Please
PT. AEON CREDIT SERVICE INDONESIA F- HRGA-002-00 attach a
recent
South Tower, Plaza Kuningan, 3A Floor Checklist: passport
Jl. HR. Rasuna Said Kav. C11-14, Setiabudi Copy of certificate photograp
Jakarta, 12940 Copy of application letter
Tel: +62 (021) 252 3331 Fax: +62 (021) 528 80231 1 pcs passport
EMPLOYMENT APPLICATION FORM
(Please complete in BLOCK LETTERS) SOURCE VACANCIES
INFORMATION
A. PERSONAL PARTICULARS 1. Internet 3. Friend
NAME
POSITION APPLIED FOR
HOME ADDRESS RELIGION
TEL. NUMBER(S) (HOME) (HANDPHONE) NATIONALITY
EMAIL ADDRESS SEX
ID NO. DATE OF BIRTH
DRIVING LICENCE CLASS EXPIRY DATE PLACE OF BIRTH
DO YOU OWN A VEHICLE? YES ( ) NO ( ) TYPE: MARITAL STATUS
SOCSO NO. INCOME TAX NO.
B. FAMILY INFORMATION
RELATIONSHIP NAME AGE OCCUPATION COMPANY / SCHOOL
FATHER
MOTHER
SPOUSE
SPOUSE INCOME TAX NO. TEL NO. (OFFICE / HANDPHONE)
SIBLINGS
M-Male;
F-Female
CHILDREN
C. LANGUAGES AND DIALECTS WRITTEN SPOKEN
GOOD FAIR POOR GOOD FAIR POOR
D. MEMBERSHIP OF TRADE, ASSOCIATION OR PROFESSIONAL BODIES
NAME OF BODY GRADE / TYPE OF MEMBERSHIP DATE
E. QUALIFICATION & EDUCATION BACKGROUND
LEVEL SCHOOL / INSTITUTION / COLLEGE PERIOD QUALIFICATION GRADE /
FROM TO
/ UNIVERSITY RESULTS
PRIMARY
SECONDARY
TERTIARY
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DETAILS OF SCHOLARSHIP
OR HONOURS
F. COURSES ATTENDED
NAME OF COURSE COURSE PROVIDER TYPE OF CERTIFICATE DATE
G. SKILLS
RELEVANT SKILLS TYPE OF SKILL (S) LEVEL YEARS OF EXPERIENCE
TO THE JOB
COMPUTER
SKILL(S)
OTHERS
H. EMPLOYMENT HISTORY (Start with your present / latest Employer)
COMPANY NAME TEL NO.
COMPANY ADDRESS
POSITION HELD REPORTING TO
TYPE OF BUSINESS EMPLOYMENT PERIOD FROM TO
OTHER BENEFITS
BRIEF JOB DESCRIPTION
REASON(S) FOR LEAVING
COMPANY NAME TEL NO.
COMPANY ADDRESS
POSITION HELD REPORTING TO
TYPE OF BUSINESS EMPLOYMENT PERIOD FROM TO
BRIEF JOB DESCRIPTION
REASON(S) FOR LEAVING
COMPANY NAME TEL NO.
COMPANY ADDRESS
POSITION HELD REPORTING TO
TYPE OF BUSINESS EMPLOYMENT PERIOD FROM TO
BRIEF JOB DESCRIPTION
REASON(S) FOR LEAVING
COMPANY NAME TEL NO.
COMPANY ADDRESS
POSITION HELD REPORTING TO
TYPE OF BUSINESS EMPLOYMENT PERIOD FROM TO
BRIEF JOB DESCRIPTION
REASON(S) FOR LEAVING
I. PUBLIC SERVICES / RECREATIONAL ACTIVITIES
HOBBIES / LEISURE ACTIVITIES / INTERESTS
PUBLIC / CHARITY DATE ACTIVITIES YOUR ROLE
SERVICES
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J. PERSONAL ACHIEVEMENTS
K. REFERENCES (Please name 2 referees. Relatives are not included)
NAME TELEPHONE NUMBER RELATIONSHIP YEARS KNOWN OCCUPATION
L. ADDITIONAL COMMENTS
(In support of your application)
PERSON TO NOTIFY IN-CASE OF EMERGENCY RELATIONSHIP:
TEL. NO. ADDRESS
M. DECLARATION
1. Have you ever been convicted of a criminal offence? NO ( ) YES ( ) If yes, please state
2. Are you suffering from diseases or disability NO ( ) YES ( ) If yes, please state
that may require periodical treatment?
3. Have you applied for a job in this Company before? NO ( ) YES ( ) If yes, please state
4. Do you have any relative working in this Company? NO ( ) YES ( ) If yes, please state
5. Do you have any objection if we conduct a background NO ( ) YES ( ) If yes, please state
check interview with your references?
6. Do you have any objection if we conduct a background NO ( ) YES ( ) If yes, please state
check for your personal credit history (SLIK)?
I, hereby declare that all the information provided above is true and complete in all aspects. I understand that any
misrepresentation or omission of information may be considered sufficient for withdrawal of an offer or subsequent dismissal from
employment.
Date of Application Signature of Applicant
(ID No: )
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