aos_hrga_level 3_recruitment application form (1)
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AOSTRANSCRIPT
Manual Title:Human Resources ManualForm name:Recruitment Application Form
Form No.:AOS-04-01-F002-TBAManual Number:AOS-04-01
Issue Date:23-May-12
Rev. Date:N/A
Series No:Level 3Issued By:HRGAApproved By:General ManagerRev. No:00
PRIVATE & CONFIDENTIAL
PERSONAL DETAILS DATA PRIBADI
Full Name
Nama LengkapRONY PRAYITNO SIMEON
Place / Date Of Birth
Tempat / Tanggal LahirBOGOR, 17TH DECEMBER 1980
Nationality
KebangsaanINDONESIA
Blood Type
Golongan Darah[ ]A[ ]B[ ]AB[ ]O
Marital Status
Status Pernikahan[ ]Single
Lajang[ ]Married
Menikah[ ]Widower
Duda / Janda
Religion
Agama[ ]Moslem
Muslim[ ]Christian
Kristen[ ]Catholic
Katolik[ ]Hindu
Hindu[ ]Buddha
Budha
ID Card Number
Nomor KTP2171071712809003Date of ExpiryBerlaku Hingga17 DECEMBER 2017
Place of IssueDikeluarkan DiKOTA DEPOK
Passport Number
Nomor PasporA 3526831Date of Expiry
Berlaku Hingga14 NOVEMBER 2017
Place of IssueDikeluarkan diDEPOK
Driving License Number
Nomor SIM801212211298Date of Expiry
Berlaku Hingga17 DECEMBER 2018
Place of IssueDikeluarkan diKOTA DEPOK
Jamsostek Number
Nomor Jamsostek12040693165Date of IssueTanggal Terbit11/2012
Indonesia Tax Number
NPWP68.052.269.5-215.000Date of IssueTanggal Terbit14 JANUARY 2009
Clothe Size
Ukuran BajuXXLShoe Size
Ukuran Sepatu9 / 43
PERSONAL CONTACT KONTAK PRIBADI
Address
AlamatPesona Khayangan Juanda Blok BC No.18Post CodeKode Pos16411
Home Telephone Number
Nomor Telepon RumahNA
Mobile Number
Nomor Telepon Selular+6281288499710
Email Address
Alamat [email protected]
LEISURE INTEREST (HOBBY) KEGIATAN WAKTU LUANG (HOBI)
Reading, Swimming and Watch movie
FAMILY DETAILS DATA KELUARGA
Spouse
Suami / IstriJUNIKE CHRISTIEN KODOATIE
Place / Date of Birth
Tempat / Tanggal LahirSOROWAKO, 10 JUNE 1978
Nationality
KebangsaanINDONESIAN
ID Card Number
Nomor KTP2171105006789011Date of Expiry
Berlaku Hingga10 JUNE 2018
Place of IssueDikeluarkan DiKOTA DEPOK
Passport Number
Nomor PasporA 0271299Date of Expiry
Berlaku Hingga26 APRIL 2016
Place of IssueDikeluarkan DiBATAM
CHILDREN
ANAKFull Name
Nama LengkapPlace / Date of Birth
Tempat / Tanggal LahirGender L / PEducation Level
Pendidikan
First
Anak-1WILLIAM WICAKSONO SIMEONBRUNEI, 28 AUG 2012LNA
Second
Anak-2WILBERT WIBISONO SIMEONDEPOK, 11 JAN 2014LNA
Third
Anak-3
EMERGENCY CONTACT KONTAK DARURAT
Full Name
Nama LengkapJUNIKE CHRISTIEN KODOATIE
Relationship
HubunganISTRI
Address
AlamatPesona Khayangan Juanda Blok BC No.18Post CodeKode Pos16411
Home Telephone Number
Nomor Telepon RumahNA
Mobile Number
Nomor Telepon Selular+6281317974211
Email Address
Alamat [email protected]
FORMAL EDUCATION PENDIDIKAN FORMAL
School / Academy / UniversityMajorDegreeGradeYear
Sekolah / Akademi / UniversitasJurusanGelar PendidikanIPKTahun
Gadjah Mada UniversityPhysics EngineeringSarjana Teknik3.382006
TRAINING / COURSE PELATIHAN / KURSUS
InstitutionSubjectCertification (Number)ScoreYear
Nama PenyelenggaraNama Pelatihan / KursusSertifikasi (Nomor)NilaiTahun
AINSCOUGH UKAPPOINTED PERSON9985-21387NA2013
JTN TECHNICAL SERVICESOPITO COMPETENCE ASSESSOR63729018170215JTN496NA2014
NORTH SEA LIFTING UKCOMBINED RIGGING & LIFTING AND BANKSMAN/SLINGERG20372/1NA2013
NORTH SEA LIFTING UKADVANCED RIGGING & LIFTING TECHNICAL SUPPORTG20372NA2013
NORTH SEA LIFTING UKE-LEARNING FOR LIFTING TA:1. BP Criteria,
2. UK, US and Norwegian Regulation
3. Lift Planning
