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CONFIDENTIAL

Name :

Filling Date :

Head Office: Jl. RP. Soeroso No. 7 CIkini, Menteng, Jakarta 10330. Indonesia
Telp. +62 (21) 31931708 . Fax. +62 (21) 3107059 . PO. Box 3108 /Jkt 10330.

Branch Office : Metro Trade Center Blok B No. 32, Jl. Soekarno Hatta Bandung, West Java. Indonesia
Telp. +62 (22) 70840018 . Fax. +62 (21) 7536430.

Factory 1: Jl. Raya Jakarta Bogor KM 29 Cimanggis, Depok - West Java. Indonesia
Telp. +62 (21) 8710641 . Fax. +62 (21) 8710962.

Factory 2: Kampung Meriuk Desa Gandasari, Cikarang Barat, Bekasi, West Java. Indonesia
Telp. +62 (21) 88332211 . Fax. +62 (21) 8831201.
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To Applicant : We deeply appreciate your interest in our organization and

assure you that we are sincerely interested in your
qualifications.

A clear understanding of your background and work history PHOTO (3x4)

will help us in orienting you to the position that best meets
your qualifications and may assist us in possible future
development.

Please write done your data at this form with BIG LETTER.

PERSONAL DATA
Full Name : Nick Name

Present Address :
(at Indonesia)

Permanent Address :

(homeland address)

Phone

Business Telephone : Private Phone

Place & Date of Birth :

Place DD MM YY

Passport : Expired date :

Visa : Expired date :

IKTA : Expired date :

Sex : Male Female

Religion :

Marital Status : Single Married Divorced / Widowed / Separated

Nuclear Family :

Name Age Education Occupation Address

Spouse

Children 1

Extended Family :

Name Age Education Occupation Address

Father

Mother

Sibling: 1

Have you ever followed YKK International Recruitment process before? Yes No
If yes, How many times? When?
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WORK INTEREST

Position applied for :

Why do you choose this position ?

How do you know about this vacancy ?

Internet Advertisement Newspaper Advertisement Apply Spontaneously

Other (please mention)

Other position(s) for which you consider to be qualified :

or

Monthly Salary expected (Take Home Pay) :

Work location preferred :

If your application is considered favorable, on what date you will be available to start working

with PT. YKK ZIPPER INDONESIA ?

EDUCATION BACKGROUND
Name and State / Country Graduated/
School From - To Location Major Course Degree GPA
Received

Elementery

Jr. High

Sr. High

Academy

University :

- Bachelor

- Master

- PhD

FOREIGN LANGUAGE SKILLS

Read Write Speak

Language
F G V E F G V E F G V E

English F = Fair Please tick ( √ ) one of

Bahasa Ind G = Good your language

Mandarin V = Very Good qualification level.

E = Excellent

SPECIAL SKILL
List your special skill, starting with the most used for your position & work. Level :

Skill Level Last Used (year) Kind of Certification F = Fair

G = Good

M = Mastery

E = Excellent
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TRAINING/COURSE/APPRENTICESHIP RECORDS

Kind of Training/Course/ Training

From - To Organized by Qualification Certificate
Apprenticeship Location
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No

EMPLOYMENT RECORDS
List all present and past employment records, starting with the most recent one.
Use separate block for each employment.

1 Period : to
Company : Location :
Type of business : Total of Employees :
Starting position : Lastest position :
Starting Salary : ( gross/net ) Salary at Leaving : ( gross/net )
Reporting to (Name & Position) :
Number of employees supervised ( if any ) :
Brief description of activities ( in the last position) :

Achievement at this company :

Reason for Leaving :

2 Period : to
Company : Location :
Type of business : Total of Employees :
Starting position : Lastest position :
Starting Salary : ( gross/net ) Salary at Leaving : ( gross/net )
Reporting to (Name & Position) :
Number of employees supervised ( if any ) :

Brief description of activities ( in the last position) :

Achievement at this company :

Reason for Leaving :

3 Period : to
Company : Location :
Type of business : Total of Employees :
Starting position : Lastest position :
Starting Salary : ( gross/net ) Salary at Leaving : ( gross/net )
Reporting to (Name & Position) :
Number of employees supervised ( if any ) :
Brief description of activities ( in the last position) :

Achievement at this company :

Reason for Leaving :

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4 Period : to
Company : Location :
Type of business : Total of Employees :
Starting position : Lastest position :
Starting Salary : ( gross/net ) Salary at Leaving : ( gross/net )
Reporting to (Name & Position) :
Number of employees supervised ( if any ) :
Brief description of activities ( in the last position) :

Achievement at this company :

Reason for Leaving :

ORGANIZATIONAL STRUCTURE & YOUR POSITION

Draw organization structure regarding with your position (just draw two of your last ex-company).

1 2

3 4

Disease that ever : Disease : When : (In/Out - patient)

get (from the bigest) Disease : When : (In/Out - patient)

PERSONAL REFERENCES (Former Employers or Lecturers)

Name :
Occupation : Connection :
Address :
E-mail : Phone :
Can we contact him/her? : Yes No
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Name :
Occupation : Connection :
Address :
E-mail : Phone :
Can we contact him/her? : Yes No

Name :
Occupation : Connection :
Address :
E-mail : Phone :
Can we contact him/her? : Yes No

ADDITIONAL INFORMATION (if any)

The facts stated in this application for employment are true and complete to the best of my knowledge and belief.
I understand that false information in this application shall be considered sufficient for dismissal from employment.

Date : Applicant's Signature :

N.B. : Please supply documentary evidence which supports the statements you have made above. Do not, in any event,
submit the originals of references, testimonials, certificates or diplomas, unless they have been obtained for the sole
use of YKK INDONESIA.

Photographs and documents are non returnable and shall thereafter be deemed to be the property of YKK
INDONESIA.