New Application Form
New Application Form
New Application Form
IDENTITY
KTP No. : SIM No.
Fullname :
Nickname : Sex : M/ F
Twitter account : __________________________________________________Facebook account: _____________________
Active email address : __________________________________________________
Address :
Address as in KTP :
Phone : Mobile phone:
House's owner status : Parents Own Rent/Lease
Place and Date of Birth :
Religion :
Marital Status : Single / Married / Widowed Nationality
MEDICAL CONDITION
Blood Type : Allergy
Accident experienced : Smoking : Yes / No
Ongoing health treatment :
SIBLINGS' Data
Phone
Relation Name DoB Education Address Name of office Address of office Job
Number
Brother/ Sister
Brother/ Sister
Brother/ Sister
Brother/ Sister
CHILDREN'S DATA
Date of Level/
Name Address Name of School Address of School
Birth Class
NEXT OF KIN
Date of Level/
Name Address Name of School Address of School
Birth Class
How much salary do you hope will you get from CIKAL? (must be filled)
PERSONALITY
How do you solve a problem and who do you ask for opinion when you meet a problem in your job?
What kind of problems that you often face in your previous job? How do you solve it?
Do you like working with children? Yes No Are you keen in interacting with children? Yes No
If the answer is yes, in what condition do you interact with children?
What kind of problems that you usually face in interacting with children?
What do you know about CIKAL and where did you get the information from?
The one who signed below tells that all the information that have been written above is true.
Jakarta, _________________________
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