Employment ApplicationAPPLICATION OF EMPLOYMENTF/HR/05/R03(to be completed in BLOCK LETTERS and BLACK INK only)Private & ConfidentialPage 1 of 5Personal ParticularsFirst Name:AliyantoLast Name:-LatestName in past:-photographReligion:MoslemBuddhistHinduChristianCatholicMarital Status:SingleMarriedDivorcedNumber of Children:13 X 4GenderMaleFemaleDate of Marriage :KTP# (Indonesia ID):3510011906910000Jamsostek ID:14013446589Birth Date :7/19/91NPWP# (Indonesia Tax):66.789.5700-627.000Birth City :BanyuwangiCitizenship:IndonesiaBirth Country :IndonesiaResidentialStreetAddress:Dusun Rejoagung RT/RW: 03/01 Desa Sumberagung Kecamatan PesanggaranCityBanyuwangiPostal Code48688Contact #:Home6221Country CodeArea CodePhone Number 1Phone Number 2Mobile6281336024093Country CodeMobile Number 1Mobile Number 2Personal Email:asmarakanthi@yahoo.comInformation of Spouse (if applicable)First Name:Last Name:Birth Country:Birth City:Birth Date:Employer:Occupation:Contact #:MobileCountry Code62TelephoneInformation of Children (if applicable)First Name:Last Name:Gender:MaleFemaleBirth Country:Birth City:Birth Date:First Name:Last Name:Gender:MaleFemaleBirth Country:Birth City:Birth Date:First Name:Last Name:Gender:MaleFemaleBirth Country:Birth City:Birth Date:First Name:Last Name:Gender:MaleFemaleBirth Country:Birth City:Birth Date:Information of Parent & Siblings (if applicable)First NameLast NameM/FDate of BirthEducationOccupationFatherBibitMBanyuwangi, 28-10-1960SDPetaniMotherSriWulanFBanyuwangi, 17-06-1965SDPetaniFirst ChildAliyantoMBanyuwangi, 19-07-1991S1SwastaSecond ChildIdaRosintaFBanyuwangi, 20-03-2000SLTPPelajarThird ChildForth ChildFifth ChildSixth ChildParent'sHomeCountry Code62Area CodeTelephoneContact #:MobileCountry Code62TelephonePrivate & ConfidentialPage 2 of 5Information of Emergency ContactFirst NameBibitLast Name:-RelationshipBapakContact #:HomeCountry Code62Area CodeTelephoneMobileCountry Code62TelephoneFirst NameLast Name:RelationshipContact #:HomeCountry Code62Area CodeTelephoneMobileCountry Code62Telephone81231132108Employment Background(Give all periods of employment up to present position, including SAS employment. Use additional sheet if necessary)Company Name:PT Grand Kartech TbkStart Date:4/2/14Business Type:Engineering and ContractingEnd Date:1/17/15Company Location:Jl. Rawa Gelam III No. 1 Kawasan Industri Pulogadung Jakarta TimurPosition:Project Leader and EngineerJob Description &Mengkoordinir seluruh aktivitas proses fabrikasi/instalasi project, meliputi design calculation dan drawings, purchase and instalasi sesuai dengan client specification/standar sesuai Schedule , Kwalitas dan Budget.Responsibility:Mereview drawing dan document untuk mengidentifikasi, jumlah maupun dimensi dari scope pekerjaan, Prepare Purchase, BQ dan ScaduleRequest Material sesuai BQ dan Drawing dan Prepare material sekaligus investigasi kedatangannya. Update Progress Fabrikasi dan InstalasiMaterial Purchase. Koordinasi dengan Subcont, Survey Site dan kick of meeting.Report to:Manager ProjectReason for leaving:Ingin berkarir diperusahaan yang menerapkan standard industri dan mencari pengalaman dengan wawasan baruLast Gross Salary:Rp. 3.500.000,-Contact:NameAbdurrahman ATitleManager ProjectPhoneCountry Code62Area CodeTelephone8881989160Company Name:Muhammadiyah Applied Technology Center (MATC)Start Date:9/28/10Business Type:Training CAD dan Manual DrawingEnd Date:2/10/13Company Location:Jl. Tlogomas No 146 MalangPosition:Asisten InstructurJob Description &Mengkoordinir/ mendampingi peserta pada materi CAD menggunakan AUTOCAD dan InventorResponsibility:Membuat Jadwal Training, menyiapkan materi dan ujian untuk peserta maupun kepala laboratoriumMempresentasikan materi, menyiapkan tool hardware maupun softwarememberikan penilaian peserta dan memberikan pengarahan tentang materi dan semua yang berhubungan dengan trainingReport to:Kepala LaboratoriumReason for leaving:Ingin fokus skripsiLast Gross Salary:Rp. 600.000,-Contact:NameAkhid RosyidiTitleLaboranPhoneCountry Code62Area CodeTelephone81252233457Company Name:Start Date:Business Type:End Date:Company Location:Position:Job Description &Responsibility:Report to:Reason for leaving:Last Gross Salary:Contact:NameTitlePhoneCountry CodeArea CodeTelephonePrivate & ConfidentialPage 3 of 5Company Name:Start Date:Business Type:End Date:Company Location:Position:Job Description &Responsibility:Report to:Reason for leaving:Last Gross Salary:Contact:NameTitlePhoneCountry CodeArea CodeTelephoneCompany Name:Start Date:Business Type:End Date:Company Location:Position:Job Description &Responsibility:Report to:Reason for leaving:Last Gross Salary:Contact:NameTitlePhoneCountry CodeArea CodeTelephoneEducation Details (Starting from the highest qualification)College Name:Country:Degree Earned:Year Earned:Major:GPA:College Name:Country:Degree Earned:Year Earned:Major:GPA:College Name:Country:Degree Earned:Year Earned:Major:GPA:Language AbilityLanguageNativeReadWriteSpeakInggrisY / NHigh / Moderate / LowHigh / Moderate / LowHigh / Moderate / LowIndonesiaY / NHigh / Moderate / LowHigh / Moderate / LowHigh / Moderate / LowY / NHigh / Moderate / LowHigh / Moderate / LowHigh / Moderate / LowY / NHigh / Moderate / LowHigh / Moderate / LowHigh / Moderate / LowY / NHigh / Moderate / LowHigh / Moderate / LowHigh / Moderate / LowPrivate & ConfidentialPage 4 of 5Computer & Software AbilityComputer/Software TypeSkillAutodesk InventorHigh / Moderate / LowAutocadHigh / Moderate / LowGoogle Sketch UpHigh / Moderate / LowCaesarHigh / Moderate / LowMS ProjectHigh / Moderate / LowProfessional TrainingTrainingVenuePeriodPiping