APPLICATION FORMPT. Intra Asia Worldwide

Wisma Kosgoro18th FloorJl. MH. Thamrin Kav 53 Jakarta 10350 IndonesiaTelephone : +6221 390 0631

HR Recruitment Use only

HR Interview Date:

User Interview Date:

POSITION APPLIED for:

PHOTO3X4PHOTO

INSTRUCTIONS:1.Please accomplish this form by fill up all blanks. Write N/A if not applicable. 2.Use separate of paper if needed3.Use CAPITAL LETTER

Personal

Full NameNick Name

Permanent Address(As stated on ID/KTP)

Area CodeDistrict/City/Province

Telephone Number / Handphone

Email Address

ID/KTP NumberDate & City of Issued

Date of Birth(dd/mm/yy)PlaceSexReligion

Civil StatusSingleNationality

(Put X in the Selected Box)Divorce

Widower/Widow

Married (Date of Wedding (dd/mm/yy)

Do you live inOwn House

(Put X in the Selected Box)Rented House

With Parents

Others

Language Skills(Put X in the Selected Box)EnglishBahasaChineseOther 1Other 2Other 3

Spoken

Written

Do you have own car/motor cycle? (Put X in the Selected Box)Yes No

Do you have Driving Licence? (Put X in the Selected Box)YesNo

FamilyName Of Wife/Husband

Full NamePlaceBirthday(dd/mm/yy)Religion

Occupation of Spouse

Company/Place EmployedPosition HeldTelephone No

Details of Living Children(Eldest First)Full NameSexM/FPlace & Date of Birth(dd/mm/yy

1.

2.

3.

4.

5.

Father

Full NamePlace & Date of Birth (dd/mm/yy)Occupation & Position

Mother

Full NamePlace & Date of Birth (dd/mm/yy)Occupation & Position

Brother/Sister1.

Full NamePlace & Date of Birth (dd/mm/yy)Occupation & Position

2.

Full NamePlace & Date of Birth (dd/mm/yy)Occupation & Position

3.

Full NamePlace & Date of Birth (dd/mm/yy)Occupation & Position

4.

Full NamePlace & Date of Birth (dd/mm/yy)Occupation & Position

5.

Full NamePlace & Date of Birth (dd/mm/yy)Occupation & Position

Education & Professional QualificationFormal Education

Name of Elementary / High School Location (City, Country)MajorYears AttendedScholastic Standing(Highest Grade Possible)

FromTo

Name of College/Graduate School & Location (City & Country)MajorDate of EntryDate of GraduatedGPA

Informal Education

Write down your Informal activities, incl. Participations in Course, Workshop, Training, etc.

Name of Training/IntitutionCity/CountrySubjectDuration

FromTo

1

2

3

4

5

6

Other ActivitiesWrite down your extracurricular activities, Incl. Participations in Organization, Society, Proffesional, Sport, Etc.

Name Of OrganizationType of ActivityPosition Held and ResponsibilitiesTime Period

Write down your Name your hobbies, interests & activities

1

2

3

4

Experience & CompanyPlease indicate the functions/business you are interested to: (Put X in the selected box)

Human ResourcesMineral & Environment ServicesIndustrial Services

Finance & AccountingOil, Gas, & ChemicalSystem & Services Certification

Information TechnologyAgricultural Services Government & Intitution Services

Quality Health Safety EnvironmentConsumer Testing ServicesOther

Please give detailed description current or last employment

Company NamePositionWorking PeriodReason for Leaving

FromUntil

Please describe your strengths.

Please describe your weakness.

Please tell about your best achievement based on your experience.

Please explain your reason interested in this position.

Please explain your reason join with WQA.

Please explain what do you know about WQA.

Are you willing to be assigned anywhere the company operates?Yes

No, Why?

Are you comfortable work withAlone, Why?

Team, Why?

Other InformationChannel of Application

Job Fair/Campus RecruitmentWQA WebsiteClassified Ads

Walk InOther WebsiteReferral (Specify Name)

Letter / e-mailExecutive SearchJobstreet

Have you ever applied with WQA before?Yes, When?

For What Position?

No

Do you have relatives and/or friends who have worked with us at one time or another or are presently in our employ? If so state name(s) and relationship(s)

NameRelationship

Please write date & name of companies with thich you have pending application for employment

NameDate (dd/mm/yyyy)

How soon can you start working with us?

Date (DD/MM/YYYY)

Renumeration InformationPlease detail your last or present renumeration package as follows:

Basic Salary(Nett)

Transportation(If any)

Medical(If any)

Other Benefits(If any)

Please inform your salary expectationRp.

I hereby confirm all the above details to be true and correct. Should untruths be discovered during my employment in any position in this company, I fully agree to being immediately dismissed for just cause.

Date:Applicant Signature

1WQA-APAC 63 issue 4WQA-APAC Sep 2014