YRE

1. Application Form – Yayasan Rumah Energi Page 1 of 2
YAYASANRUMAH ENERGI
APPLICATION FORM
Do not write in this
space
Position Applied For
INSTRUCTIONS
Pleaseanswer each questionclearly and completely. Typeor
print in ink. Read carefully andfollow alldirections.
1. Family Name
2. FirstName
3. Present Nationality
4. Address Permanent Phone
Present Phone
Email
5. Employment Record Starting with your present post,list in reverse order every employment you have had. Usea separateblock for eachpost. Include
also servicein thearmedforces and noteanyperiodduring which youwere not gainfully employed.Ifyou needmorespace, attach additional pages ofthe
same size. Give netsalaries permonth for your last orpresentpost.
Title of your post Start date End date
Name of employer Salaries per month (IDR)
Address of employer Other Monetary Benefits
Other Non-Monetary Benefits
Name of supervisor
Main responsibilities
Reason for leaving
Title of your post Start date End date
Name of employer Salaries per month (IDR)
Address of employer Other Monetary Benefits
Other Non-Monetary Benefits
Name of supervisor
Main responsibilities
Reason for leaving
Title of your post Start date End date
Name of employer Salaries per month (IDR)
Address of employer Other Monetary Benefits
Other Non-Monetary Benefits
Name of supervisor
Main responsibilities
Reason for leaving
Title of your post Start date End date
Name of employer Salaries per month (IDR)
Address of employer Other Monetary Benefits
Other Non-Monetary Benefits

2. Application Form – Yayasan Rumah Energi Page 2 of 2
Name of supervisor
Main responsibilities
Reason for leaving
6. Preferred field to work
7. Expected monthly compensation
8. Availability / Notice Period Required
9. Would you accept employment for less than six months? Yes No
10. If you aredisabled,pleasestatewhether you require any adjustments to be made to facilitate
your participation in theselection process.Human Resources willcontactyou todiscuss at a later date.
Yes No
11. Have you previously submitted an application for employment with YRE?
If the answer is “yes”, when and for what position(s)?
Yes No
12. Knowledge of
languages
Mother language
Other languages
Read Write Speak Understand
Easily Not
Easily
Easily Not
Easily
Easily Not
Easily
Easily Not
Easily
13. Educational (University or equivalent,pleasedo not translateor equate toother degrees)
Name, Place and Country
Attended (Month/Year)
Degrees Main Course of Study
From To
14. Other formal trainingor education
Name, Place and Country
Attended (Month/Year)
Type Certificates
From To
15. Have you any objections to our making inquiries of your present employer? Yes No
16. References List three persons, notrelated to you,who are familiar with your character and qualifications.
Full Name Full Address Business or occupation
17. Have your ever been arrested, indicted, or summoned into court as a defendant in a criminal
proceeding, or convicted, fined or imprisoned for the violation of any law(excludi ngminor
traffic violations)? If “yes”, give full particulars of each casein an attached statement.
Yes No
I certify that the statements made by me in answer to the foregoing questions aretrue, complete and correct to the best of my
knowledge and belief. I understand that any misrepresentation or material omission madeon a Personal History formor other
document requested by the Organization renders a staff member of the Yayasan Rumah Energi liableto termination or dismissal.
Date: Signature: