APPLICATION FORM

Photo

Position Applied For :

(a) Personal Particulars

Full Name : in Chinese :

Residential :
Address
Date of Birth : Place of Birth :
NRIC (Old) : (New) :
Passport No : Nationality :
Race / Dialect : Religion :
I/Tax No : E.P.F :
Socso : Type of Blood :
Sex : Marital Status :
Height/Weight : Date Of Married :
Phone No (Mobile) : Date Of Divorce :
Phone No (Home) : Health :

(b) Family : - (Spouse, Children, Parent, Siblings only)

Name Relationship Sex Age Occupation Place

In case of Emergency, notify : ………...…………………………… Relationship : ….….………………….

Address : …..…………………………………………………… Contact No : …..…………………….

(c) Qualifications Academic / Professional / Technical *(please enclosed the copies cert.diploma.degree)
Name of School / Institution Period Certificate, Diploma or Degree
Course of Study
Attended From To Obtained (State Subjects & Grade)

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 (d) Course and Seminar (Attended or Presently Attending)
Name of Institute / Organiser Title of Course Duration of Course

(e) Employment History

Period
Name of Employer Position Salary Reason For Leaving
From To

Briefly describe the duties and responsibilities:-

Period
Name of Employer Position Salary Reason For Leaving
From To

Briefly describe the duties and responsibilities:-

Period
Name of Employer Position Salary Reason For Leaving
From To

Briefly describe the duties and responsibilities:-

(f) Language Profienciency (State "Yes" where applicable)

Language Read Write Speak

(g) Hobbies & Sports You Are Involved With:-

(h) Other Activities (Social, Civic & Professional Organisations)

(i) Referees (Please Provide Two Names Not Related To You)

Name
Address
Tel No
Occupation
Years Known

Expected Salary :
When you available to start work :

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 (j) Other Information
1. Do you have any physical disablity or handicap?
Yes or No :
2. Do you suffured from any long illness/drug addiction?
Yes or No :
3. Have you held any responsible position in a club, Trade Union or association?
Yes or No :
4. Do you have any friend or relatives working in this company or its subsidiaries?
Yes or No :
5. Are you pregnant at the moment? (For female applicants only)
Yes or No :
6. Have you ever been a bankrupt?
Yes or No :
7. Have you ever been convicted of criminal offence in any cours of law, wheter in M'sia or Overseas?
Yes or No :
8. Are you a director of any private or public limited company or partner in any partnership?
Yes or No :
9. Do you have a car/ motorcycle ? :
Vehicle Registration No : Licence No :
Type : Enginee :

Declaration
I hereby declare that to the best aknowledge and belief, the information given in this Application
Form are true and correct. I also hereby accept that any misrepresentation or omission of facts will
be sufficient grounds for termination of my employment with the Company, should I be offered
employment with the Company. I also hereby authorise you to contact the relevant third parties to
verify the accuracy of the imformation provided herein.

Date : Signature :

For Office Use Only

No Interviewed by Comments
1.
2.
3.

Position Offered : Salary Offered :

Date of Commencent : Allowance :
Dept : :

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