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STRICTLY CONFIDENTIAL

APPLICATION FOR EMPLOYMENT

RECENT
PHOTO
POSITION APPLIED FOR

PERSONAL PARTICULARS / Data Pribadi

Mr. Mdm. Miss

First Name (Nama depan):

Last Name (Nama Belakang):

e.g: Aldo Ferry Setiawan ( first name: Aldo Ferry ; last name: Setiawan)
Address: (isi nama jalan, komplek, nama desa, dll) Contact No
Alamat Sekarang RT/RW No. Telpon
(Local) Village
Desa/Kel.
Sub distric (Home) :
Kecamatan. Rumah -
Distric/City
Kab/kota
Province
Provinsi
Postal code
Kode Pos

RT/RW
Village
Desa/Kel
Sub distric (Mobile
Permanent Address Kecamatan Phone):
(Alamat Tetap) Distric/City
Kab/kota
Handphone
Province
Provinsi
Postal code
Kode Pos
Email Address (Office):
-
Alamat e - mail Kantor
Country of Origin ID Card No.:
Negara Asal: No. KTP
Place of Origin Expiry Date:
Daerah Asal: Berlaku sampai
Date of Birth: Age: Income Tax No.:
-
Tanggal lahir usia No. NPWP
Place of Birth : Passport No.:
- Type: -
Tempat Lahir No. Passport
Blood Group: Expiry Date:
--
Gol. Darah Berlaku sampai
Citizenship: Country of Issue:-
warganegara Dikeluarkan di negara

FAMILY DETAILS / Data Keluarga

Parents’ / Brothers’ / Sisters’ Full Name Relationship Occupation Company Name

 Nama Lengkap Orang Tua / Sdr
Hubungan Pekerjaan Nama Perusahaan / Tempat Kerja
Laki2/Sdr Wanita

Marital Status: Single Married Divorced Widowed

Status Perkawinan belum kawin kawin cerai duda/janda

Spouse’s Name Date of Birth Occupation Company Name

Nama pasangan Tanggal lahir Pekerjaan Nama Perusahaan

Children’s Name Gender Date of Birth Occupation Company Name

Nama Anak Jenis Kelamin Tanggal lahir Pekerjaan Nama Perusahaan

Person to contact in case of Emergency / orang yang dapat di hubungi dalam keadaan darurat :
Name Relationship Address Tel No. / /HP
Nama hubungan Alamat No telepon

EDUCATIONAL DETAILS / Perincian Pendidikan

Highest
Standard
Date
School / Institution Name Country Date Joined Passed
Level Graduated
Nama Sekolah Negara masuk (Grade /
Tamat
Degree)
NEM / IPK
Primary
SD
Secondary
SMP
High School
SMU
Polytechnic/University
Politeknik/Universitas
Others
Lain-lain
Other Academic or Professional Qualifications
(including Training Courses Attended): Kursus / profesional training
Year Tahun
Particulars Keterangan
From Dari To Sampai
Details of Education or Training presently pursuing / or intend to pursue in the next six months.
Keterangan lengkap tentang pendidikan atau training yang sedang diikuti hingga 6 bulan kedepan
Expected Date of
Start Date
Particulars Keterangan Completion
Tanggal mulai
Perkiraan selesai

PROFESSIONAL MEMBERSHIP / Keanggotaan organisasi / Keahlian

Name of Professional Body Membership Position Date Admitted

Nama organisasi Jabatan Masa keanggotaan

EMPLOYMENT HISTORY / Pengalaman Kerja

Date of Position Basic Salary

Employment H Gaji Pokok
e
l
d

P
o
Reason(s
Industry s
Company Allowance ) For
Location Sector i
Nama Start Date End Date Last (if any) Leaving
Lokasi Sektor s Start
Perusahaan Dari Sampai Drawn Tunjangan Alasan
Industri dd-mm-yy dd-mm-yy i Awal
akhir keluar
s
e
b
a
g
a
i

Indicate past / present duties and responsibilities relevant to position applied for.
Cantumkan hubungan tugas dan tanggung jawab di tempat kerja lama dengan posisi yang dilamar
Have you any objection to reference being made to your apakah anda keberatan jika kami menghubungi :
a) Past Employers b) Present Employer
Perusahaan lama Yes Ya No Tidak Perusahaan anda Yes Ya No TIdak
anda sekarang
If you are successful in your application jika lamaran anda diterma
If appointed what is your
What is the length of notice you are required to
expected salary?
terminate your present employment?
Berapa gaji yang
Kapan anda siap bekerja?
diharapkan?

