Date Update Date UpdateCLASSIFICATION

DATE

REF

Name I.C. No.

Home Address

Sex:

Do you live in : Own House [ ] Tel. No. (Off)

Rented House [ ] (Res)

With Parents [ ] (H/P)

Others [ ] (E-mail)

Date of Birth : Age: Place of Birth:

Marital Status : Nationality: Race: Religion:

Driving License : Do you own a car : Yes No

EDUCATION & PROFESSIONAL QUALIFICATIONFROM – TO

(STATE DATE) NAME OF SCHOOL, COLLEGE STATE LEVEL ATTAINED MAJOR COURSE OR SUBJECT

MEMBERSHIP OF PROFESSIONAL & OTHER SOCIETIES (state dates and position held)

Yes No Type:

Program/Languages:

Position applied for:

Are you interested in any other position:

Current Salary : Salary Expected:

Details of current remuneration package:

When are you available for work: Notice Period:

EMPLOYEMENT HISTORY

PHOTO

Computer proficient

(Commence with current or last employment)

Date of Employment Date Employment Ended:

Name of Employer:

Address of Employer:

State nature of employer’s business:

Position Held:

Name & designation of immediate supervisor:

Total number of employees in company: Number of staff supervised by you:

Give detailed description of duties/responsibilities:

How did you get employed in this company(Through Advertisement, Recommendation, etc.)

Reason for Leaving:

Last Drawn Salary:

Date of Employment Date Employment Ended:

Name of Employer:

Address of Employer:

State nature of employer’s business:

Position Held:

Name & designation of immediate supervisor:

Total number of employees in company: Number of staff supervised by you:

Give detailed description of duties/responsibilities:

How did you get employed in this company(Through Advertisement, Recommendation, etc.)

Reason for Leaving:

Last Drawn Salary:

Date of Employment Date Employment Ended:

Name of Employer:

Address of Employer:

State nature of employer’s business:

Position Held:

Name & designation of immediate supervisor:

Total number of employees in company: Number of staff supervised by you:

Give detailed description of duties/responsibilities:

How did you get employed in this company(Through Advertisement, Recommendation, etc.)

Reason for Leaving:

Last Drawn Salary:

Date of Employment Date Employment Ended:

Name of Employer:

Address of Employer:

State nature of employer’s business:

Position Held:

Name & designation of immediate supervisor:

Total number of employees in company: Number of staff supervised by you:

Give detailed description of duties/responsibilities:

How did you get employed in this company(Through Advertisement, Recommendation, etc.)

Reason for Leaving:

Last Drawn Salary:

FAMILY DETAILS

RELATIONSHIP NAME AGE ADDRESSOCCUPATION

PRESENT/PASTNAME OF

EMPLOYER

Father

Mother

Brother/

Sister

Spouse

Children

MEDICAL DETAILS

Are you in good health? Yes No If no, why?Please state with dates, any serious illness, allergies, operations, disabilities or accidents, you had.

Have you been refused insurance coverage? Yes No

Do you take alcohol/drugs? Yes No To what extent?

Have you ever been convicted in a court of law? Yes NoIf so, give details:

Are you involved in any administrative, civil or criminal case?

Are you in debt? Yes No

If so, to whom, to what extent & for what reason?Have you been dismissed or suspended from any position? Yes NoIf so, state details:

Are you interested or engaged in any business? Yes No

What type of Business?

Do you have any other sources of income? Yes No(Please specify)

LANGUAGES INDONESIA ENGLISH CHINESE (SPECIFY) ………... …….….. ………… SPOKEN WRITTENHobbies, game & other interests

ADDITIONAL INFORMATION – Give any additional information which you consider may be of interest to a prospective employer, if possible state why you believe you are suitable for the position you are applying

ORGANISATION CHART OF COMPANY MOST RELEVANT TO POSITION APPLIED FOR.(PREVIOUS OR CURRENT EMPLOYER)State name of company, indicate where you fit in within the organization.

EMPLOYEMENT REFERENCESFrom past & present employment

Name: Name :

Position: Position:

Company Name: Company Name:

Company Address: Company Address:

Tel: (Office) (Res) Tel: (Office) (Res)

PERSONAL REFERENCESGive names or person of responsibility who have known you for at least 3 years

Name: Name :

Position: Position:

Company Name: Company Name:

Company Address: Company Address:

Tel: (Office) (Res) Tel: (Office) (Res)

Years of Acquaintance Years of Acquaintance

Name of companies with which you have pending application for employment.(Give dates of application)1.

2.

3.

Have you applied with this office before? Yes No State Date:

I HEREBY CONFIRM ALL THE ABOVE DETAILS TO BE TRUE AND CORRECT. I AUTHORISE BTI CONSULTANTS TO CARRY OUT REFERENCE CHECKS WITH PAST EMPLOYERS AND REFEREES IN CONNECTION WITH THIS APPLICATION.I ALSO AGREE NOT TO SEEK OR ACCEPT EMPLOYMENT EITHER DIRECTLY OR INDIRECTLY FROM ANY CLIENT OF BTI CONSULTANTS TO WHOM I HAVE BEEN SENT FOR AN INTERVIEW, FOR AT LEAST THREE MONTHS AFTER DATE OF INTERVIEW. SHOULD I ACCEPT EMPLOYMENT WITH ANY CLIENT OF BTI CONSULTANTS, AND LEAVE WITHIN THREE (3) MONTHS OF THE DATE OF SELECTION, I AGREE TO PAY BTI CONSULTANTS 50% OF MY CONFIRMED 1ST MONTH’S SALARY.I UNDERSTAND THAT ANY MISREPRESENTATION OR OMISSION OF INFORMATION WILL BE SUFFICIENT REASON FOR WITHDRAWAL OF AN OFFER OR SUBSEQUENT DISMISSAL, IF EMPLOYED.

Date Signature: