EMPLOYMENT APPLICATION FORM

DATE: ______________

Client Name :-

Applying for Position as : _______________________

Salary expectation : _______________________

Join date available : _______________________

A. PERSONAL DATA

1. Name :
2. Nationality :
3. Gender (for reporting purpose only) : Male Female
4. Religion (for reporting purpose only) :
5. Permanent Address :

6. Postal Code :
7. Home Telephone Number :
8. Cellular Phone Number :
9. Identity Card No. :
10. Email Address :
11. NPWP Card No. :
12. Place & Birth Date (MM/DD/YYYY) :
13. Marital status : Single Married Divorce/Widowed/Separated
14. Number of children :
15. Number of other dependents :
16. Size of Uniform : Clothes : Pants : Shoes :

B. FAMILY DETAIL

Name Education/School Occupation/Employer

Father

Mother

Husband/Wife*

Son/Daughter/Relative*
Son/Daughter/Relative*

Son/Daughter/Relative*
 C. CURRENT REMUNERATION
Current salary and benefits

 Monthly basic salary  Pension Fund (on top of Jamsostek):

Starting basic salary: Rp. Employee contribution: Rp. or % from monthly salary
 net  gross
Latest basic salary: Rp. Company contribution: Rp. or % from monthly salary
 net  gross
Overtime (average): Rp.
 net  gross

 Company car provided:  yes  no

If yes, car type: Year:
 Monthly Allowances:
Meal: Rp. Operational cost:
 net  gross  Reimbursed, monthly limit Rp.
Transportation: Rp.
 net  gross  Monthly allowance Rp.
Handphone: Rp. Driver provided:
 net  gross  yes  no
Other (pls specify):
Rp.
-  net  gross  Loan facilities provided by the Employer:
Rp. Housing Car Personal
-  net  gross
Rp. Max. limit (Rp.)
-  net  gross
Interest per year (%)
Repayment period (months)
 Annual Bonus:
THR: Rp. Outstanding balance
 net  gross
Leave allowance: Rp.
 net  gross  Annual Leave:
Variable bonus: Rp. Entitlement: days
 net  gross
Additional leave: days, after years of service

 Medical Benefits:
Outpatient: Rp. per year
 cash  reimbursement  Other Benefits, please explain:
In-patient: Rp. (Room & Board) or
Rp. Annual Limit
Routine medical check up, every months/years
Last medical check up:

REFEREES: List three persons who are your former supervisors and have known you for at least one year.
No. of
Name Company Phone & email Relationship years
known

D. GENERAL
GENERAL
1. Have you ever applied for any post with Client? □ Yes, please explain: □ No
2. Have you previously been employed by Client or its subsidiaries? □ Yes, please explain: □ No
)
3. Have you any relative* working with Client? □ Yes, please explain: □ No
4. Are you willing to work overtime? □ Yes □ No, please explain:
5. Are you willing to travel? □ Yes □ No, please explain:
6. Are you willing to relocate? □ Yes □ No, please explain:
7.
*) Relatives are: main family and extended family
E. EDUCATIONAL BACKGROUND
Education Level Name of Date Major Year of Degree
Graduation Received
School (From- To)

High School

University/Academy

Post Graduate

F. TRAININGS, SEMINARS, AND WORKSHOPS ATTENDED

Name of Trainings, Seminars, or Workshops Institution Year

G. LATEST EMPLOYMENT RECORDS

Company name:____________________________________ Employed from ___________ to ____________

Company address ________________________________ City __________ Telephone number ___________

Your title __________________________________ Base salary or Earning start _________ Finish _________

Brief description of duties __________________________________________________________________

_________________________________________________________________________________________

Reason for terminating _________________________________

Name and title of immediate Supervisor _______________________________ Phone ___________________

May we contact present employer? Yes No

H. LANGUAGE SKILL

Language Spoken Reading Written

Note: Please specify either in Fair or Fluent or Limited

I. COMPUTER LITERACY
1. 2.

3. 4.

5. 6.

J. SOCIAL ACTIVITIES
List membership in Professional Association, Honorary and/or Societies

Organization, Societies, Club, and Position and Year

Association
Responsibilities

APPLICANT DECLARATION

I hereby acknowledge that the information given above, at the time of submission, is true and correct, and should it be found
that I have provided incorrect details, the success of my application for employment with PT. Oryx Services (Oryx) may be
jeopardized; if I gain employment with Oryx, my employment may be terminated by Oryx immediately and at its absolute
discretion.

I authorize the investigation of all information provided by me in this Application for Employment Form except those pertaining
to my current employment. I understand that as part of recruitment process, Company will ask me to submit copies of
reference letter of my current and previous employers, copies of relevant certificates, copies of latest salary slip and check my
references. I also understand that a misrepresentation or omission of facts called for herein will be sufficient cause for
cancellation of consideration for employment or dismissal from the Oryx if I have been employed.

__________________________________ ______________________

(Signature of Applicant) (Date)