No.

F-PC-PMO-37-01032017-00

APPLICATION FORM
FOR INTERNAL USE :
job vacancy as Java Developer

Title Of Job : Java Developer

Please take a few minute to fill out this application form and skills checklist. Provide your answers based on
your own working experience. This checklist is designed for a preliminary assessment to all proficiency
levels, from entry-level to senior level.

Personal Information
Full Name Deni Utama
Nationality Indonesian
Sex Male
Place and Date Of Birth Bengkulu, 25-09-1994 (dd-mm-yyyy)
Address Jl. Pemuda Asli IV No. 37 Rawamangun Jakarta Timur
Marital Status Single
Religion Moslem
Languages indonesian language, English
Address Jl. Pemuda Asli IV No. 37 Rawamangun Jakarta Timur
City Jakarta Timur
Postal Code 13220
State / Povince Jakarta
Country Indonesia
Private Email Denyutama25@gmail.com
Phone 085216696070

Office Phone Number -

Home (Fix Line Phone Number) -
Emergency Number 085268488823
Mobile (optional) -
ID Card 1771022509940011
NPWP 82.185.115.1-311.000
Indicate the URL / mailing list Harian Kompas / www.kompas.com
of the advertisement you are www.jobsdb.com
responding to. www.iklanbaris.co.id
www.binuscareer.com
Mailing list..
Others (Jobsreet)
Website URL or design sample http://ra-al-azhar-bengkulu.sch.id/
(mandatory for those applying http://lazismubengkulu.org
for Website Developers)

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Family Information
The Last Job
Relationship Name M/F Age Education Description
Position Company
PEMPROV
Father Harudin M 42 S1 Staf BENGKULU PNS
Heni
Rosita
Mother (almh) F - S1 - - -
Deta
Brother/Sister 1*) Malo M 20 SMA Mahasiswa
Della
Brother/Sister 2*) Novita F 16 SMP Pelajar
Devy
Brother/Sister 3*) Janisca F 13 SD Pelajar
Dhiya
Brother/Sister 4*) Faizah F 8 TK Pelajar

Brother/Sister 5*)

Wife/Husband
Child 1
Child 2
Child 3
..
*)Including yoursel
Formal & Informal Education

Education Description
Level of Education Bachelor Degree
Universitys Name University of Bengkulu
Majority Engineering
From (mmyy) to (mmyy) 0812 to 0516
City Bengkulu
GPA 3.30

Education Description
Level of Education
Universitys Name
Majority

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From (mmyy) to (mmyy)

City
GPA

Course / Training
Course / Training Organizer Place / City Year (mmyy)

Social Activities
Organization Activity Title Year (mmyy)
Rohis Al Fattah Chairman
Himatif UNIB Member
Monstaneer Member

Hobbies : Chess and football

Describe your hobbies :
Play Chess and football with my friend

You read : The main when you read :

A few at rest
What you read usually ?

News paper :-

Magazine :-

Blog : Detik,kompas,ucer

SUMMARY OF EXPERIENCE
-

Working Experience

From mm/yy Until mm/yy Company Title / Salary Reason To

Responsibility Leave

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From mm/yy Until mm/yy Company Title / Salary Reason To

Responsibility Leave

IT Projects

Project Name
From (mm-yyyy) to (mm-yyyy)
Project Description
Company Name
Clients Name
Platform
Database
Development Tools
Role
Description of your job assignment

Number of Team Members

Project Name
From (mm-yyyy) to (mm-yyyy)
Project Description
Company Name
Clients Name
Platform
Database
Development Tools
Role
Description of your job assignment

Number of Team Members

Project Name
From (mm-yyyy) to (mm-yyyy)
Project Description
Company Name
Clients Name
Platform
Database
Development Tools
Role
Description of your job assignment

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 No. F-PC-PMO-37-01032017-00

Number of Team Members

You may add the above list by copying the table.

Skill Inventory

Please fill in the skill table below as our skill inventory information, you are not expected to have all the skills listed
here.
Indicate the skill proficiency using the following level :
0 = None 1=Beginner 2=Basic 3=Intermediate 4=Advance 5=Expert

Language Skill :
You can add qualification rows to indicates your specific experience.
Spoken Level Written Level
Languange
1 2 3 4 5 1 2 3 4 5
English
Mandarin
Indonesia

Technical Skills:
You can add qualification rows to indicates your specific experience.
# Skills Proficiency Level Years of Experience
Remark
A Operating System 1 2 3 4 5 (in years)
1 Windows 95
2 Windows NT
3 Windows 2000
4 Windows XP
5 Novell Netware
6 Sun Solaris
7 Linux

B Application Programming 1 2 3 4 5
1 Visual Basic
2 Visual Basic .NET
3 Visual C++
4 Visual C++ .NET
5 COM/DCOM
6 Active Server Page (ASP)
7 ASP .NET
8 C / C++
9 Java
10 Servlet
11 EJB

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 No. F-PC-PMO-37-01032017-00

12 Java Server Pages (JSP)

13 IBM WSAD
14 IBM Visual Age
15 JBuilder
16 PHP
17 Crystal Report
18 Actuate

C Database 1 2 3 4 5
1 Microsoft Access
2 SQL Server
3 Oracle
4 DB2
5 MySQL

D Application Server 1 2 3 4 5
1 Exchange Server
2 Proxy Server
3 Site Server
4 Site Server Commerce Edition
5 SNA Server
6 System Management Server (SMS)
7 Microsoft Transaction Server (MTS)

E Scripting Languange 1 2 3 4 5
1 HTML / DHTML
2 XML / WML
3 Perl Script
4 Java Script
5 VB Script
6 Cascading Style Sheet (CSS)

F Lotus Notes 1 2 3 4 5
1 Lotus Notes
2 Lotus Script
3 Domino Application
4 CLP (Y/N)

G Application Package 1 2 3 4 5
1 Microsoft Word
2 Microsoft Excel
3 Microsoft Power Point
4 Microsoft Front Page
5 Microsoft Access
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6 Microsoft Outlook
7 Microsoft Project
8 Erwin
9 Rational Rose

H Web Server 1 2 3 4 5
1 Internet Information Server (IIS)
Websphere Application Server
2 (WAS)
3 Java Web Server
4 Apache Tomcat
5 Netscape Enterprise Server
6 JRUN

I Design Tools 1 2 3 4 5
1 Macromedia Flash
2 Macromedia Director
3 Macromedia Dreamweaver
4 Adobe Photoshop
5 Adobe Image Ready
6 Photo Vista
7 GIF Animator
8 Corel Draw
9 Asymetric 3DFX

J Network 1 2 3 4 5
1 Network Protocol (TCP/IP, IPX/SPX,
NetBEUI)
2 Network Design

K Methodologies 1 2 3 4 5
Object Oriented Programming
1 (OOP)

2 Object Oriented Analysis and

Design (OOAD)
3 UML

L Oracle-Siebel 1 2 3 4 5
1 Configuration
2 CRM Business Analys
3 Integration - EAI
4 Data Migration - EIM
5 Technical Architec

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M Others 1 2 3 4 5
1
2
FOR HR PURPOSES

Question
The Question The Answer
Do you bind a contract with the company where you
work in this time?
Do you mind if we ask a reference to your company
where you have worked?
Do you have a part time job? Where and what is your
position?
Have you ever have a cronic disease, accident,
operation? When and what kind?
Are you willing to travel to other city?
What are you previous monthly salary and any facilities
that you get at present?

How much salary and other facilities do you expect?

When you can start to work?

Any additional notes / description :

I herewith confirm that all my above statements are true and fully responsible for all the consequences.

,20..
Color Photo

(..)

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