design and engineerOil Institut11-02-1014/11-01-2015Rigging Plan AnalysisHagun Institut dan LSO Otomotf22-9-2012/23-9-2012ReferenceHow were you referred to us?E-recruit / agency / write in / advertisement / employee referral / Others (Please specify)Have you previously been employed in any SAS organization?YesNoIf yes, please provide:Position:Country:Start Date:Location:End Date:Reason for Leaving:Have you previously applied for employment with any SAS organization?YesNoIf yes, please provide:Position applied:When:Result of your application:Relative Working in SAS (Permanent or Contract or Temporary staff) (if applicable)(Relatives are defined as spouse, child, parent, brother/sister, uncle/aunt, nephew/niece, parents in-law, brother/sister in-law, son/daughter in-law)Do you have any relative working in SAS`group companies?YesNoName:Relationship:Department:Contact #:PhoneCountry CodeArea CodeTelephoneName:Relationship:Department:Contact #:PhoneCountry CodeArea CodeTelephoneName:Relationship:Department:Contact #:PhoneCountry CodeArea CodeTelephoneDo you have any outside business activities besides employment with SAS group companies?YesNoCompany Name:Address:Fee Payable:Private & ConfidentialPage 5 of 5Have you ever been involved in any criminal activities (weapons, money laundering, drugs related, physical assults etc)?YesNoIf yes, please explain:Have you ever been involved in a criminal lawsuit or in civil court?YesNoIf yes, please explain:Have you ever been discharged / requested to resign from employment?YesNoIf yes, please explain:Have you ever had issues related to banking / trading licenses before?YesNoIf yes, please explain:Have you ever been addicted in drugs, alcohol or any other similar condition?YesNoIf yes, please explain:Have you ever had a bad credit history with any banks, loan companies, and/or credit card companies?YesNoIf yes, please explain:Are you holding an officer, director or executive power in an organization or firm?YesNoIf yes, please explain:When will you be able to join us?2/2/15Please state your expected salary:Rp. 5000.000,-Consent FormCREDIT CHECK:I authorize SAS to conduct a background review of my credit information, such as credit history of past and pending loans, credit card accounts and other assetaccounts and payment history as a condition of my being offered employment. I authorize the banking/lending institutions and card companies to provideinformation about my credit status. I hereby hold SAS and its officers, employees and authorized representatives, free and harmless against any loss, damage orliability arising from or as a result of the execution of this authority.BACKGROUND CHECK:I understand that I am being considered for a position (or have been offered employment) with SAS and its subsidiaries and affiliates ("the Corporation") that willallow me access to highly sensitive information concerning the Corporation's technology and systems. As a condition of my being considered for employment(or continuing my employment), I hereby consent to the Corporation's conducting a background information review of my employment experience. This reviewwill include, but not limited to, a copy of my most recent performance evaluation, most recent security clearances (if applicable) and a discussion with myprevious / current employer (s) concerning my professional qualifications, work performance, and ethical standards.I authorize the contacts listed on Employment Background section to provide the Corporation with any requested information about my previous employment.I hereby waive any claims against the Corporation and its current / former officer, directors, employees for performing the background information review.I understand the Corporation has a sole discretion to determine the eligibility for employment.PERSONAL DATA AUTHORIZATIONI fully understand and accept that in the evaluation of my application and, if hired, for the duration of my employment, information regarding my personalcircumstances, background, credit experience, service record and other employment data (collectively, "Personal Data") may be shared between and amongthe branches, subsidiaries and affiliates of SAS. I further understand and accept that SAS maintains computer systems in data centers and at other locations inIndonesia and that SAS and its affiliated companies may collect, store, process, disseminates or use my Personal Data in manner that causes it to betransferred or accessed from computer systems owned or operated by or on behalf of SAS or its affiliated companies throughout its computer network.By signing this form, I expressly manifest my consent to SAS' collection, storage, processing, dissemination or use of my Personal Data for all purposes relating toSAS' or its affiliated companies' administration of its human resources policies and programs.I hereby apply for employment in SAS. I certify that all statements made in this application, to the best of my knowledge, are true. I have not knowingly withheldany fact or circumstances, which would, if disclosed, affect my application unfavorably. I understand that any false information on this application will besufficient cause for termination at any time if employed. I also authorize SAS to check/verify any information contained in this application.I accept that failure of consent to the credit check, background check and drug test will render me ineligible for employment.AliyantoJakarta, 11/01/2015Applicant's Name:Applicant's Signature:Date: (dd/mmm/yy)Country Code62Area CodeTelephone81336024093

asmarakanthi@yahoo.com