INTERNSHIP APPLICATION FORM

Personal Data

Name
Nickname
Place/Birth date
Religion
Address
Marital Status
ID Number (KTP/Passport)
Tax Number (NPWP)
Bank Mandiri Account / Account Number:
Student Number
Telephone / Home:
Mobile:
Email
Emergency Contact / Name:
Phone:
Address:

Physical Condition

State if there is any physical disability
State if you have any major illness/accident in the last six months
State your weight and height
State your blood type

Family Data

Relation / Name / Birth date / Occupation
Spouse
Child (1)
Child (2)
Child (3)
Father
Mother
Sister (1)
Sister (2)
Sister (3)
Brother (1)
Brother (2)
Brother (3)

Education (list from latest education)

School/University / Major / Year / GPA/Honors

Professional Qualifications Achieved

Professional Licenses/Certification / Year / Institution

Training/Course/Seminar/Program

Training/Course/Seminar/Program / Year / Institution

Languages

Language / Proficiency / Qualification (TOEFL/TOEIC/etc)
Bahasa
English
Mandarin

Personality

Describe your strength and weakness
Describe what activities & interest do you have
Describe achievement/things that you are proud of
Describe your family background

Organizational Background

Organization Name / Position / Year

References

Name / Address / Telephone / Occupation

Work Function Interest (sort three)

Capital Market
Investment Banking
Equity Research
Fixed Income Research
Economic Research
Strategy & Performance
Accounting/Settlement
Corporate Communication
Human Capital/Human Resource
Information Technology
Risk Management/Legal/Compliance

Time to Internship Program (tick one)

√ / Duration / Availability Join Date*
2 Months / From to
3 Months / From to
More than 3 Months / From to

*please take attention when deciding joining date. Join date mean the date that you available to start your internship program (exclude duration). Sample; if you inform your availability join date from 29-31 July with 2 months duration, we will assume your requested internship period by 29 July – 28 September or 31 July – 30 September.

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Signature & Name Date

Attach a photo/scanned of your ID card or passport here

(First identity page and last page for passport)

Attach a photo/scanned of first page of your Bank Mandiri bankbook

Describe what is your purpose and expectation for internship program