Recent Photo

CANDIDATE INFORMATION FORMS

with a

Passport Size
Strictly Confidential !!!

Please fill in this form completely in order to be further processed.

Position Applied:

PERSONAL INFORMATION

Title : ☐ Mr. ☐ Miss. ☐ Ms. ☐ Mdm. ☐ Others

Full Name :
Nick Name :
Gender :
Place & Date of Birth :
Religion :
Nationality :
Ethnic :
Marital Status :
No. Of Dependent :
E-mail Address :
Mobile Telephone No. :
Tax Identification Number
:
(NPWP)
Blood Type + Rhesus :

☐ Owned – No Loan ☐ Owned - With Loan ☐ Owned – No Loan ☐ Owned - With Loan
☐ Rented ☐ Employer’s ☐ Rented ☐ Employer’s ☐ Rented ☐ Rented
Present Home Phone No.: - Home Telephone No.:
Length Of Stay : ..0……..Year (s) … …8.…..Month (s) Length of Stay : …26…..Year (s) …….... Month (s)

PERSONAL IDENTITY

Type: Number: Place Of Issue: Date Of Issue: Date Of Expiry:

TMS Page 1 of 10 3/2/22

Passport
Identity Card (I.C)
Driving License

SPOUSE DETAILS

Full name :
Place & Date of Birth :
Nationality :
Ethnic :
Religion :
Occupations :
Email Address :
Present Residential Address: Previous Address (If current address is less than 3 years):

☐ Owned – No Loan ☐ Owned - With Loan ☐ Owned – No Loan ☐ Owned - With Loan
☐ Rented ☐ Employer’s ☐ Rented ☐ Rented ☐ Employer’s ☐ Rented
Present Home Phone No.: Mobile Phone No.:
Length Of Stay : ..……..Year (s) … ….…..Month (s) Length of Stay : ……..Year (s) …….... Month (s)

CHILDREN INFORMATION

1. Full Name :
Place & Date Of Birth :
Gender :
Last Education :
Occupation :

2. Full Name :
Place & Date Of Birth :
Gender :
Last Education :
Occupation :

3. Full Name :
Place & Date Of Birth :
Gender :
Last Education :
Occupation :

4. Full Name :
Place & Date Of Birth :
Gender :

TMS Page 2 of 10 3/2/22

Last Education :
Occupation :

5. Full Name :
Place & Date Of Birth :
Gender :
Last Education :
Occupation :

ACADEMIC INFORMATION

From – to
Diploma
(States month & Schools, Colleges, Universities Major GPA (Yes / No)
year)

SEMINAR / COURSE / WORKSHOP

From – To Topic Organizer & Location
Certificate
(States dates, month & year) (Yes / No)

WORKING EXPERIENCE

* Fill from current, previous to first position

TMS Page 3 of 10 3/2/22

Commence Date –
Date Of Completion Name Of Employer Job Category
(States dates, month & year)

TMS Page 4 of 10 3/2/22

EMPLOYMENT DETAIL
Date of Employment : Date Employment Ended :
Name Of Company
Office Address
Tel No.
Nature Of Business
Position Held
Years Of Service
Report Directly To
Total Number Of Employees
Number Of Sub-Ordinates
o
o
o
Job Description o
o
o
o
Achievement -
How Did You Get Employed ☐ Through Advertisement ☐ Others
☐ Recommendation
Last Drawn Salary
Reason For Leaving

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

TMS Page 5 of 10 3/2/22

Date of Employment : Date Employment Ended :
Name Of Company
Office Address
Tel No.
Nature Of Business
Position Held
Years Of Service
Report Directly To
Total Number Of Employees
Number Of Sub-Ordinates



Job Description (Exploration Department)

Job Description (Mining department)

Achievement -

How Did You Get Employed

☐ Through Advertisement ☐ Others
☐ Recommendation
Last Drawn Salary 7.500.000 ( NET )
TERMINATE DUE TO COVID 19
Reason For Leaving

Date of Employment : Date Employment Ended :

Name Of Company
Office Address
Tel No.
Nature Of Business
Position Held
Years Of Service
Report Directly To
Total Number Of Employees
Number Of Sub-Ordinates








TMS Page 6 of 10 3/2/22

Achievement
How Did You Get Employed
☐ Through Advertisement ☐ Others
☐ Recommendation
Last Drawn Salary
Reason For Leaving

Date of Employment : Date Employment Ended :

Name Of Company
Office Address
Tel No.
Nature Of Business
Position Held
Years Of Service
Report Directly To
Total Number Of Employees
Number Of Sub-Ordinates







Achievement
☐ Through Advertisement
How Did You Get Employed How Did You Get Employed
☐ Recommendation
Last Drawn Salary

Reason For Leaving

FINANCIAL INFORMATION

I hereby declare that:

☐ I do not have any non-bank organization Outstanding debts.
☐ I do have non-bank organization outstanding debts as per below details.
Type of Facility : Loan Outstanding Monthly
☐ Bank ☐ Housing Loan (HL) Amount Balance instalmen
☐ Finance Company ☐ Car Loan (CL) (Rp) : (Rp) : t
(Rp) ;
☐ Others ☐ Personal Loan (PL)
☐ Others

1.
2.
3.

Do you own Bank’s Credit Card / Accounts? NO

Card Company: Member Since : Card No. :

TMS Page 7 of 10 3/2/22

1.
2.
3.
Do you own ☐ Car (s) ☐ Motorcycle (s) :
Leasing Company:

ADDITIONAL INFORMATION
SPECIAL ACTIVITIES

From – To Name of Organization Place Position

LANGUAGE SKILLS

Language Reading Writing Speaking Understanding

Notes: E = Excellent G = Good F = Fair P = Poor

OTHER PERSONAL INFORMATION

Computer Proficiency (Program/Language: )

Other Skills & expertise
Interest

EMERGENCY CONTACT

Name of relative / friends not staying with you: Relationship: Email Address: -
Sister
Office Address:
-
Residence Telephone No.: 082233576708 Office Telephone No.:-

OTHER INFORMATION

Core competencies:

TMS Page 8 of 10 3/2/22

Have you been dismissed or suspended from any position? ☐ Yes ☐ No.
If so, state details :

Are you engaged in any business? ☐ Yes ☐ No.

What kind of business?
Current Salary: Expected salary:
Details of current remuneration package:

Do you have any other sources of income? ☐ Yes ☐ No.

If so, state details :

When are you available for work: As soon as possible Notice Period: 1 month

FAMILY DETAILS

Highest
Relationship Name F/M Age Occupation
Educational

Father
Mother

Brother
(s) /
Sister (s)

You have ______________brother (s) / sister (s) and are the _______________child in the family.

EMPLOYMENT REFERENCE

MANDATORY

* Please submit a photocopy of IC (Kartu Tanda Penduduk) together with anyone or more of the following document.
☐ Latest Salary Slip ☐ Latest Tax Return With IRD Receipt

☐ Personal Bank Statement (showing salary credited) ☐ Latest BPJS

TMS Page 9 of 10 3/2/22

By signing this form I certify that the information in this application is factually correct, honestly presented, and is an accurate
account of my professional experience. Should it be untrue, I would be prepared for a dismissal at any time without any
conditions.

Signature: _______________________________ Date:

TMS Page 10 of 10 3/2/22