APPLICATION FORM - PT ORIX INDONESIA 1

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 : Height/Weight :

Nick Name : ID (KTP) Number :
Gender : Male / Female Driving License A / C / B1 :
Place & Date of : (Max. 2 License) :
Birth
Age : Owned Credit Card : Yes / No
Marital Status : Single / Married Blood Type : A / B / AB / O
Nationality : Heavy Illness Record : Ever / Never
Religion : (If ever, please specify) :
Residential Status : Rent / Owned / Living with Family Heavy Accident Record : Ever / Never
Postal Address : (If ever, Month & Year) :
E-mail address :

Emergency call
Contact phone no : Name :
Relationship :
Other Data Address :
Outside town
Contact phone no :
Address :
Contact phone no :

II. FAMILY DETAILS

Family (including you and your passed away family member (if any), 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/Apr 2020

 APPLICATION FORM - PT ORIX INDONESIA FINANCE 2

III. EDUCATION DETAILS

Period (Year) :
School/College/University Major GPA Address
From – To

Courses/Training

Period : Certificate
Name of Course / Training Held by Place
From – To Any / None

Languages Skill

English Poor Fair Good Excellent

1 Verbal
Written
Others (Please Specifiy) Poor Fair Good Excellent
2 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 Experiences
Organization City Period Position

Confidential – Form HRD/Apr 2020

 APPLICATION FORM - PT ORIX INDONESIA 3
FINANCE
V. EMPLOYMENT HISTORY (Three Last Work Experienced)

Period (Month & Year) Monthly Remuneration Address

No Company Name Line of Business Position
: From- To Nett Gross
& Telephone

Job Description & Responsibility :

Reason to Leave

Period (Month & Year) Monthly Remuneration Address

No Company Name Line of Business Position : From- To Nett Gross & Telephone

Job Description & Responsibility :

Reason to Leave :

Period (Month & Year) Monthly Remuneration Address

No Company Name Line of Business Position
: From- To Nett Gross
& Telephone

Job Description & Responsibility :

Reason to Leave :

VI. REFERENCE

Name Company Position Address & Phone Relationship

(In the same company)

(In the same company)

Confidential – Form HRD/Apr 2020

 VII. PLEASE BRIEFLY EXPLAIN ABOUT YOUR CAREER EXPECTATION

VIII. ADDITIONAL INFORMATION

Minimum Expected salary / month (Rupiah) :

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

Availability (Please tick one)

Immediate available

IX. DECLARATION

1. I am ready to be placed/rotated within PT. ORIX Indonesia Finance brances througout 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
omissions in any detail is ground for disqualification from consideration for employment or if hired for dismissal from employment.

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(Signature & Name)