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APPLICATION FOR EMPLOYMENT
A. Check (v) Desired Employment
Preschool Principal / Teacher Senior High Principal / Teacher
Kindergarten Principal / Teacher Part Time Teacher
Elementary Principal / Teacher Administration
Junior High Principal / Teacher _______________________
Location : East / West Campus / ________________
B. Personal Data
Name : ______________________________________ (M / F)
Identity / Passport Number : ____________________________________________
Place / Date of Birth : ____________________________________________
Address : ____________________________________________
____________________________________________
Nationality : ____________________________________________
Phone / Fax Number : ____________________________________________
Mobile Phone Number : ____________________________________________
Email Address : ____________________________________________
Marital Status : ____________________________________________
Religion : ____________________________________________
FAMILY
Name Relationship Occupation Contact Number
FORMAL EDUCATION
College / University Dates From To GPA / ee Year of Graduation
Degr
WORKSHOPS / SEMINARS ATTENDED

Field Institution / Organization City Year
ORGANIZATION MEMBERSHIP
Name of Position Year
Organization
C. Employment History (start with most recent job)

1. Employer / Supervisor : __________________________________________________
Address : __________________________________________________
Phone No. / Email Address : __________________________________________________
Working Since / Until : __________________________________________________
Monthly Salary (Start & Final) :
__________________________________________________ Last Job Title :
__________________________________________________
Reason(s) for Leaving : __________________________________________________
__________________________________________________
2. Employer / Supervisor : __________________________________________________

Address : __________________________________________________
Phone No. / Email Address : __________________________________________________
Working Since / Until : __________________________________________________
Monthly Salary (Start & Final) :
__________________________________________________
Last Job Title : __________________________________________________
Reason(s) for Leaving : __________________________________________________
__________________________________________________
D. JOB DATA
(Check areas in which you have had experienced or training)
___ Computer Skills (Please specify program) ________ ___ Counseling ___
Library Management ___ Accounting
___ Sunday School Teacher ___ Electrical
___ Writing and Editing ___ Building Maintenance
___ Musical Instrument ___ Others ______________
E. Health
How would you describe your general health?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Hearing _________________________ Eyesight __________________________________
Physical defects, if any? __________________________________________________________
Date of last physical examination ___________________________________________________
F. General Information
1. Have you ever applied for any position in this Institution? ___ Yes, I have ___ No, I
haven’t
2. Do you have any friends / relatives working in this Institution? (Please specify)
___________________________________________________________________________
3. (local staff only) Have you ever taken any work related tests / Psychological test or others?
___ Yes, I have ___ No, I haven’t If Yes, please
specify (When, Where, Purpose,Type of Test)
___________________________________________________________________________
4. a. What level would you like to teach? (For teachers only)
___________________________________________________________________________
b. What level have you taught?
___________________________________________________________________________
5. What is your ultimate goal professionally and your plan for reaching that goal?
___________________________________________________________________________
___________________________________________________________________________ 6.
Would you like to work full time or part time? ________________________________________
7. a. Do you own a house or vehicle?
___ Yes, I do ___ No, I don’t
Please specify ____________________________________________________________ b.
Do you have a Driver’s Licence? (please specify) __________________________________ 8. Do
you have a habit of a) smoking? __ Yes __ No c) drug abuse? __ Yes __ No b) drinking?
__ Yes __ No d) gambling? __ Yes __ No
9. Have you ever been convicted of a crime?
___ Yes, I have ___ No, I haven’t
If yes what matter? What year? Please specify ______________________________________
___________________________________________________________________________
10. Are you willing to support us regarding morality, dress code, and Christian beliefs?
___ Yes, I am willing ___ No, I am not willing
11. Are you willing to be placed in any positions under the Yayasan Pendidikan Kristen Buah Hati?
12. Are you willing to work overtime if required?
13. Are you willing to abide by the rules of the institution?
14. Start Date __________________________________________________________________
15. Approximate salary expected?
___________________________________________________
G.Character References (other than relatives or previous employer)

1. Name : ___________________________________________________ Address :
___________________________________________________ Phone Number :
___________________________________________________ Email Address :
___________________________________________________ Occupation :
___________________________________________________
Years Known / Relationship : ___________________________________________________
2. Name : ___________________________________________________ Address :

___________________________________________________ Phone Number :
___________________________________________________ Email Address :
___________________________________________________ Occupation :
___________________________________________________
Years Known / Relationship : ____________________________________________________
G. Additional Information
(Please do not complete if not applicable)
1. Name of Church / Denomination : ________________________________________
2. Address of Church : ________________________________________
3. Name of Pastor : ________________________________________
4. Please list any religious or social activities
________________________________________________________________________
________________________________________________________________________
5. Please describe your statement of faith
________________________________________________________________________
________________________________________________________________________
I the undersigned certified that statements made by herewith are complete and true to
the best of knowledge and belief.
I understand that any willful misstatement may lead to disqualification or to dismissal.
Date, __________________________
______________________________
Signature
www.bchati.sch.id
Authorized: Accredited by

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WORKSHOPS / SEMINARS ATTENDED

C. Employment History (start with most recent job)

2. Employer / Supervisor : __________________________________________________

G.Character References (other than relatives or previous employer)

2. Name : ___________________________________________________ Address :

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