Application for Employment

HR.1.003 Page 1

PT DIAN INDAH PERDANA
Jalan Wahidin II No. 4 Padang Timur
Padang Sumatera Barat
Telp +62751 28618

APPLICATION FOR EMPLOYMENT

Read through this form carefully before completing it. Attach copy of relevant certificates and/or testimonials but bring along the
originals for the interview. Please complete in Your Own Handwriting but do not write on shaded ccolumn. All information will be
treated in strict confidentiality.


PERSONEL INFORMATION

Employee No.


First Name Middle Name Last Name Write down the name
You are known by :


Present Permanent Address :






Sex : Male Female

Religion :

Marital Status :

Single Married


Divorced Widow/Widower






Photograph
E-mail Address :


Telephone/ Fax No.

Residence :

Handphone :

Fax :
Plece of Birth

City : Padang Sibusuk, Sijunjung

Province : Sumatera Barat

Country : Indonesia


Date of Birth

Month Date Year
Date Employment

Month Date Year
Nationality
Indonesia
ID No.
1303102907900001
Passport No



EDUCATIONAL INFORMATION
SCHOOL NAME & ADDRESS GRADUATE
(Yes/No)
MAJOR SUBJECTS DEGREE
ELEMENTARY
YEAR COMPLETED :
2002





Yes

V
V
20

M. Syah

Addinal

Huda

Huda

Jorong Kapalo Koto, Padang
Sibusuk, Kec. Kupitan, Kab.
Sijunjung, Suamatera Barat.

[email protected]

+628-5263618269

07

29

1990

- SD PELITA Jakarta, Tahun 1996-2000
- SD N 09 Sijunjung, Tahun 2000-2002

HR.1.003 Page 2

JUNIOR HIGH SCHOOL
YEAR COMPLETED :
2005

SMP N 3 Sijunjung



Yes

SENIOR HIGH SCHOOL
YEAR COMPLETED :
2008

SMA N 2 Ma. Bungo, Jambi



Yes

Natural Science

COLLEGE
YEAR COMPLETED :
2012

Universitas Negeri Padang



Yes

Mining
Engineering

D 3
GRADUATE
YEAR COMPLETED :






POST GRADUATE
YEAR COMPLETED :












COMPUTER PROFECIENCY

Please indicate your computer
proficiency by making A, B, C each
application/language :

A = Expert
B = Intermediate
C = Some

APPLICATIONS

PROFICIENCY
Microsoft Office

B






















LANGUAGE PROFECIENCY


Please indicate your language(s)
proficiency by marking A, B, or C
against each language


LANGUAGE(S)


SPOKEN

WRITTEN

READ
English C B B


HR.1.003 Page 3



























TRAINING/ SHORT COURSES ATTENDED


TYPE/ SUBJECT


NAME OF INSTITUTION

CITY
PERIOD
FINANCED BY FROM TO
Geological
Structure


University Negeri Padang Sumatera Barat 11 November
2010
12
November
2010




















EMPLOYMENT HISTORY
(Start with present or last employment)


NAME OF EMPLOYER:

NATURE OF BUSINESS:

ADDRESS:




TELEPHONE NO : FAX NO :
EMPLOYMENT DATES (MONTH & YEAR) FROM TO

JOB TITLE :

NAME OF SUPERVISOR:

HR.1.003 Page 4

SUPERVISOR’S TITLE:


REASON FOR LEAVING:

STARTING SALARY:



FINAL SALARY:




DESCRIPTION OF WORK AND RESPONSIBILITIES :












Organization Structure of Current / Last Employment
Draw a brief diagram indicating your position in relation to your department and total set-up
Please provide titles of superiors and subordinates















Please also provide other important information that relates to your current/last employment i.e other benefit, number
of subordinate etc








2. NEXT PREVIOUS EMPLOYER



NAME OF EMPLOYER

NATURE OF BUSINESS

ADDRESS


EMPLOYMENT DATES (MONTH & YEAR) FROM TO

JOB TITLE
HR.1.003 Page 5



TELEPHONE NO : FAX NO :

