BENEFIT RECEIVED BENEFIT DIDAPAT EMPLOYMENT TYPE STATUS KARYAWAN INITIAL SALARY GAJI AWAL [Rp] LAST SALARY GAJI AKHIR [Rp] PREV. COMP. PERUSAHAAN SEBELUMNYA BENEFIT RECEIVED BENEFIT DIDAPAT EMPLOYMENT TYPE STATUS KARYAWAN INITIAL SALARY GAJI AWAL [Rp] LAST SALARY GAJI AKHIR [Rp] I hereby certify the above information according to the best of my knowledge to be correct and complete. I accept, if I write untrue statement. PT. ICA shall have the right to cancel my application and My employement status, and I shall have no claims at all against PT. ICA. Dengan ini saya menyatakan bahwa informasi tersebut diatas adalah benar dan lengkap sesuai dengan pengetahuan saya. Saya menerima apabila saya menulis pernyataan yang tidak benar. PT. ICA mempunyai hak untuk membatalkan aplikasi dan status kepegawaian saya, dan saya tidak akan menuntut apapun kepada PT. ICA. SIGNATURE TANDA TANGAN DATE TANGGAL Original Form filed by Learning & Org. Dev.