FM.03.HCD - Employment Application Form (Biyan Abi Yoga) [PDF]

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FM.03.HCD



EMPLOYMENT APPLICATION FORM



Date: Februari, 27th, 2017



Position you applying for: HSE



A. PERSONAL INFORMATION Full name: Biyan Abi Yoga Place & Date of Birth: Surakarta, Februari 13, 1993 Religion: Islam Nationality: Indonesia Height:



Marital status: Not Married



170 cm,



Weight



: 75



Kg



Home Address: Uray Bawadi Street, Sentosa Alley, Number 11 Pontianak Phone: -



HP: 083840914932



Email: [email protected] Emergency Contact: 083840914932



B. FAMILY 1. Direct Family Name Father Mother Husband/Wife Children No.1 Children No.2 Children No.3



(Alm)Siswanto Lisyawati



Occupation – Company Name PNS Pekerjaan



Education Bachelor



62



Umum (PU) PNS Balai Kajian



Degree Master



52



Sejarah Pontianak



Degree



Age



Telp No. 082149929569



2. Siblings: Brothers/Sisters



No. 1 2 3 4 5 6



Name Rendi Tesa Hendrawan Reza Fahlevi Megasari Devi Kurnila Reva Dadi Delima



Age 28 26 22 20



M/F M M F M



1



Telp No. 082358888188 087739853384 085799592997 -



Email Address [email protected] [email protected] -



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7 8 9 10 Please answer this below question  Why do you apply for this position/reply to the advertisement? Because im interested to be a HSE in PT Carsurin and have a passion in HSE field  Do you have any bonding agreement with your current company? No If yes, please explain  Please inform your availability to join with Carsurin Im ready anytime at this moment because im not working right now. How would you describe yourself? I am the type of person who can work both individually and in teams. This can be seen from my experience in several organizations in my time in college without having to sacrifice my study. I can communicate well with others. I learned this from my experience in college organizations. I have experience in several organizations such as candles, envirochamp, HMTL, and sc. I often speak on behalf of my division. Thirdly, I easily adapt to new circumstances and conditions. I come from a very far town in Kalimantan and can adjust in a new place and has a lot of friends. I also good at analyzing a problem. It is proved from my thesis on analyzing the water quality  



Please describe your 3 strengths and 3 weakness Strength 1. Teamwork 2. Good Communication 3. Willing to learn



Weakness 1. Forget Small detail 2. Little bit slow when multitasking 3. Over Thinking



But Im trying to fix my weakness  Criminal Convictions 



Do you have any criminal record?







If yes, please describe:



Yes [ ]



No [ X ]



See this picture carefully, focus on the nose! Which part is more dominance, women or the man? Man



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C. EDUCATION, WORKSHOP, TRAINING 1. Education EDUCATION S1 Environmental



Name & Place Education Institute Islamic University Of Indonesia



September



Yogyakarta



01, 2011 –



Dates



Engineering



March



Senior Highschool



17,2016 July



SMAN 1 Pontianak



Remarks 3.22



8.6



01,2009 – July Junior Highschool



01,2011 January 01,



SMPN 3 Pontianak



7,7



2007 – January 01, Elementary School



SD Muhammadiyah 2 Pontianak



2009 January 01,



8,15



2002 – January 01, 2007



2. Training



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TRAINING



Name & Place Education Institute PT Mitra K3 Semesta



Ahli K3 Umum



Dates



Remarks



16-28



Verified Ahli K3



January 2017



3. Please provide at least 2 professional references from your previous job.



Company



Name



Title



If you need additional space please write on the back of this form.



Phone



HP



-



-



4. What languages do you speak and are proficient in?



Language English



Speaking



Listening



Good



Good



Writing Good



Remarks Please use the following abbreviation above VG: Very Good G: Good F: Fair



D. WORKING Dates (From-To) -



P: Poor



EXPERIENCE Title



Fresh Graduate



Company Name -



Reason for Leaving -



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-



Fresh Fresh Fresh Fresh Fresh



Graduate Graduate Graduate Graduate Graduate



--



-



EMPLOYMENT DETAILS Date of Employment : Company Company Address Business Line Latest Position Report directly (Name/Position) Number of Sub-Ordinates Job Description



Achievement



How did you get employed Reason for leaving Last Drawn Salary



Fresh Graduate



Date Employment Ended :



           -



-



ORGANIZATION STRUCTURE



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*) Please draw your position within current/latest organization (including two levels up & below)



Ketua Umum



Ketua Div Minat dan Bakat



Anggota (saya merangkap sebagai penasehat)



Date of Employment :



Fresh Graduate



Company Company Address Business Line Latest Position Report directly (Name/Position) Number of Sub-Ordinates Job Description



Date Employment Ended : -



-



Achievement



How did you get employed Reason for leaving Last Drawn Salary



Date of Employment :



-



           -



-



Fresh Graduate



Date Employment Ended :



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-



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Company Company Address Business Line Latest Position Report directly (Name/Position) Number of Sub-Ordinates Job Description



Achievement



How did you get employed Reason for leaving Last Drawn Salary



           -



-



E. COMPENSATION & BENEFIT DETAIL No. 1. 2. 3. 4.



5. 6.



Detail Compensation & Benefit Salary Nett/Gross (monthly) THR Incentive Bonus Allowance a. b. c. d. e. Car Ownership Program House Ownership Program



Current -



Remark -



What is your expected salary?_Rp. 6.000.000 (Negotiable)__________________________



F. ABOUT PT. CARSURIN 1. What do you know about Carsurin? A company who work in survey field also provide monitoring services that focus on the coal mining industry 2. Are you willing to place in any Carsurin Branches? Yes 3. Do you know anybody working for Carsurin? No



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If yes, who is he/she? 4. Are you open for other position you are applying for? Yes “What is your passion in life?” Working on the field that I like and be the best for my family



What is the 3 most important thing in your life? 1. Family 2. Occupation 3. Friend



I confirm that the information in this application form is true and honest.



Pontianak 27 Februari 2017



Biyan Abi Yoga



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