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)
