Swedish Institute (SI) Scholarship Programmes

Enclosure to the application for Swedish Institute Study

Scholarships for studies in Sweden at Masters level for the
academic year 2016/2017
WORK EXPERIENCE FORM (Instructions)
How do I fill out the form?
To prove that you have 2 years, or the equivalent of 2,800 hours, of work experience
you must request former supervisor/s or manager/s at your current/previous work to
sign off on your experience. Please use only the most relevant references for this. If
you have the required amount of work experience from one relevant work place you
need only fill in one of the boxes below. Please ask your referees to fill out the
appropriate information and sign with their signature.
Examples of eligible signatures

Former/current manager
Former/current supervisor

Examples of who cannot be referred to and used as reference person

Co-workers
Family members/relatives/partners
Friends
Individuals who demand compensation (money, goods, favours, services or
other means) from you in order to give you a statement of reference

Why do we ask for proof of work experience in this format?

The reason SI asks for 2 years work experience is that SI is looking for scholarship
holders who are likely to return to their home country and work for a continued
development of their country. In order to be successful at this we believe it is
important to be able to demonstrate both academic as well as practical knowledge of
the needs of the home country. SI also believes that people who have previous work
experience are able to take the acquired knowledge from their masters programme
and translate it into a practical context, thus further deepening the understanding of
what they have learnt. All types of work can be counted, including volunteer
experience, internships, employment, and positions of trust (such as presidency of a
student council).
Restrictions
The letter must be completed in English and cannot exceed two pages (exempt the
instruction page). Any additional page/s will be disregarded. In order to be valid, the
work experience must be dated and signed by a referee and the document must be
signed by the applicant. Any format except for this will be disregarded and not
considered.

The completed letter of reference is then to be scanned to PDF format (please do not
include this instructions page in the conversion) and enclosed along with your online
application. A letter that is not signed will be disregarded.
SI will carry out random checks on the applications and applicants to control any false
or misleading information, including fabricated documentation. Should any false
information be found, the applicant will be automatically disqualified from this and
future SI scholarship programmes. Any false information discovered during the
scholarship period will be cause for termination of the scholarship. The scholarship
holder will then have to repay the full scholarship amount to SI.
Should you have special circumstances such as any sensitive information in your work
experience preventing you from filling out this form properly, please contact the
Scholarship Team at sischolarships@si.se.

Swedish Institute (SI) Scholarship Programmes

Enclosure to the application for Swedish Institute Study
Scholarships for studies in Sweden at Masters level for the
academic year 2016/2017
WORK EXPERIENCE FORM (Two pages maximum
including this page)
The reference form must be completed in English. Any additional page/s will be
disregarded. The completed letter must be signed and converted into PDF format.
FIRST NAME of applicant /as written in the
application form/
LAST NAME of applicant /as written in the
application form/
DATE OF BIRTH of applicant /YYYY-MM-DD/
CITIZENSHIP of applicant
SIGNATURE of applicant, date and place

Yasmin

FULL NAME of company/university/enterprise

Lembaga Pengembangan
Inovasi & Kewirausahaan ITB (LPIK-ITB) / Institute of
Innovation and
Entrepreneurship
Development (IIED - ITB)
Account Representative
Aug 2016 - Present
800
Prof. Suhono Harso
Supangkat
Director of LPIK-ITB
suhonosupangkat@yahoo.c
om

TITLE/POSITION applicant held during employment

TIME OF EMPLOYMENT
HOURS WORKED in total
FULL NAME of reference person
TITLE/POSITION of reference person
E-MAIL ADDRESS of reference person
TELEPHONE NUMBER of reference person
SIGNATURE of reference person, date and place

FULL NAME of company/university/enterprise

TITLE/POSITION applicant held during employment

TIME OF EMPLOYMENT
HOURS WORKED in total
FULL NAME of reference person
TITLE/POSITION of reference person
E-MAIL ADDRESS of reference person

Aruni
1994-10-02
Indonesian

Industrial Engineering
Undergraduate
Programme, Institut
Teknologi Bandung
Practicum Assistant
July 2013 - April 2016
752
Dr. Ir. Sukoyo, M.T.
Head of Industrial
Engineering Undergraduate
Study Programme
sukoyo@mail.ti.itb.ac.id

TELEPHONE NUMBER of reference person

SIGNATURE of reference person, date and place

FULL NAME of company/university/enterprise

TITLE/POSITION applicant held during employment
TIME OF EMPLOYMENT
HOURS WORKED in total
FULL NAME of reference person
TITLE/POSITION of reference person
E-MAIL ADDRESS of reference person
TELEPHONE NUMBER of reference person
SIGNATURE of reference person, date and place

Kantor Berita ITB

News Reporter
June 2015 - June 2016
450
Teguh Yassi Akasyah
General Manager
teguhyassi@gmail.com
+6281392005566

FULL NAME of company/university/enterprise

TITLE/POSITION applicant held during employment
TIME OF EMPLOYMENT
HOURS WORKED in total
FULL NAME of reference person
TITLE/POSITION of reference person
E-MAIL ADDRESS of reference person

Rumah Langit
Voluntary Teacher
March 2016 - Present
360
Fadhilaz Digdaya Haq
Founder of Rumah Langit
fadhilazdigdaya.haq@gmail
.com
+6282225337889

TELEPHONE NUMBER of reference person

SIGNATURE of reference person, date and place

LEADERSHIP EXPERIENCE
THIS SECTION IS OPTIONAL
Should you have any specific leadership experience that you wish SI to know about,
please ask former supervisor/s or manager/s to fill out the section below.
FULL NAME of company/university/enterprise
TITLE/POSITION held during employment
TIME OF EMPLOYMENT
HOURS WORKED in total
LEADERSHIP specific tasks

FULL NAME of reference person

TITLE/POSITION of reference person
ORGANISATION/UNIVERSITY/ENTERPRISE of
reference person
E-MAIL ADDRESS of reference person
TELEPHONE NUMBER of reference person

Industrial Engineering
Student Association (MTIITB)
Secretary General
Feb 2015 - Mar 2016
924

Support and manage the

activities within the student
association. Plot &
coordinate events from 7
departments & 4 divisions.
Mochammad Arya Zamal
President
Industrial Engineering
Student Association
muchammadaryazamal@g
mail.com
+6287823255349

SIGNATURE of reference person, date and place

FULL NAME of company/university/enterprise

TITLE/POSITION held during employment
TIME OF EMPLOYMENT
HOURS WORKED in total
LEADERSHIP specific tasks
FULL NAME of reference person
TITLE/POSITION of reference person
ORGANISATION/UNIVERSITY/ENTERPRISE of
reference person
E-MAIL ADDRESS of reference person
TELEPHONE NUMBER of reference person
SIGNATURE of reference person, date and place