PRU-E-Recruitment Application Form 2012

7/29/2019 PRU-E-Recruitment Application Form 2012

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Mandatory fields are marked with red color and asterix

Place of Issue*

Date of Issue (dd-mm-yyyy)* 9 2011

9 1990

City*

Postcode*

City*

Postcode*

Home*

Office

Cellular

E-mail

Emergency Contact* (preferably in different address )

Name

Relationship

Address

Phone Numbers

Date of Marriage (dd-mm-yyyy)

Name of referral source

Relationship

Religion*

Jatirahayu, Pondok Melati

Current Address*

Bekasi

Nationality*

Civil Status*

INTERNET - Internet ad

Islam - ISL

96096121

Jl Melati 2 A no 66 RT 001 / RW 022


Rusmani Bustomi

Advertisement Code and Job Position

bekasi (west java)

Name* Russeno Dwi Putra

HRIS Analyst

MaleGender*

327512121009900004ID No.*

JakartaPlace of Birth*

Jl Melati 2 A no 66 RT 001 / RW 022

8477551

10-Sep-199010

Phone Numbers

Date of Birth (dd-mm-yyyy)*

Indonesia

ID Address* Jl Melati 2 A no 66 RT 001 / RW 022


Bekasi

17414

10-Sep-201110

Personal Data

Jobstreet

---

[email protected]

How were you referred to us?*

087887415980

17414

Single - SG

Parents
mailto:[email protected]


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Date of Birth

Day Month Year (system use)

Father ---Mother ---

---

---

---

---

---

---

Spouse and Children

Date of Birth

Day Month Year (system use)

---

---

---

---

Occupation / Emplo

Family Details

Occupation / Emplo

Date of BirthName

Name RelationshipDate of Birth

Education / School

Relationship Education / School


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Start End

Senior High School

Academy

University

Post Graduate

Start End

Major Honor / Award

Formal Education

Period

Name of School and Location Degree

Informal Education / Courses / Seminar / Training

Period

Subject / Topic Honor / AwardName of Institution and Location

Computer Programming Languages and Operating System most proficient (Use comma as separator)

Language


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Specified Other Language Written

English

Chinese, please specify:

Other, please specify:

Period

(yyyy - yyyy)Activities Po

Membership of Professional, Social or Political Activities

Spoken

Name of Organization Type of Organization


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Name Organization Phone RelationshipNo. of Years

Known

1. Have you been or are you suffering from any physical disability or disease?

IfYes , please explain

2. Have you ever applied for any post with Prudential Life Assurance?

IfYes

, please explain

3. Have you previously been employed at this company or its subsidiaries?


Name Relationship

Referrees

List three persons not related to you who have known you at least one year

General

4.Do you have any family relation or close friend working as a Prudential's agent or in agency office orPrudential's employee or

Prudential's supplier?

Work as: Prudential's agent / work in agency office /

Prudential's employee / Prudential's supplier

IfYes , please state the information


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5.Do you have any family relation or close f riend working in anotherLife Insurance and or in Reassurance?

Name Relationship

6. Have you ever been dismissed or suspended by any previous employer?


7. Have you ever been charged or convicted in any Court of Law?


8. Are you willing to work overtime?

IfNo , please explain

9. Are you willing to travel?


10. Are you willing to assigned outside your point of hire?


IfYes , please state the information

Company


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Start with present employment, including temporary work and vocational training

Employer Starting Salary: Rp.

Nature of Business Final Salary: Rp.

Address:

Phone Number:

Employment Dates: From: To:

Supervisor's Name and Title:

May we contact?



Address:

Phone Number:



May we contact?

If No, please explain

Previous Employment

Reason for Leaving:If No, please explain

Reason for Leaving:

Employment History

Position Title and Work Performed:

Present Employment



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Address:

Phone Number:



May we contact?



Address:

Phone Number:



May we contact?



Address:

Phone Number:



May we contact?


If No, please explain Reason for Leaving:

If No, please explain



Reason for Leaving:



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Address:

Phone Number:



May we contact?



Address:

Phone Number:



May we contact?



Address:

Phone Number:







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May we contact?



Address:

Phone Number:



May we contact?



Address:

Phone Number:



May we contact?









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Phone Number:



May we contact?



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Monthly Basic Salary: Rp. Pension Funds (on top of Jamsostek):

Eligible for Overtime: Employee Contribution Rp.

If Yes, monthly average: Rp. or

Monthly Allowances: Company Contribution Rp.

Meal: Rp. or

Transportation: Rp. Company car provided

Handphone: Rp. If yes, car type:

Operational cost:

Driver provided:

Others (please specify): Loan facilities provided by the Employer:

Rp.

Rp. Max limit (Rp.)

Rp. Interest per year (%)

Annual Bonnus: Repayment period (year)

THR: Rp. Annual Leave:

Variable Bonus: Rp. Entitlement: day

or % from annual salary Additional Leave: day

Medical Benefits: Other Benefits, please explain:

Outpatient: Rp. per year

In-patient: Rp. (Room and Board)

Rp. Annual Limit

Life & Disability Coverage: Rp.

or x monthly salary

B. Please Give Details of Your Salary and Benefits

DETAILS OF CURRENT EMPLOYER

A. Organization Chart


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1. If you are offered employment with us, when can you start work? ---

2. What is your salary expectations if you are offered employment with us? Rp.

(dd-mm-yyyy)

Commencement and Salary Expectation

I authorize the investigation of all information provided by me in this Application for Employment Form except those pertaining to my current

employment. I understand that as part of recruitment process, PT Prudential Life Assurance will ask me to submit copies of reference letter of

my current and previous employers, copies of relevant certificates, last salary statement and check my references. I also understand that a

misrepresentation or ommission of facts called for herein will be sufficient cause for cancellation of consideration for employment or dismissal

from the Prudential's service if I have been employed.

Declaration

Russeno Dwi Putra

Date Name

PRU-E-Recruitment Application Form 2012

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