NAME OF SUPERVISOR

SUPERVISOR’S TITLE


REASON FOR LEAVING

STARTING SALARY

FINAL SALARY


DESCRIPTION OF WORK AND RESPONSIBILITIES :











3. NEXT PREVIOUS EMPLOYER



NAME OF EMPLOYER

NATURE OF BUSINESS

ADDRESS




TELEPHONE NO : FAX NO :
EMPLOYMENT DATES (MONTH & YEAR) FROM TO

JOB TITLE

NAME OF SUPERVISOR

SUPERVISOR’S TITLE


REASON FOR LEAVING:

STARTING SALARY

FINAL SALARY


DESCRIPTION OF WORK AND RESPONSIBILITIES :









4. NEXT PREVIOUS EMPLOYER



NAME OF EMPLOYER

NATURE OF BUSINESS

ADDRESS


EMPLOYMENT DATES (MONTH & YEAR) FROM TO

JOB TITLE
HR.1.003 Page 6



TELEPHONE NO : FAX NO :

NAME OF SUPERVISOR

SUPERVISOR’S TITLE


REASON FOR LEAVING

STARTING SALARY

FINAL SALARY


DESCRIPTION OF WORK AND RESPONSIBILITIES :












PROFESIONAL REFERENCES


NAME


COMPANY NAME & ADDRESS

POSITION

PHONE NO.











EMERGENCY CONTACT
(Person to contact in case of emergency other than your direct family member i.e. brother, uncle etc)

NAME


ADDRESS

PHONE NO.

RELATION
Syari Rahma Yanti

Jln. Rajawali 2 no 127, air
tawar barat. Padang
081535423315 relatives





FAMILY INFORMATION


RELATION

NAME
SEX
F/M

PLACE OF BIRTH

DATE OF BIRTH

ADDRESS/PHONE NO. & OCCUPATION

FATHER

Syafrial Anas, SE

Sijunjung July, 16
th
1964 Entreprenuer
081366275647

MOTHER

Efni Maya

Sijunjung December, 16
th
1966
Housewife
081366656319

M

F

HR.1.003 Page 7

SPOUSE


CHILD 1



CHILD 2



CHILD 3



CHILD 4





ADDITIONAL INFORMATION


How did you learn about our company and/or vacancies ?



Based of mining engineering department UNP and
searching at media internet

Do you habe any friends or relatives who currently working at
our company ? if yes, please state the name



I don’t have

Have you previously applied to work at our company ?
If yes, please state when.


I don’t have

Do you have any physical or mental disabilities ?
If yes, please state details.


I don’t have

Do you suffer from, or are being treated for any serious illness?
(E.g. heart-related problems, high blood pressure, epilepsy,
diabetes etc) If yes, please state details.

I don’t have

Have you ever been convicted of any criminal offense in any
country ? If yes, please state details.


I don’t have

Have you ever been dismissed or terminated from any jobs?
If yes, please state details.


Never

When will you be available to start work ?



I’m ready anytime

Can you surrender written evidence on your last drawn salary ?
If no, pleas explain.


I’m a less experience, but I have much spirit for the
future
HR.1.003 Page 8




I certify that all information given on this application is true and correct. I understand that PT
Regio Aviasi Industri may make an investigation of my work and personal history and I authorize all
persons, schools, corporations and law enforcement agencies to supply any information concerning my
background and release from any liability and responsibility arising from their doing so. I also understand
that my employment is subject to passing tests/ examintions, and probationary period required by PT.
Regio Aviasi Industri. Any misrepresentation or omission of facts called for on this application is sufficient
cause for immediate dismissal.







M. Syah Addinal Huda Date : April, 14
th
2014
Signature

DO NOT WRITE BELOW THIS LINE


Interviewed by :

Department Head :
Name


Comments
Name


Commens

Human Resource Manager :
Grade Assigned



Test Result


HR Officer