Employee Application Form
NO:
The following information will help us to assess your employment opportunity with ASTON BATAM HOTEL &
RESIDENCE (hereinafter called the “Employer”). All portions of this application pertaining to you must
Recent Photograph
be completed.
We appreciate the time you spend completing this application form. 4X6 cm
Position applied for : Front Desk Agent
Other position (s) you would like to be considered for :
Salary Expectation : Rp.4.185.000
Date Available to start : 11 January 2022
PERSONAL DATA
Full Name : Nurizan Date of Birth : 21 September 1990
Address : Perum Oasis BL.C NO.10 Batu Aji
City : Batam Post Code : 29472
Telephone : +6281991064703
Telephone : (Office)
I.D Card Number :217203 Date of Expiry :
2109900
004
Marital Status : Single Hobby : Singing
Height / Weight : 170/69 Blood Group : AB
Distinguishing Marks
EDUCATION AND TRAINING
Name and address of school, From Date To Date Major Course or Decree of Certificate
University or other training Study
institution
SMA.N.06 Tanjungpinang 2008 2010 Science yes
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Employee Application Form
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Employee Application Form
RECORD OF PREVIOUS EMPLOYMENT
1. Company Name : Harris Resort Barelang Batam
Position : Front Desk Agent
Period : From : 06 July 2018 To : Currently
Address : Jl.Trans barelang.Btam
Telephone : +62 778 4091111
Nature of Business : Supervisor’s Name : Devi Fathurrahma
Duties :
Last salary : Rp 4.200.000
Reason for leaving :
2. Company Name : Coffe Bean & Tea Leaf
Position : Supervisor
Period : From: 15 March 2015 To 4 july 2018
Address : Bandara Hangnadim Batam
Telephone :
Nature of Business : Supervisor’s Name : Inaziratur Robi
Duties :
Last salary : Rp 3.520.000
Reason for leaving :
3. Company Name : Pizza Hut Tanjungpinang
Position : Cashier
Period : From 16July 2012 To 25 December 2014
Address : JL.Ketapang no.1-3 Ruko Ketapang,Tanjungpiang
Telephone : +628113249496
Nature of Business : Supervisor’s Name : Nova Sinuhaji
Duties :
Last salary : Rp 2.664.000
Reason for leaving :
REFERENCES (Non – Relatives)
1. Name : Telephone Number :
Occupation : Years known :
Address :
2. Name : Telephone Number :
Occupation : Years known :
Address :
3. Name : Telephone Number :
Occupation : Years known :
Address :
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Employee Application Form
LANGUAGE PROFICIENCY
Language Skill ( Language Spoken)
Language Speaking Reading Writing
English Poor Good Excellent Poor Good Excellent Poor Good Excellent
Mandarin Poor Good Excellent Poor Good Excellent Poor Good Excellent
Others Poor Good Excellent Poor Good Excellent Poor Good Excellent
FAMILY RECORD
Father’s Name : Razali Age : 72 Occupation :
Mother’s Name : Nurhayati Age : 60 Occupation :
Permanent Address :
City : Telephone :
Husband / Wife’s Name : Birth of Date : Occupation :
Children :
1. Name : Birth of Date : Male Female
2. Name : Birth of Date : Male Female
3. Name : Birth of Date : Male Female
GENERAL INFORMATION
Are you presently employed ? Yes Yes No
Have you ever been discharged from employment ? If yes, Please explain : NO
Have you any objection to our contacting your previous employers ? NO Yes No
Have you had any serious illnesses, injuries or operations within the last (5) years? If so, please describe
Have you ever suffered from any of the following illnesses?
Tuberculosis Yes No Heart Disease Yes No
Hypertension Yes No Diabetes Yes No
Venereal Disease Yes No Epilepsy Yes No
Hepatitis Yes No HIV / AIDS Virus Yes No
Do you have any immediate family members, i.e. husband, wife, parents, child, brother, sister, working within the
company ? Yes No
If yes, who ?
(1)
(2)
(3)
DECLARATION
I certify that all statements made on this application are true and complete to the best of my knowledge. I
understand that misrepresentation or omission when discovered, will subject me to discharge and I hereby
authorize any investigation relating to my work experience, education or reputation for the purpose of my
application for employment.
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Employee Application Form
Applicant’s Signature Date
INTERVIEW ASSESSMENT
CODE : 1. Excellent 2. Very Good 3. Good 4. Need Improvement 5. Poor
Subject 1st 2nd 3rd
Interview Comment Interview Comment Interview Comment
Appearance
Verbal Skill
Language Skill
Interpersonal Skills
Technical Skills
Professional Skills
Initiative Leader Ability
Motivation
Stability
Co-Operative Attitude
Reliability
Interviewer’s Name
Date
Overall Comment
For Human Resources Department Only
Position :
Starting Date :
Level :
Basic Salary :
Transportation Allowance :
Service Charge :
Service Charge Point :
Housing Allowance :
Others :
Gross Salary :
REFERENCE CHECKING
1. Name / Company : Date : Comment :
2. Name / Company : Date : Comment :
APPROVED FOR HIRE
Department Head Date :
Human Resources Manager / Director Date :
General Manager Date :
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