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
Tel: +62 (021) 252 3331 Fax: +62 (021) 528 80231

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

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D. MEMBERSHIP OF TRADE, ASSOCIATION OR PROFESSIONAL BODIES

NAME OF BODY GRADE / TYPE OF MEMBERSHIP DATE

E. QUALIFICATION & EDUCATION BACKGROUND

LEVEL SCHOOL / INSTITUTION / PERIOD QUALIFICATION GRADE /

COLLEGE / UNIVERSITY FROM TO RESULTS

PRIMARY

SECONDARY

TERTIARY

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

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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. I declare never have a crime record NO ( ) YES ( )

2. I do not mind if PT ACSI checks my credit quality through SLIK NO ( ) YES ( )

3. I do not mind if PT ACSI checks reference against my background NO ( ) YES ( )

4. Are you suffering from diseases or disability

that may require periodical treatment? NO ( ) YES ( ) If yes, please state

5. Have you applied for a job in this Company before? NO ( ) YES ( ) If yes, please state

6. Do you have any relative working in this Company? NO ( ) YES ( ) If yes, please state

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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