4. Rigging Loft Management
5. Equipment Certification
6. Gantry Cranes and Overhead Cranes
7. Forklift Operation
8. Winches and Pulling Operations
9. Cargo Carrying Unit and Cargo handling
10. Dropped Object
11. Cranes onshore / Offshore and Marine
12. Man Riding and Personnel Transfer
13.Crane FMEA, FAT and Commisioning
14. Helicopter Lifting
15. Subsea Lifting
16. Self Verification, Assurance and Audit1462013-01-30
1462013-01-30
1462013-01-31
1462013-02-05
1462013-02-09
1462013-02-06
1462013-02-10
1462013-02-07 1462013-02-081462013-02-091462013-02-261462013-03-02 1462013-05-021462013-06-131462013-06-301462013-07-03
NA2013
LIFTING EQUIPMENT ENGINEER ASSOCIATION UKLIFTING EQUIPMENT GENERAL DIPLOMANAA2010
LIFTING EQUIPMENT ENGINEER ASSOCIATION UKLIFTING MACHINE MANUAL DIPLOMANAB2011
LIFTING EQUIPMENT ENGINEER ASSOCIATION UKLIFTING MACHINE POWER DIPLOMANAA2011
LIFTING EQUIPMENT ENGINEER ASSOCIATION UKRUNWAY & LIGHT CRANE STRUCTURES DIPLOMANAC2014
LIFTING EQUIPMENT ENGINEER ASSOCIATION UKOVERHEAD TRAVELLING & PORTAL CRANE DIPLOMANAB2014
LIFTING EQUIPMENT ENGINEER ASSOCIATION UKOFFSHORE CONTAINERS DIPLOMANAB2014
SILVER DOT UKDROP OBJECT PREVENTION SCHEME (DROPS) TRAINING FOR TRAINERNANA2011
KPDM MIGASCRANE INSPECTOR286/IPA/MIGAS/2009Very Good2009
IKBAL M YOSWELDING INSPECTOR375/WI-XV/X/2008Satisfactory2008
IKBAL M YOSASNT LEVEL II RTFI1093/RI-II/SKB/2009NA2009
DB SCHOOL OF NDTASNT LEVEL II MTMT-104285.52010
DB SCHOOL OF NDTASNT LEVEL II PTPT-104288.12010
DB SCHOOL OF NDTASNT LEVEL II UTUT-PP-1111186.62011
TANLA TESCOR WELINDOASNT LEVEL II ECI1446/ET-II/SU/2011NA2011
PT RIGSPEK PERKASAWIRE ROPE SOCKETING1467NA2010
PT RIGSPEK PERKASAWIRE ROPE INSPECTOR1468NA2010
PT RIGSPEK PERKASAWIRE ROPE INSPECTOR1578NA2010
SGS INDONESIALEAD AUDITOR ISO 9001 IRCA REGISTEREDON PROGRESSNA2015
EXPERIENCE & ACHIEVEMENTS PENGALAMAN & PRESTASI
Best 20 % Graduate at the Faculty of Engineering Gadjah Mada University, Indonesia
3rd Rank of Crane Inspector MIGAS 11th enrollment
Lifting Equipment Engineer Association Lifting Gear General Diploma, Pass with Distinction (96 % Pass)
Lifting Equipment Engineer Association Lifting Machine Power Diploma, Pass with Distinction (80 % Pass) Passed BP Level 4 competency for Regional Lifting TA positionIncrease BP Aspac Lifting Performance as following KPI:
Safety trend were improving in quantity and quality compare to HiPo Forklift brake failure on 2012
Lifting plan generated were increased by number and quality. We could see it from increasing of lifting categorisation to the higher level based on risk assessment which also indicate the skills of the site lifting team to identify the hazard were improved
No Lifting related incident from last TAR 5 vs 4 lifting incident on TAR 4 which means lesson learn and improvement were identified and implemented
Log book system already been implemented in Tangguh to achieve systematic competency development and targeted by end 2015 all lifting crew achieved benchmarking competency acknowledge by BP and Industrial practices such as Rigger would be OPITO Stage 3 or ECITB Level 3 moving Load or EAL CoC Level 2 A + B
HAVE YOU EVER BEEN IMPRISONED
Apakah Anda pernah berurusan dengan hukum / penjara[ ]Yes Ya[ ]No Tidak
(Please specify if you have any)(Beri keterangan bila jawaban anda Ya)
HEALTH CONDITION (Please specify if you have any)
KONDISI KESEHATAN (Beri keterangan bila jawaban anda Ya)
Inherent Illness? Penyakit keturunan?
