EMPLOYMENT APPLICATION FORM

POSITION APPLIED FOR: FItter

PERSONAL PARTICULARS
FULL NAME: NAME IN CHINESE:
ANDRIADI
(KTP/Passport) (if applicable)

RESIDENTIAL
JLN.BALI SEKIP UJUNG NO.2262 RT.15.RW.10 KEL.20ILIR KEC.KEMUNING PALEMBANG
ADDRESS:
CONTACT DETAILS:
(Home): - (Mobile): 081325852022 (Email):
BIRTH DATE: 03-OKTOBER-1992 PLACE OF BIRTH: RANTAU PANJANG (OI)

GENDER: MALE NATIONALITY: INDONESIA

RACE: RELIGION: ISLAM

IDENTITY CARD - KTP: PASSPORT NO:
1671010310920002

FILL IN THIS SECTION IF YOU ARE HOLDING EMPLOYMENT PASS (EP) / SPECIAL PASS / WORK PERMIT HOLDERS (WP)

EP/SP/WP NO: FIN NO:

LANGUAGES AND DIALECTS (VERY GOOD, GOOD, FAIR)

LANGUAGES/DIALECTS ENGLISH CHINESE ………………………. …………………………….

SPOKEN FAIR

WRITE GOOD

PERSONAL SKILLS

COMPUTER KNOWLEDGE
(State types of software applications)

DRIVING LICENSE A&C

OTHER SKILLS MECHANICAL OTOMOTIF,CUSTOMER SERVICE

COURSES /AWARDS / PROFESSIONAL MEMBERSHIP

PERIOD
NAME OF INSTITUTIONS / ORGANSATION QUALIFICATIONS/AWARDS/MEMBERSHIP
FROM TO

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EMPLOYMENT HISTORY
MONTHLY
FROM TO NAME OF COMPANY POSITION REASON FOR LEAVING
SALARY
2012 2013 PT.ASTRA RENT A CAR MEKANIK 2.500.000 HABIS KONTRAK

2014 2016 PT.HINDOLI A CARGILL MEKANIK 5.800.000 MUTASI LUAR PULAU

COMPANY BERTEPATAN DENGAN
TANGGAL NIKAH
2016 2021 PT.ENCHARTA INDONESIA MEKANIK- 5.500.000 PENGURANGAN
(DAIHATSU) SERVICE KARYAWAN AKIBAT
ADVISOR OMSET PERUSAHAAN
MENURUN AKIBAT COVID

FAMILY PARTICULARS (SPOUSE, CHILDREN, PARENTS, SIBLINGS)

MARITAL STATUS: NO. OF KIDS

MARRIED

RELATIONSHI BIRTH DATE IDENTITY OCCUPATION EMPLOYER

FULL NAME
P NO. (if applicable)
SITI RACHMADINA WIFE 15-02-1995 16710955029 IBU RUMAH
50003 TANGGA
MUHAMMAD KHALID CHILD 19-09-2019 16710919091
ALFATIH 90004

REQUIRED NOTICE PERIOD:

EXPECTED SALARY: IDR 5.300.000/ Gross

FURTHER INFORMATION
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What are your interest or hobbies? MOTOR CUSTOM,ARCHERY

Do you do Sports? Yes

When was your last holiday? 6 bulan lalu

Do you like travelling? Yes

Are you willing to travel aboard for work purpose or be posted If YES, kindly state number of months:2
Yes
overseas?

Do you have any caregiver responsibility over any family If YES, kindly state details:
No
member who have medical condition?

Have you been or are you suffering from any If YES, kindly state details:
disease/illness/major medical condition or physical No
impairment?

Have you been dismissed or discharged from service by If YES, kindly state details:omset perusahaan menurun
Yes
previous employers?

Have you ever been convicted by a court of law in any If YES, kindly state details:
No
country?

If YES, kindly state details:

Have you ever been declared a bankrupt? No

Do you have any share in any business undertaking other than If YES, kindly state details:
Yes / No
a public listed company?

Are you holding directorship or other appointment in any If YES, kindly state details:
Yes / No
company?

Do you have friends or relative working within Cartrack If YES, kindly list their names & positions.
Yes / No
Group?

EMERGENCY CONTACT
CONTACT NO: RELATIONSHIP:
NAME:

ADDRESS:

REFERENCES

1. NAME OF REFEREE: POSITION: TECNICAL ADVISOR

COMPANY: PT.ENCARTHA INDONESIA(DAIHATSU) CONTACT: 089620898303

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 2. NAME OF REFEREE: POSITION: SUPERVISIOR MEKANIK

COMPANY: CONTACT: 081225632000

DECLARATION:宣
I hereby declared that the information given by me in this application is correct and true to my full knowledge and belief, and that I have not
suppressed any facts.

I fully understand and accept that if any time after the application or employment, it is found that a false declaration has been made in this
form, the Company has the absolute right to terminate my employment forthwith without assigning any reasons.

Palembang,20-10-2022
Applicant’s Signature and Date

ACKNOWLEDGEMENT OF AUTHORISATION FOR PREVIOUS EMPLOYMENT INQUIRY REFERENCE CHECK

I hereby irrevocably and unconditionally:

(i) (in consideration of my prospective employer contemplating my possible employment) authorise my prospective employer
Cartrack Technologies Indonesia to make reference check inquiry regarding my previous employment(s); and
(ii) (in consideration of my previous employer(s) responding to any such inquiry) waive and release each of my previous
employer(s) liability for all information supplied in good faith in response to any such inquiry from my

Palembang,20-10-2022
Applicant’s Signature and Date

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