PT.

TOPSYSTEM ASIA BASE

APPLICATION FORM
FORMULIR APLIKASI

Position Applied For (Untuk Posisi) :

A. Personal Information (Informasi Pribadi)
Full Name
(Nama Lengkap)
Alias
(Nama
Panggilan)
PHOTO
Phone (H)
(Telephone)
Permanent
Address Mobile
(Alamat (Handphone)
Sekarang) Email Address
(Alamat
Email)
Race
Gender (not
Male/Female
(Jenis applicable
(Laki-laki/Wanita) for
Parents Address Kelamin)
(Alamat Tinggal Indonesia)
Orang Tua) No. of
Marital Status
Children
(Status
(Jumlah
Pernikahan)
Anak)
Date of Birth
Country / State of Birth
(Tgl & thn Lahir)
(Negara/Tempat Lahir)
(DD/MM/YYYY)
Identity Card Nationality
(Kartu Identitas) (Kebangsaan)
Religion Blood Type
(Agama) (Golongan Darah)

B. Education Background (Please attach copies of certificates/testimonial)

(Latar belakang Pendidikan - Harap dilampirkan salinan sertifikat/Ijazah)
Highest Level
Academic
Name of Institution Year Achieved
Level (Nama Institusi) (Tahun) (Tingkat
(Tingkat Akademik)
Tertinggi)

Primary From To
(Sampai
(Ke-1) (Sejak)
)
Secondary
(Ke-2)
Pre-U/College
(Perguruan Tingi)
Vocational
(Kejuruan)
(e.g. ITE)

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Diploma
(Diploma)
Tertiary
(Pendidikan
Lanjutan)
Other
(Lain-lain)

C. Language Skill (Keterampilan Bahasa)

Oral Reading
(Berbicara) (Membaca) Written
Language (Menulis)
(Jenis Bahasa) (Limited/Average/Good (Limited/Average/Good
(Limited/Average/Good)
) )

D. Work Experience (Pengalaman Pekerjaan)

(Pls. begin with the three most current job, and attach a copy of detailed resume if all employment history could not be completed in this form –
Dimulai dari tiga pengalaman kerja terakhir)
Current
Employer Date Basic Monthly
(Pekerjaan saat [MM/YYYY] Salary
ini)

Position Start Start

(Jabatan/Posisi) /
Report To
(Lapor ke) Left Last Drawn
(Position) /
(Posisi)
Nature of
Business
(Bidang Bisnis)
Reason(s) for
Leaving
(Alasan berhenti)
Did you receive any other remuneration / Allowance? [ ] Yes [ ] No
(Apakah ada tunjangan lain)
If yes, please specify :
(Jika ya, harap sebutkan)
Previous
Employer Date Basic Monthly
(Pekerjaan [MM/YYYY] Salary
sebelumnya)
Position Start Start
(Jabatan/Posisi) /

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Report To
(Lapor ke) Left Last Drawn
(Position) /
(Posisi)
Nature of
Business
(Bidang Bisnis)
Reason(s) for
Leaving
(Alasan berhenti)
Did you receive any other remuneration / Allowance? [ ] Yes [ ] No
(Apakah ada tunjangan lain)
If yes, please specify :
(Jika ya, harap sebutkan)

Previous
Employer Date Basic Monthly
(Pekerjaan [MM/YYYY] Salary
sebelumnya)
Position Start Start
(Jabatan/Posisi) /
Report To
(Lapor ke) Left Last Drawn
(Position) /
(Posisi)
Nature of
Business
(Bidang Bisnis)
Reason(s) for
Leaving
(Alasan berhenti)
Did you receive any other remuneration / Allowance? [ ] Yes [ ] No
(Apakah ada tunjangan lain)
If yes, please specify :
(Jika ya, harap sebutkan)

Previous Employer Last

(Pekerjaan Drawn
sebelumnya) Start Left Position Salary Reason(s) for Leaving
(Continue from (Mulai) (Akhir) (Jabatan/Posisi) Amount (Alasan berhenti)
above) (Gaji
(Lanjutan dari atas) terakhir)