CHARACTER REFEREES (Family members / relatives should not be used)

Orang yang dapat memberikan keterangan tentang anda ( bukan dari anggota keluarga / family)

Full Name: Full Name:

Nama lengkap Nama lengkap
Address: Address:
Alamat Alamat

Occupation: Occupation:
Pekerjaan Pekerjaan
Company Name: Company Name:
Nama Nama
Perusahaan Perusahaan
Contact No.: Contact No.:
No Telepon No Telepon

Have you been or are you currently involved in any criminal or governmental investigation?
Apakah Anda pernah atau saat ini terlibat dalam suatu tindak kejahatan atau diinvestigasi pemerintah? Yes No
If yes, please give details. Kalau Ya, berikan keterangan
Have you been previously employed by any Infineon Technologies group?
Apakah pernah bekerja di Infineon Technologies group? Yes No
If yes, when and name of Company kalau pernah kapan dan dimana?
Do you have any friends / relatives working in Infineon Technologies
Apakah ada yang dikenal di PT Infineon Technologies Yes No
If yes, please give details. Jika ya tuliskan namanya
Do you have any history of illness or medical problems?
Apakah anda memiliki riwayat penyakit atau punya masalah dengan kesehatan Yes No
If yes, please give details. Kalau ya, berikan keterangan
Have you ever been convicted of any criminal offence by court of law?
Apakah anda pernah terlibat masalah kriminal menentang hukum? Yes No
If yes, please give details. Kalau ya, berikan keterangan
Are you bounded by any bond to serve the government or any organisation?
Apakah anda terikat kerja dengan pemerintah atau organisasi lainnya? Yes No
If yes, please give details. Kalau ya, berikan keterangan
For Female Only – Hanya untuk wanita
Yes No
Are you pregnant? Apakah anda sedang hamil?
Are you agree to be bounded in contract employment for 2 year(s)?
Yes No
Apakah Anda setuju bila dikontrak selama 2 tahun?

1. I understand and agree that all personal data that I have provided in this application form can be collected, retained and used by
Company (PT. Infineon Technologies Batam) for the purposes of process my application and managing my employment
relationship with the Company and/or its affiliates.

Saya memahami dan menyetujui bahwa semua data pribadi yang saya cantumkan dalam formulir aplikasi ini dapat diambil,
disimpan dan digunakan oleh Perusahaan (PT. Infineon Technologies Batam) untuk keperluan pemrosesan aplikasi saya dan
pengaturan hubungan kerja dengan Perusahaan dan atau afiliasinya.
2. I declare that the information given in this form are true and correct. Any false or misrepresented information will render my
application null and void; and if employed, I agree that my appointment shall be terminated.

Saya menyatakan bahwa informasi yang diberikan di dalam lembaran ini adalah benar dan sah. Jika ada informasi yang salah
akan membuat lamaran saya batal demi hukum; dan saya setuju diberhentikan andaikan saya sudah bekerja

Date/tanggal Signature of Applicant/Tanda Tangan Pelamar

FOR OFFICIAL USE ( kolom dibawah khusus diisi oleh Perusahaan)

Applicant referred by: Lamaran berdasarkan atas Selected / KIV / Rejected

Diterima / Cadangan / Ditolak
Advertisement Agency Employee Others
Iklan Agen Karyawan Lainnya
Point of Hire : Cost Centre Badge No. Date Join:
Salary
Tempat Asal Rekrut: No. Badge Tanggal bergabung
Gaji
Status of Recruitment
Rekrutment Status :
Designation/Grade:
Organization Unit:
Kedudukan(jabatan)/Grade

Functional Unit (FU): Functional Manager (FM): Job Family (JF): Sub Family (SF):

Income Tax Status: Status Pajak Penghasilan

Single Status: Status Lajang (TK): Married Status: Status Menikah (K):

TK/0 K/0
TK/1 K/1
TK/2 K/2
TK/3 K/3

Interviewed by: diinterview oleh

Name: Signature:
Date:
Comments: Endorsed by:

Head of Department Date

HR Business Partner
Date
HR SC updated on: