1

APPLICATION FORM - PT ORIX INDONESIA FINANCE

Specific position applied for : Application date:
First Choice : __________________________
Second Choice : __________________________
Vacancy Information from: Newspaper / Magazine / Job Fair / Internet / ORIX Website / By Reference (____________) / Others
(____________)
I. PERSONAL PARTICULARS

Full name :___________________________ Place & Date of birth :___________________________

Nick name :___________________________ Age :___________________________
Religion :___________________________ Gender : Male / Female
Marital Status : single/married/widowed Nationality :___________________________
Postal Address : Height/Weight :___________________________
ID (KTP) Number :___________________________
Driving License A / C / B1 :___________________________

(Max. 2 license) :___________________________

E-mail address :___________________________

Contact phone no :_________________________ Emergency call

Name :
Other Data Relationship :
Outside town Address :
Contact phone no :_________________________
Address :

Contact phone no :_________________________

II. FAMILY DETAILS
Family (including you and if your family passed away, with education & previous job)
Relationship Name Sex Date of Birth Education Company name
Father

Mother

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Child 7

Relationship Name Sex Date of Birth Education Company name

Husband/Wife

Child 1

Child 2

Child 3

Child 4
Confidential - Form HRD/Sept 2015

APPLICATION FORM - PT ORIX INDONESIA FINANCE

 2
III. EDUCATION DETAILS
School/College/University Major GPA Period Address

Courses/Training

No Courses/Training Subject City Period

Languages Skill

1 English Poor Fair Good Excellent

Verbal

Written

2 Others (please specify) Poor Fair Good Excellent

Verbal

Written
Computer Literacy
1 Microsoft Office Poor Fair Good Excellent

Word

Excel

Power point

2 Internet

3 Others (Please specify) :

IV. SOCIAL ACTIVITY

Sports

Hobby

Organizational Experience

No Organization City Period Position

Confidential - Form HRD/Sept 2015

APPLICATION FORM - PT ORIX INDONESIA FINANCE

V. EMPLOYMENT HISTORY (List all work experienced beginning with your current or most recent job)

No Company Name Period Address Position Salary Reason for leaving

 3

VI. COMPENSATION & BENEFIT (List all compensation &benefit in your current job)

No Compensation & Benefit Ammount (monthly/ yearly) Additional Info

1 Salary

2 Bonus

3 THR

.....

.....

Additional Information

Willingness to travel : Yes / No Willingness to relocate : Yes /

No Posses own transportation vehicle : Yes / No
Involvement in any dishonest or fraudulent acts,
: Yes / No
drugs and other crime acts

Availability (Please tick one)

Immediate available
Available on (date) ___________ (month) _____________

DECLARATION

1. I am ready to be placed/rotated in PT. ORIX Indonesia Finance branches throughout Indonesia. If I object to be placed/rotated, I will resign from PT.
ORIX Indonesia Finance.
2. I certify that I have non-involvement in any fraudulent act in the past and if otherwise facts found in the future within my employment period with PT.
ORIX Indonesia Finance, I would be automatically considered as resigning voluntarily from my position in the company and ending the work
employment with PT. ORIX Indonesia Finance with no request of any compensation.
3. I certify that the information contained in this application is correct to the bst of my knowledge, and understand that falsifications and / or missions in

any detail is ground for disqualification from consideration for employment or if hired, for dismissal from employment. ______________________ ,

______________ 20_____

_______________________

Confidential Form HRD/Sept 2015

(Signature & Name)
APPLICATION FORM - PT ORIX INDONESIA FINANCE 3
Confidential Form HRD/Sept 2015