APPLICATION FOR EMPLOYMENT

POSITION APPLIED FOR: ___________________________________________________ (Please fill up in English)

PERSONAL PARTICULARS
Name Permanent Address (Parents address)

_______________________________________________________________________________ _______________________________________________________________________________ Phone Number (must fill): Home :__________________________________________________

Mobile :__________________________________________________ Foreign Address (Dormitory / Rental House address) _______________________________________________________________________________ _______________________________________________________________________________ Phone Number Email Address Date of Birth Age Place of Birth Race Religion Language Spoken (including Dialect) Language Written Citizenship: Sex : Male / Female Identity Card No : Please write the number Social Security No.: Income Tax No.: Passport No.: Type: : __________________________________________________

Passport Expiry Date:

FAMILY DETAILS (Include yourself)

Parents/ Siblings Full Name Father Mother 1. 2. 3. 4. 5. Relationship Occupation Company/Institution Name

(*) Please delete whichever not applicable.

Marital Status: Single / Married / Divorced / Separated / Widowed (*) If Married, please provide spouses and childrens details below: Spouses Name Date of Birth Occupation Company Name

Childrens Name

Date of Birth

Occupation

Company/Institution Name

In case of emergency, please contact : (must fill) Name Relationship Address Telephone No.

EDUCATIONAL DETAILS
School / Institution City/Country Name
Elementary Jr. High Senior High Diploma University Others

Date Joined

Date Graduated

Highest Standard Passed (Grade / Degree)

Other Academic or Professional Qualifications (including Training Courses attended): Particulars From Year To

Details of Education or Training presently pursuing: Particulars Commencement Date Expected Date of Completion

PROFESSIONAL MEMBERSHIP
Name of Professional Body Membership Position Date Admitted

(*) Please delete whichever not applicable.

EMPLOYMENT EMPLOYMENT HISTORY PAST EMPLOYMENT

Year Company From To Position Held Last Drawn Salary Allowance (if any) Reason(s) for Leaving

PRESENT EMPLOYMENT
Company Employed since Position Current Salary Allowance (if any) Reason(s) for Wanting to Leave

Indicate past / present duties and responsibilities relevant to position applied for :

Have you any objections to reference being made to your (a) Past Employers / No * Yes Present Employers Yes / No *

If you are successful in this application: What is the length of notice required to terminate your present employment: If appointed, what is your expected GROSS salary (gross= plus income tax & 2% Jamsostek contribution) ? Rp. __________________ Negotiable / Fixed (*)

(*) Please delete whichever not applicable.

CHARACTER REFEREES (Family members / relatives should not be used) Full Name : Full Name :

Address & Phone Number

Address & Phone Number

Company Name:

Company Name:

Occupation :

Occupation :

Relation with you :

Relation with you :

HEALTH DECLARATION Have you suffered from any disease, ailment, injury or any other medical/psychological conditions in the past that required treatment, hospitalization and or surgery? Yes / No (*) If yes, please specify: _____________________________________________________________________________________ _____________________________________________________________________________________ Are you currently undergoing any medical/psychological treatment, medication or medical follow-up? Yes / No (*) If yes, please specify: _____________________________________________________________________________________ _____________________________________________________________________________________ Do you smoke? Yes / No (*) If yes, please indicate accordingly: [ ] social smoker [ ] habitual smoker [ ] chain smoker

Have you been under medical treatment regarding with drugs and/or psychotropic medicine? Yes / No (*) If yes, please specify: _____________________________________________________________________________________ _____________________________________________________________________________________ Have you suffered from any trauma attack? Yes / No (*) If yes, please specify: _____________________________________________________________________________________ _____________________________________________________________________________________

(*) Please delete whichever not applicable.

OTHER INFORMATION
Are you a member of any union? Yes / No (*)

If yes, please specify: ______________________________________________________________________________ Have you been convicted in a court of law? Yes / No (*)

If yes, please specify: ______________________________________________________________________________ Have you ever taken part in any Psychological test ? Yes / No (*) If yes, please mention : Date/year of Psychological test conducted ______________________________________________________________ Purpose of the Psychological test _____________________________________________________________________ For Female Only Are you presently expecting a child? For Singaporean Male Only Have you served your National Service liability?

Yes / No *

Yes / No *

If you have been exempted, state reason: ______________________________________________________________ If you have served NS, please complete the following: Vocation in the Army: Mobilisation Code Name: Rank: Unit: Period of Service: From Next In-camp Training Due Date : To

ANSWER THE QUESTIONS BELOW 1. Tell us about yourself!

2.

What are your hobbies?

3.

What is your biggest weakness and strengths?

Strength :

Weakness :

4.

Why do you want this job?

(*) Please delete whichever not applicable.

5.

Why should Oberthur Technologies hire you?

6.

Where do you want to be in five years time?

7.

Why are you leaving your current role?

8.

Please explain your best achievement and failure in job!

The best achievements :

The worst failure :

9. Explain a situation where you have to handle big pressure!

What were the situations?

What were your actions?

What were the results of your action?

I declare that the information given in this form is true and correct. Any false or misrepresented information will render my application null and void; and if employed, I agree that my appointment shall be terminated.

_________________________ Date

______________________________ Signature of Applicant

(*) Please delete whichever not applicable.