PRIVATE & CONFIDENTIAL

JOB APPLICATION FORM

BORANG PERMOHONAN PEKERJAAN
Note:
Please read the form carefully and decide on your reply before attempting to complete the form. A separate sheet may be attached if there is Passport
insufficient space on this form for you to answer the various questions. The reply should be typed, or written in the handwriting of the applicant,
signed and returned with one passport-size photograph. Copies of any certificates or testimonials should be attached to the form. Original Size Photo
certificates shall be brought during an interview.
Nota:
Sila baca keterangan di dalam borang ini dengan teliti sebelum mengisinya. Kertas tambahan boleh digunakan sekiranya ruang yang disediakan
tidak mencukupi untuk menjawab soalan-soalan tersebut. Jawapan hendaklah ditulis oleh calon sendiri, ditandatangani dan dikembalikan dengan
sekeping gambar berukuran paspot. Salinan sijil-sijil atau surat akuan hendaklah disertakan bersama borang ini. Sijil-sijil asal hendaklah dibawa
bersama semasa menghadiri temuduga.

POSITION APPLIED : EXPECTED SALARY : NOTICE PERIOD :

JAWATAN DIPOHON: GAJI YANG DIPOHON: TEMPOH NOTIS :
PERSONAL DETAILS
BUTIR-BUTIR PERIBADI
NAME (As per NRIC):
Nama (Mengikut K.P.):
Present / Permanent Address:
Alamat Tetap / Sekarang:

Mobile Phone. No: Email Address : NRIC No. (Old /New): Marital Status:
No. Tel. Bimbit: Alamat E-Mail : No.K.P (Lama /Baru): Status Perkahwinan:
 Single  Married  Divorced
Bujang Berkahwin Bercerai

Age : Gender: Religion: Nationality:

Umur : Jantina: Agama: Kerakyatan:
 Perempuan/ Female Race:  Warganegara / Citizen
 Lelaki / Male Bangsa:  Bukan Warganegara / Non-Citizen
Name of Spouse Occupation Employer No. of Children
Nama Pasangan Pekerjaan Majikan Bil. Anak

ACADEMIC / PROFESSIONAL QUALIFICATION

KELAYAKAN AKADEMIK / PROFESIONAL
Year
Academic Achievement /
School/College/University Tahun Major
Qualifications / CGPA
Sekolah/Kolej/Universiti From To Pengkhususan
Kelayakan Akademik Pencapaian / CGPA
Dari Hingga

LANGUAGE PROFICIENCY
KEMAHIRAN BAHASA
Written Spoken
Language Penulisan Pertuturan
Bahasa
Good Average Poor Good Average Poor

E EMPLOYMENT HISTORY (List your current and former employers in the period of 7 years prior)
Note: For candidate who has been appointed as Dealer / Broker are required to list down all your previous employment.
PENGALAMAN KERJA (Senaraikan jawatan dan majikan anda bagi 7 tahun terakhir)
Nota: Bagi calon yang pernah menjawat jawatan sebagai Dealer / Broker anda dikehendaki menyatakan kesemua jawatan dan nama majikan
terdahulu.
Last Drawn Reason(s) for
From To Employer’s Name Position
Dari Hingga Nama Majikan Jawatan Salary Leaving
Gaji Akhir Sebab berhenti

BSM-PJ (Pin 0622) Page 1 of 2

 PRIVATE & CONFIDENTIAL
REFEREES
RUJUKAN
Please provide 2 professional referees (other than relative)
Sila nama 2 rujukan professional (bukan saudara)
Name Designation Orgnization Contact No. Period Known
Nama Jawatan Organisasi No. Telefon Tempoh Mengenali

DECLARATION YES NO
PENGAKUAN YA TIDAK
Do you have any family member working with BSN? If so, please specify
Adakah anda mempunyai ahli keluarga yang bekerja dengan BSN? Jika ada, sila nyatakan
Name/ Nama :
Relative/ Hubungan :
No. ID /No. ID :
Position/ Jawatan :

Do you have immediate family member appointed as Board of Directors/Shariah Committee of

BSN? If so, please specify
Adakah anda mempunyai ahli keluarga terdekat yang dilantik sebagai Ahli Lembaga Pengarah/Jawatankuasa Shariah BSN?
Jika ada, sila nyatakan
Name/ Nama:
Relative / Hubungan :
Position/ Jawatan :

Do you hold any directorship or key management in any organization? If yes, please state name of
the company, amount of shares owned and/ or the positions you are holding.
Adakah anda menyandang jawatan pengarah atau Pengurusan Kanan di mana-mana syarikat? Jika ya, nyatakan
nama syarikat tersebut, jumlah saham yang dimiliki dan jawatan yang disandang, jika ada

Have you ever been charged / found guilty by a court?

Pernahkah anda didakwa / didapati bersalah oleh Mahkamah?
Have you ever been fired, terminated or suspended from work?
Pernahkah anda dipecat, diberhentikan atau digantung dari pekerjaan
Have you ever been convicted of a crime in any country? If yes, please explain
Adakah anda pernah disabitkan kesalahan dimana-mana Negara? Jika ya, sila nyatakan
Are you a guarantor to anyone who has been charged on bail? If yes, please give details
Adakah anda seorang penjamin kepada seseorang yang dituduh atas jaminan jenayah?Jika ya, sila nyatakan
Are you a bankrupt or declared a bankrupt?
Adakah anda seorang muflis atau pernah diisytiharkan muflis?
Do you have any other independent means or source of income? If yes, please give details
Adakah anda mempunyai sumber pendapatan sendiri yang lain? Jika ya, sila nyatakan

Do you or your relative i.e. mother / father / spouse / children have any financing with BSN? If
yes, please give details.
Adakah anda atau ibu / bapa / pasangan mempunyai pinjaman di BSN? Jika ya, sila nyatakan.
Are you a guarantor to anyone who has financing facilities with BSN or any other Banks?
If yes, please give details.
Adakah anda seorang penjamin kepada peminjam di BSN atau Bank-Bank lain? Jika ya, sila nyatakan.
Have you undergone any surgical operations in the past? If yes, please give details
Pernahkan anda menjalani apa-apa pembedahan sebelum ini? Jika ya, sila nyatakan

Have you been, or are you suffering from any physical impairment or disease? If yes, please give
details.
Adakah anda pernah atau menghidapi kecacatan anggota atau mempunyai sebarang penyakit? Jika ya, sila nyatakan.
I hereby affirm that the information given in this application are correct. I understand that if after engagement it is
found that I have made a false declaration in this form, BSN reserves the right to terminate my service.
Saya dengan ini mengesahkan bahawa maklumat yang diberi di dalam permohonan ini adalah benar. Saya faham jika selepas ditawarkan
jawatan, dan didapati saya membuat keterangan palsu, pihak BSN mempunyai hak untuk menamatkan perkhidmatan saya.

___________________________________ _________________________________
Signature of Application /Tandatangan Pemohon Date / Tarikh

BSM-PJ (Pin 0622) Page 2 of 2