[Yes]:
[ ]Yes Ya[ ]No Tidak
Physical Disease? Cacat?
[Yes]:
[ ]Yes Ya[ ]No Tidak
Did you ever have a disease that need long term recovery?
Pernah mengalami penyakit menahun?
[Yes]:
[ ]Yes Ya[ ]No Tidak
Others Lain lain
[Yes]:
[ ]Yes Ya[ ]No Tidak
Do you consume alcoholic drink?
Mengkonsumsi minuman keras?[ ]Yes
Ya[ ]No
Tidak[ ]Mild Drinker
Sesekali[ ]Drinker
Sering
MEMBERSHIP OF PROFESSIONAL ASSOCIATION
ANGGOTA ORGANISASI / PERKUMPULANYear Attended / Attending
Tahun (dari-hingga)
LIFTING EQUIPMENT ENGINEER ASSOCIATION2009 Now
IKATAN AHLI TENAGA MIGAS INDONESIA BRUNEI CHAPTER2011 - 2012
PRESENT EMPLOYMENT PEKERJAAN SEKARANG
Employer
Nama PerusahaanPT INSPEKTINDO SINERGI PERSADA
Address of Employer
Alamat PerusahaanMall Mobil Building, JL. TB Simatupang Kav 1-S
Job Title
JabatanAdvisor for Lifting Contract and Trainer
Working PeriodPeriode KerjaApril 1st 2015 - Now
Salary (Compulsory)
Gaji (Wajib Diisi)Depend on the Job
[ ] Gross
[ ] Net
Resignation Notice PeriodBatas Waktu Pemberitahuan Berhenti Bekerja1 Month notice
Duties
Tugas
1.Develop lifting procedure for Inspection, Maintenance and Lifting Operation for tender at Oil and Gas Company 2.Conduct training as per LEEA, OPITO and ECITB scheme for Lifting Inspectors, Lifting Supervisor, Lifting Engineer, Rigger, Crane Operator, banksman, etc.
PREVIOUS EMPLOYMENT (from most recent post)
PEKERJAAN SEBELUMNYA (Dimulai dari tahun terbaru)
Working PeriodEmployer, Address & Phone NumberJob Title / DutiesLast SalaryReason of Leaving
Periode KerjaPerusahaan, Alamat & TeleponJabatan / TugasGaji TerakhirAlasan Berhenti
Oct 2012 Mar 2015BP BerauRegional Deputy Lifting TAIDR 65,000,000Employee Reduction
Nov 2011 Oct 2012Brunei Shell PetroleumLifting SurveyorBND 6,500Accepted By BP
Jul 2009 Nov 2011PT Rigspek PerkasaInspection & Testing ManagerIDR 25,000,000Accepted By BSP
REFERENCE IN KS DRILLING / ATLANTIC OILFIELD SERVICES (AOS)REFERENSI DI LINGKUNGAN KS DRILLING / ATLANTIC OILFIELD SERVICES (AOS)
No.Name
NamaPosition / Company
Jabatan / PerusahaanContact (Phone / E-Mail)Kontak (Telepon / Surel)
REFERENCE REFERENSI
Please give the Name, Position / Company, Phone / Email, who are able and willing to give an opinion on your academic / professional experience. One referee should be your present or past Employer.
Tuliskan Nama, Jabatan / Perusahaan, Telepon / Surel, yang dapat memberikan pendapat mengenai kemampuan / pengalaman profesional Anda. Sedikitnya 1 orang referensi berasal dari Perusahaan yang sekarang atau sebelumnya.
No.Name
NamaPosition / Company
Jabatan / PerusahaanContact (Phone / E-Mail)Kontak (Telepon / Surel)
1Kevin BoyleSETA Lifting / BP International+447825681385
2Mohd Sani AbdullahLifting TA / Brunei Shell Petroleum+6738878771
3Jannes SibueaManaging Director / Rigspek Perkasa+628127050231
ADDITIONAL INFORMATION KETERANGAN TAMBAHAN
POSITION APPLIED
JABATAN YANG DIINGINKANLIFTING SPECIALIST
Expected Salary (Compulsory)
Gaji yang Diharapkan (Wajib Diisi) IDR 80,0000,000 / Month
[ ] Gross
[ ] Net
DECLARATION PERNYATAAN
I hereby declare that the information contained in this form is to the best of my knowledge correct. I understand that any willful misstatement renders me liable to disqualification or instant dismissal if engaged.Saya yang bertandatangan di bawah ini menyatakan bahwa seluruh keterangan pada formulir ini adalah benar dan dengan tanggungjawab. Saya menyadari bila ada keterangan yang bertentangan (palsu) maka Saya bersedia untuk dikeluarkan dari Proses Penerimaan Karyawan atau diberhentikan dari pekerjaan.
Signed Tanda Tangan:
Date Tanggal:
HRGA DepartmentRecruitment Application Form4/7