GA Staff - Career - PT Cicero Indonesia

EMPLOYMENT APPLICATION FORM

IV. TRAINING / COURSE

COMPANY NAME	CORE BUSINESS	WORK LOCATION	LAST POSITION

RESPONSIBILITY	REASON OF LEAVE

	JOIN DATE	LEAVE DATE	REFFERENCE

Please draw/describe your Organization Chart

COMPANY NAME	CORE BUSINESS	WORK LOCATION	LAST POSITION

RESPONSIBILITY	REASON OF LEAVE

	JOIN DATE	LEAVE DATE	REFFERENCE

Please draw/describe your Organization Chart

COMPANY NAME	CORE BUSINESS	WORK LOCATION	LAST POSITION

RESPONSIBILITY	REASON OF LEAVE

	JOIN DATE	LEAVE DATE	REFFERENCE

Please draw/describe your Organization Chart

CURRENT BASIC SALARY	DESIRED BASIC SALARY
Monthly	Monthly

IX. OTHERS
Have you ever applied to PT Cicero Indonesia before ? If yes, please mention the time and position applied.
Do you have any side jobs? If yes, please explain.

Do you mind if we confirm your previous employer for a reference ? If no, please mention the address and phone number.

Please give three (3) personal references, but NOT relatives, former employers or teachers.
NAME	RELATION	CONTACT NUMBER	COMPANY

Do you have relatives and/or friends who have worked in our company ? If yes, please mention the name(s) and relationship(s).
Do you ever take a psychological evaluation ? If yes, please mention the time and place.
Do you mind if we do medical exam, including but not limited to HIV-AIDS and Psychotropics / Drugs usage?* If yes, please explain

* = HIV-AIDS test will not use for selection process.
* = Applicant agree that the medical records are belongs to company.
I hereby certify that all the information given above are true and if under circumstances any omission or misrepresentation is found, I understand that I shall fully be held responsible.