F.hrd.02.01.02 Formulir Isian Calon Karyawan.doc

No Revisi Tanggal Halaman

FORMULIR ISIAN CALON KARYAWAN

: : : :

F.HRD.01.01.02 00 15-11-17 1-5

UNIT : ______________________________________ Isi dengan huruf cetak. Tanda *) coret yang tidak perlu JENIS PEKERJAAN YANG ANDA INGINKAN: ....................................................................................... Nama lengkap

: ............................................................................................................................

Tempat / tanggal lahir

: ........................................................................................ Laki-laki/ Perempuan *)

Agama

: ........................................................................ Belum kawin/kawin/duda/janda *)

Kewarganegaraan

: ................................................ Suku bangsa

: ..............................................

Berat Badan

: ............... Kg

: ................ Cm

Alamat

: ............................................................................................................................

Tinggi badan

............................................................................................................................ Telepon

: .............................................................HP: ........................................................

Nomor KTP

: ................................................ Berlaku : ....................... s/d .............................

Nomor Pasport

: ................................................ Berlaku : ....................... s/d .............................

Nomor & Jenis SIM

: ................................................ Berlaku : ....................... s/d .............................

Nomor NPWP

: ............................................................................................................................

Bahasa Asing

: ................................................ Tertulis : Ya/Tidak *)

Lisan

: Ya/Tidak *)

: ................................................ Tertulis : Ya/Tidak *)

Lisan

: Ya/Tidak *)

ISTERI / SUAMI *) Nama lengkap

: ..........................................................................................................................................

Tempat/tanggal lahir

: ..........................................................................................................................................

Alamat Tempat Tinggal

: ..........................................................................................................................................

Telepon

: ..........................................................................................................................................

Pekerjaan

: ..........................................................................................................................................

Perusahaan

: ..........................................................................................................................................

Alamat Perusahaan

: ..........................................................................................................................................

ANAK No

Nama Lengkap

L/P

Tempat / tanggal lahir

Nama/alamat Sekolah/Perusahaan

Jenis pekerjaan (Jika bekerja)

1 2 3 4 5

SAUDARA KANDUNG (Tidak termasuk anda) No Nama Lengkap L/P Tempat / tanggal lahir

Nama/alamat

Anda anak ke: .............. Jika bekerja

No Revisi Tanggal Halaman

FORMULIR ISIAN CALON KARYAWAN

Sekolah/Perusahaan

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F.HRD.01.01.02 00 15-11-17 2-5 Jenis pekerjaan

1 2 3 4 5

AYAH KANDUNG Nama lengkap

: ..........................................................................................................................................

Tempat/tanggal lahir

: ..........................................................................................................................................

Agama

: ..........................................................................................................................................

Pekerjaan

: ..........................................................................................................................................

Jabatan

: ..........................................................................................................................................

Alamat Tempat Tinggal

: ..........................................................................................................................................

No Telepon

: ..........................................................................................................................................

IBU KANDUNG Nama lengkap

: ..........................................................................................................................................

Tempat/tanggal lahir

: ..........................................................................................................................................

Agama

: ..........................................................................................................................................

Pekerjaan

: ..........................................................................................................................................

Jabatan

: ..........................................................................................................................................

Alamat Tempat Tinggal No Telepon

: .......................................................................................................................................... : ..........................................................................................................................................

RIWAYAT PENDIDIKAN FORMAL No

Sekolah/Universitas

Jurusan

Kota

Mulai Tahun

Sampai Tahun

Memiliki Ijazah/sertifikat

1

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

2

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

3

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

4

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

5

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

Jurusan

Kota

Mulai Tahun

Sampai Tahun

Memiliki Ijazah/sertifikat

RIWAYAT PENDIDIKAN NON FORMAL No

Sekolah/Lembaga Pendidikan

No Revisi Tanggal Halaman

FORMULIR ISIAN CALON KARYAWAN

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F.HRD.01.01.02 00 15-11-17 3-5

1

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

2

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

3

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

4

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

5

..............................................................

...................

.......................

..............

..............

Ada / tidak *)

RIWAYAT PEKERJAAN (disusun menurut tahun masuk / keluar) Tahun Nama Perusahaan Dari – s/d Alamat / telepon

Jabatan / Pekerjaan

Alasan Berhenti

.......... s/d ..........

