Unit : CORPORATE OFFICE
Position : IT PROGRAMMER
 
HOW DID YOU FIND THIS VACANCY ? *
ANY AVAILABLE LOCATION ? *
PERSONAL DATA
Full Name
Sex
Place Date Birth
Date Of Birth
Marital Status
Religion
Nationality
ID Card / Passport No
NPWP Number
Social Security No (BPJS Ketenagakerjaan)
Email
Current Address:
Permanent Address:
Contact Number (Mobile 1):
Contact Number (Mobile 2):
Contact Number (Residence):
 
FAMILY INFORMATION (for married individual, please fill in spouse & children data)
No:
Name
Sex:
Relationship:
Education/ Occupation/ Company:
 
PARENTS AND RELATIVES DATA (please fill in family members information)
No
Name
Sex
Relationship
Date of Birth
City
Education/Occupation
 
EMERGENCY CONTACT
No:
Name
Relationship
Address
Phone Number
 
FORMAL EDUCATION
No
School/Institution
City
Year
Major
Qualification Obtained
GPA
 
LANGUAGE
No
Language
Spoken
Written
Reading
 
PROFESSIONAL LICENSES OR CERTIFICATION
No:
Name of Certification
Name of Institution
Years Obtained
 
WORK EXPERIENCE
 
Current Company
Company Name
Company Address
Latest Position
 
Date (DD/MM/YYYY)
Start Date
End Date
Starting Salary
Latest Salary
Reason for leaving
May we contact this current/ previous employer directly?
If yes, please provide name, contact number If not, please explain why
Achievement(s)
Previous Company
Company Name
Company Address
Latest Position
 
Date (DD/MM/YYYY)
Start Date
End Date
Starting Salary
Latest Salary
Reason for leaving
May we contact this current/ previous employer directly?
If yes, please provide name, contact number If not, please explain why
Achievement(s)
Previous Company
Company Name
Company Address
Latest Position
 
Date (DD/MM/YYYY)
Start Date
End Date
Starting Salary
Latest Salary
Reason for leaving
May we contact this current/ previous employer directly?
If yes, please provide name, contact number If not, please explain why
Achievement(s)
ORGANIZATION STRUCTURE
(please draw organization structure showing your position in your current company)
REFERENCES
 
List two person NOT related to you, who are familiar with your character, background or work performance (preferably your direct supervisor)
 
 
Name
Contact No
 
 
Company
Job Position
 
 
Years Known
 
 
Relationship
 
 
Name
Contact No
 
 
Company
Job Position
 
 
Years Known
 
 
Relationship
CURRENT DETAILS OF SALARY AND BENEFITS
1. Monthly basic salary gross (IDR)
2. Eligible for over time ? ( Yes / No )
                                                 
If yes, monthly average ? (IDR)
3. Allowances
 
Meal (IDR)
Transportation (IDR)
Phone/ Handphone (IDR)
Others (IDR)
4. Loan facilities Type of Loan          Housing         Car         Personal
 
 
Outstanding Amount
Max Limit
 
 
Interest per Year (%)
Outstanding Period (months/ years)
 
 
Repayment Methods (months/ years)
5. Annual Leave (Days)
 
 
6. Annual Bonus
 
THR Festive Allowance (IDR)
Performance Bonus (IDR)
Others, please explain (IDR)
7. Medical Benefits          Cashless         Reimburstment
 
 
Out Patients Per Year (IDR)
In Patients (Room & Board) (IDR)
 
 
8. Life Insurance
 
 
9. Other Benefits, Please Explain:
COMPENSATION BENEFIT EXPECTATION & COMMENCEMENT
1. Monthly salary (Gross) (IDR)
2. Benefits / Others
3. If you are offered employment with us when can you start work (or notice period) ?
DECLARATIONS AND AUTHORIZATIONS
1. Do you have any family members; as an employee, who working in this company? (Yes/ No)
    If yes, please state the name of the employee, designation and relation.
2. Have you ever been dismissed or suspended from any position, or subject to internal disciplinary action by any of your previous employers? (Yes/ No)
    If yes, please state where, when and cause
3. Have you ever been convicted of a criminal offence anywhere in the world, excluding convictions that have been set aside or quashed? (Yes /No)
    If yes, please provide details.
4. Have you ever apply/ work in MAYAPADA HEALTHCARE GROUP? (choose one) (Yes/ No)
If yes, When ?
For position ?
Where
Last selection stage (for apply)
5. Are you currently holding any position in any political party or a candidate for any political office?
    If yes, please provide the detail of position and political party and your joining date to that political party and the position that you are running for as candidate.
6. Is there any member of your immediate family an official or any government agency, an employee of any government agency, an official of political party, or a candidate for political office?
    If yes, please states the detail of the name, position/office held and the family relationship. Immediate family means husband, wife, children, mother, father, siblings.
7. Do you have any other job or business activities outside the current employment?
    If yes, please provide the detail including name of enterprise, type of business, position and starting year of the position.
ATTACHMENT
Tangerang
(021)5578-1888
Jakarta Selatan
(021)2921-7777
Bogor
(0251)830-7900