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E. Family Member (Anggota Keluarga)

Male/Female Place, Date of Education

Relationship Name Occupation
(Hubungan) (Nama)
(Laki/Perempuan Birth (Pendidikan
(Pekerjaan)
) (Tempat,Tgl Lahir) )
Spouse
(Suami/Istri)
Children
no.1
(Anak ke-1)
Children
no.2
(Anak ke-2)
Children
no.3
(Anak ke-3)
Children
no.4
(Anak ke-4)
Children
no.5
(Anak ke-5)

F. General Information (Informasi Umum)

Character Reference (please provide ex-employee’s contact)

(Referensi Karakter, berikan kontak teman karyawan di Perusahaan sebelumnya)

Name Name
(Nama) (Nama)

Contac
Relationshi Contact Relationshi
t
p No. p
No. (Nomor
(Nomor (Hubungan) (Hubungan)
kontak)
kontak)

[ ] Newspaper Advertisement [ ] Agency [ ] Unsolicited/Walk-in

(Surat kabar) (Agensi) (Tidak sengaja)

How are you referred [ ] Executive Search [ ] E-recruitment (Internet)

(Pencarian Execuitve) (Internet)
to TAB
(Bagaimana anda
[ ] Employee Referral (pls. provide name : )
mengetahui tentang TAB)
(Referensi Karyawan(Mohon sebutkan nama))

[ ] Other (pls. Specify : )

(Lainnya(harap sebutkan)
Do you have any [ ] Yes [ ] No
friends/relative

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working in TAB If yes, please state name / relationship : )

(Apakah anda (Jika ya, harapa sebutkan nama/hubungan)
mempunyai teman yang
bekerja di TAB)
Were you previously
involved in a trade [ ] Yes [ ] No
union?
(Apakah Anda If yes, What is your position :
sebelumnya terlibat (Jika ya, harap sebutkan Posisi anda)
dalam serikat pekerja)
Are you willing if you
are not allowed to
form a union or join a [ ] Yes [ ] No
union?
(apakah Anda bersedia If No, What are your reasons :
jika Anda tidak diizinkan (Jika tidak, apa alasan anda)
untuk membentuk serikat
pekerja atau bergabung
dengan serikat pekerja)
Are you holding a [ ] Yes pls. state class license (e.g. 2A,2B, etc)
driving license
(including forklift) [ ] No
(Apakah anda
mempunyai SIM,
termasuk Forklift)
Have you been [ ] Yes [ ] No
convicted for any
criminal offence in If yes, please give details :
any country? (Jika ya, tolong berikan detailnya)
(Apakah Anda pernah
dihukum karena
pelanggaran pidana di
negara mana pun?)
Do you have known [ ] Yes [ ] No
illness?
(Apakah anda menderita If yes, please give details :
penyakit lain) (Jika ya, tolong berikan detailnya)
Do you have color [ ] Yes pls. state which year it was diagnosed:
blind? (Tahun diagnosis)
(Apakah anda buta [ ] No
warna)
Expected Basic
Notice Period Amount :
(Waktu siap Bekerja)
Salary (Angka)
(Gaji yang diharapkan)

G. Declaration (Pernyataan)

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I declare that the particulars given in this application are true and accurate to the best of my
knowledge.
(Saya menyatakan bahwa keterangan yang diberikan dalam aplikasi ini adalah benar dan akurat).
I understand that any omissions or false statement made by me on this application will give
sufficient grounds for immediate termination.
(Saya mengerti bahwa apabila dikemudian hari ditemukan kelalaian atau pernyataan tidak benar/palsu yang
saya buat pada aplikasi ini akan memberikan alasan yang cukup untuk pemberhentian hubungan kerja saya).

Date Applicant Signature

(Tanggal) (Tanda tangan Pemohon)

Form No. TAB-Q8-20-FO-36-13 Rev. 0