......................................................................... ......................................................................... .........................................................................

.................................... .................................... ....................................

........................................ ........................................ ........................................

.......... s/d ..........

......................................................................... ......................................................................... .........................................................................

.................................... .................................... ....................................

........................................ ........................................ ........................................

.......... s/d ..........

......................................................................... ......................................................................... .........................................................................

.................................... .................................... ....................................

........................................ ........................................ ........................................

.......... s/d ..........

......................................................................... ......................................................................... .........................................................................

.................................... .................................... ....................................

........................................ ........................................ ........................................

.......... s/d ..........

......................................................................... ......................................................................... .........................................................................

.................................... .................................... ....................................

........................................ ........................................ ........................................

......................................................................... .................................... ........................................ ......................................................................... .................................... ........................................ ......................................................................... .................................... ........................................ Aktivitas di luar jam kerja : ................................................................................................................................... .......... s/d ..........

Hobby / olahraga

: ...................................................................................................................................

Status rumah yang ditempati

: ...................................................................................................................................

Kendaraan yang dimiliki

: ...................................................................................................................................

Penyakit yang pernah diderita

: ...................................................................................................................................

Kacamata : Ya / tidak *) Min

: ..................... Plus: .................... Contact lens: ..................... Softlens: ....................

Pernahkah anda dihukum karena kejahatan atau kriminal?

Ya / Tidak *)

Pernahkah anda melamar di Perusahaan ini sebelumnya?

Ya / Tidak *)

Jenis pekerjaan yang dilamar

: ...................................................................................................................................

Melamar melalui

: ...................................................................................................................................

Apakah anda diwawancarai : Ya/tidak *) Bila ya, oleh: ........................................................................ Apakah anda mempunyai kenalan/famili yang bekerja di Perusahaan/Group ini? Ya / tidak *)

Bila ya, sebutkan:

FORMULIR ISIAN CALON KARYAWAN

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F.HRD.01.01.02 00 15-11-17 4-5

Nama

: ..........................................................................................................................................

Hubungan

: ..........................................................................................................................................

Jabatan

: ..........................................................................................................................................

Referensi ( sebutkan dua orang yang bukan keluarga yang anda kenal di luar Perusahaan ini ) Nama

: ............................................................

Nama

: ............................................................

Perusahaan

: ............................................................

Perusahaan

: ............................................................

Jabatan

: ............................................................

Jabatan

: ............................................................

Alamat

: ............................................................

Alamat

: ............................................................

Telepon : ............................................................

Telepon : ............................................................

Berapa lama mengenal anda

Berapa lama mengenal anda

: ..................................

: ..................................

Jika anda diterima: Kapan anda bisa mulai bekerja di Perusahaan ini? ........................................................................................................... Sebutkan keterangan-keterangan lain yang anda anggap penting yang dapat membantu penilaian kami untuk posisi yang anda inginkan dan apa alasan anda untuk melamar di Perusahaan ini. ............................................................................................................................................................................................ ............................................................................................................................................................................................ ............................................................................................................................................................................................ ............................................................................................................................................................................................ ............................................................................................................................................................................................ ............................................................................................................................................................................................ Demikianlah keterangan tersebut Saya buat dengan sebenarnya dan penuh kesadaran. Saya bersedia menerima sanksi atau menanggung segala akibat bila dikemudian hari terbukti bahwa keterangan yang Saya berikan tersebut ternyata tidak benar .............................., ................................ Hormat Saya,

Pelamar

1. Berapakah gaji terakhir anda? ............................................................................................................................. 2. Fasilitas apa yang anda dapatkan?

FORMULIR ISIAN CALON KARYAWAN

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............................................................................................................................................................................... ............................................................................................................................................................................... ............................................................................................................................................................................... ............................................................................................................................................................................... ............................................................................................................................................................................... ............................................................................................................................................................................... ............................................................................................................................................................................... ............................................................................................................................................................................... ............................................................................................................................................................................... 3. Berapa gaji yang anda inginkan? ......................................................................................................................... ___________________,________________________ Hormat Saya,

___________________________ Pelamar