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CANDIDATE INTERVIEW FORM

1. Date 2. Position Applied

I PERSONAL INFORMATION AND PREFERENCES

3. Full Name Oktavian Tegar Pambudi

4. Date and Place of birth 19 Oktober 1997

5. Sex Male Female

6. Marital Status (if single skip to
Single Married Divorce
number 8)
7. Number of children 1

8. Main Mode of Transportation Public Transport Car Motorbike Others

9. Home Address Jl. Merapi RT 07 RW 02 No 80b Ds. Bambe Kec Driyorejo , Gresik

10. Phone Number Home: Mobile:089528508911

Whatsapp: 089528508911
Skype:………………………………..
11. Another way to contact you
BBM: :………………………………..
GTalk:………………………………..
12. When is the most ideal time to
Anytime Office hour only After office hour Others……………………..
call you by phone?
13. Email Address
14. Current employment (other
than “still studying” skip to number Employed Self employed Unemployed Still studying
16)
15. How long do you expect to be
3-6 months 6 months – 1 year More than a year
graduated?
16. Your ideal employment term Free lance Contract Part time Permanent
17. Are you willing to be a contract
Yes No
employee?

18. Are you willing to travel? Yes No

19. Are you willing to be stationed

Yes No
in BANDUNG?
20. Where did you get information
Instagram Job Street Website Social Media Others : Teman
about this job opening?

Candidate Interview Form PT. Inova Medika Solusindo

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II EDUCATIONAL BACKGROUND
Formal
School/ University Major Degree Place Year
SD SDN 1 BAMBE GRESIK 2009
SMP SMP YPM 1 TAMAN SIDOARJO 2012
SMA SMK YPM 2 TAMAN SIDOARJO 2015
ACADEMY

UNIVERSITY ITATS SURABAYA 2019

Judul Skripsi: Implementasi Algoritma Improved K-Means pada data titik panas (hotspot) permukaan
bumi
IPK : 3.53

Non Formal/ Training/ Course

1. AUTOCAD (SERTIVIKASI)
2. MS OFFICE (SERTIVIKASI)
3. ISQ (SERTIVIKASI)
4.
5.

III SKILLS

Language
Oral 1 2 3 4 5
21. Indonesia
Written 1 2 3 4 5

Oral 1 2 3 4 5
22. English
Written 1 2 3 4 5

Oral 1 2 3 4 5
23. Other:…………………..
Written 1 2 3 4 5
Computer Skills
24. Operating System/Tools Linux Ubuntu 1 2 3 4 5
Windows Vista 1 2 3 4 5

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Windows 7 1 2 3 4 5

Office Tools 1 2 3 4 5

Mac 1 2 3 4 5

Git (Source Code Manajemen) 1 2 3 4 5

Eclipse 1 2 3 4 5

Netbean 1 2 3 4 5

Other:……………………………………………. 1 2 3 4 5

Photoshop 1 2 3 4 5

CorelDraw 1 2 3 4 5

Illustrator 1 2 3 4 5

Freehand 1 2 3 4 5

25. Multimedia Inkscape 1 2 3 4 5

Macromedia 1 2 3 4 5

Gimpp 1 2 3 4 5

Fireworks 1 2 3 4 5

Other:……………………………………………. 1 2 3 4 5
HTML 5 1 2 3 4 5
CSS3 1 2 3 4 5
Jquery 1 2 3 4 5
CMS 1 2 3 4 5
26. Web Development
Ajax 1 2 3 4 5
Json 1 2 3 4 5
Javascript 1 2 3 4 5

Other:……………………………………………. 1 2 3 4 5

PostgreSQL 1 2 3 4 5

SQL Server 1 2 3 4 5

MySQL 1 2 3 4 5
27. Database & Reporting
Oracle 1 2 3 4 5

Reporting Service 1 2 3 4 5

Other:……………………………………………. 1 2 3 4 5

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PHP 1 2 3 4 5

Java 1 2 3 4 5

C# 1 2 3 4 5

Framework YII 1 2 3 4 5
28. Programming Language
C 1 2 3 4 5

C++ 1 2 3 4 5

Dot NET 1 2 3 4 5

Other:……………………………………………. 1 2 3 4 5
PC Setup 1 2 3 4 5
LAN 1 2 3 4 5
29. Hardware
WiFi 1 2 3 4 5
File/Print Server 1 2 3 4 5
Management Skills
Power Designer 1 2 3 4 5

Microsoft Project Management 1 2 3 4 5

Other: STAR UML 1 2 3 4 5

30. Tools
Other: HIREN’S 1 2 3 4 5

Other:……………………………………………. 1 2 3 4 5

Other:……………………………………………. 1 2 3 4 5

NOTE: 5 is the highest while 1 is the lowest

IV EMPLOYMENT HISTORY

31.
Company Name MULTI COM Position TEKNISI
From-to 2013 - 2015 Salary 1.500.000
SERVICE KOMPUTER ,LAPTOP DAN PRINTER
MONITOR

Job Description

Candidate Interview Form PT. Inova Medika Solusindo

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Likes Dislikes

32.
Company Name RSIA SOERYA Position STAFF IT
From-to Salary 2.000.000
MAINTENANCE NETWORKING ( SERVER , JARINGAN KABEL & WIFI )
MAINTENANCE PC DAN PERIPERAL (KOMPUTER, PRINTER, UPS)
MAINTENACE CCTV , NURCE CALL & LISTRIK
WEBSITE ADMINISTRATOR
Job Description SIMRS ADMINISTRATOR

Likes Dislikes

33.
Company Name Position
From-to Salary

Job Description

Likes Dislikes

V ADDITIONAL QUESTIONS

JUJUR, DISIPLIN, TANGGUNG JAWAB, TEKUN, SUKA BELAJAR, RELIGIUS, MUDAH BERADAPTASI
34. Your
DENGAN LINGKUNGAN SEKITAR
Strengths
SKIL : HARDWARE TROBLESHOTING DAN MAINTENANCE

35. Your
PENDIAM, PUBLIC SPEKING KURANG,
Weaknesses

36. Expected Rp. 4.200.000 (UMK) Negotiable

Salary Non-Negotiable
37. Availability Immediately 1 month notice Other:…………………..

Candidate Interview Form PT. Inova Medika Solusindo

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OKTAVIAN TEGAR
38. Candidate’s Signature 37. Interviewer’s Name
PAMBUDI

Candidate Interview Form PT. Inova Medika Solusindo