ASEAN Secretariat Jl.

Sisingamangaraja 70A Jakarta 12011

EMPLOYMENT APPLICATION FORM

I.PERSONAL NameRACHMANSAYCH DEDIE : ____________________________________________ [email protected] address : _________________________ Last Name First Name Middle Name Present Address : Jakarta Utara Jl. Swasembada Barat XIV. No.34 14320 __________________________________________________________________________________________ Street City Country Zip +6281808373631 Code Telephone : _______________ (office) _______________ (residence) ___________________ (hand phone)
11/September/1985 Jakarta Date/month/year of Birth : _________________ Place of Birth : __________________ Male Gender :________________________

Marital Status : Single _____________________

DKI Jakarta Citizenship : _________________

Identification Card KTP/Passport ) No.: ________________________ 09.5103.110985.4018

Jakarta Utara : Issued by September 11th -date : Issued 2010

Married ____________________ Widow(er) __________________

Jakarta Utara Place of issue : _______________

September 11th : Expiration date - 2015

II. FAMILY BACKGROUND a. Parents Name H.Sjamsuddin Palari HJ. Ranteni

Relationship Father Mother

Date Of Birth Oct-17 1945 Aug-05 1950

Education Diploma High School

Occupation Former of BUMN House Wife

Family / Dependent Relations Name hip Vivi Yanti YA, M.Sc Sister Siti Syarliani, SE Sister

Sex Fema le Fema le

Date of birth June 20 1977 Jan 01 1981

Education Master of Science Economy Degree

Occupation Government Employee Secretary

III. FORMAL EDUCATION Years attended Start 2001 Endin g 2006 Name of School Jayabaya University Location Jakarta

Major Degree granted Social Diploma

Main Subjects International Relation

IV. EMPLOYMENT RECORD (Start from the most recent) 1. Years employed/duration From 2008 To 2009 Name of Organisatio n/ Company Ministry Of Youth & Sports Net Salary per annum (Excluding allowances) Starting Rp. 750.000,Final Rp. 1.500.000,-

Address/Phone

Position

Jl. Gerbang Staff Penuda Senayan, Jakarta Description of your work : Collecting data, Make arrangement and Assistance for Youth Expert Staff for Ministry of Youth and Sports

Reason for leaving : Rotation Position 2. Years employed/duration From 2009 To 2010 Name of Organisatio n/ Company Ministry Of Youth & Sports

Supervisors Name : Mr. Raffly Effendy Telephone : Net Salary per annum (Excluding allowances) Starting Rp.1.500.000,Final Rp. 1.500.000,-

Address/Phone

Position

Jl. Gerbang Penuda Senayan, Jakarta Description of your work:

Staff

Collecting data, Make arrangement and Assistance for Admin staff Reason for leaving : Register for Indonesia National Army 3. Years employed/duration From 2006 To 2007 Name of Organisatio n/ Company Indosat Tbk. Supervisors Name : Mr.Mozart Telephone : Net Salary per annum (Excluding allowances) Starting Rp.800.000,Final Rp. 1.750.000,-

Address/Phone Jl. Medan Merdeka Barat

Position Front Liner

Description of your work : Collecting data, Answer the telephone and Promote Indosat 3.5 G Broadband Reason for leaving : Supervisors Name : Mrs. Vivi

Joint for Ship for SouthEast Asian Youth Program (SSEAYP)

Telephone :

Proper Salary in ASEAN Secretariat Salary expectation: __________________

Please note that in evaluating your candidature ASEAN Secretariat reserved the right to approach your previous employer(s) for references. It is not our policy to approach your present employer at the evaluation stage unless you expressly authorize this. Have you any objections to our making inquiries of your present employer? Yes No Please note, however, that before making an offer of employment ASEAN Secretariat is required to contact both your present and previous employers. _______________________________________________________________________________________________

V. SKILLS Remarks Computer MAINTENANCE

PC

LAN

Language English French Portuguese Other

Softwares : Speak Fair Good Fluent Fair

Read /Write Good Fluent

Beginner

VI. COURSE / TRAINING RECORD Certification/Seminar/ Description/Typ Institution Course e On the Job Training/Training Certification Internship United Nation Programe Certification Course Embassy of Portugal Training Youth Rotaract Club Leadership Certification SSEAYP Government

Place/Location

Duration

Jakarta Jakarta Jakarta ASEAN-Japan

9 Month 6 Month 5 Days 3.5 Month

Have you been charged for committing to any crime? If yes, please explain. NO Are you a member of labour organization or political party? If yes, please state the name, address and your position in the organization. NO

Employment by the ASEAN Secretariat may require assignment and travel to any area. Have you any disabilities or reservations that may restrict your activities in this respect? If yes, please explain.

Yes No

Are you under any obligation to return/stay in the service Yes of your company in recognition of sponsored training or No education? Please show your position at your current job in an organization chart.
DEPUTY

DEPUTY ASSISTANCE

SUB DEPUTY ASSICTANCE I

SUB DEPUTY ASSICTANCE II

SUB DEPUTY ASSICTANCE III

STAFF (MY POSISTION)

If this space not enough, please use next page. Please mention three (3) references No. 1 Name Ms. Vivi Yanti Occupation Government Employee Address & Email [email protected] o.uk Telephone 08129469008

I hereby certify that the above information is true and correct. I agree that any misinterpretation made in this application for the purpose of securing employment shall be grounds for termination or denial of employment. Final appointment will be subject to a physical examination.

Applicants Signature : ___________________________