PRIVATE AND CONFIDENTIAL

EMPLOYEE PROFILE FORM

Reference No.:

Please enter your particulars into the form and submit to the Management. He/ she will
review and verify all the information you have provided. upon verification, a copy of the
form will be printed out for you to sign off the staement of Declaration.

*Required Field
PERSONAL PARTICULARS
Personal Details

Salutation * Mr / MRS / Ms / Miss

First Name *

Last Name *

NIRC No. * Passport No.*

(For Non-Malaysian)

Date of Birth * Place of Birth *

Gender * Marital Status *

Religion * Nationality *

Ethnicity * Bumiputera Yes No

Contact Details

Mobile Phone No.

Personal E-mail

Current Home Address

Address *

City * Postcode *

State * Country *

Permanent Address (if different from above)

Address

City Postcode

State Country

Emergency Contact Details

First Name *

Last Name *

Address

City Postcode

State Country
Telephone No. * Mobile Phone No. *

SPOUSE AND DEPENDANTS

Spouse Details (* compulsory if married)

First Name *

Last Name *

NIRC No. * Passport No.*

(For Non-Malaysian)

Date of Birth * Place of Birth *

Gender * Married Since

Religion * Nationality *

Ethnicity *

Telephone No. * Mobile Phone No. *

Name of
Employer
Occupation

Dependant Details (* compulsory if with dependant)

Dependant type *

First Name *

Last Name *

NIRC No. * Passport No.*

(For Non-Malaysian)

Birth Cert No * Place of Birth *

Gender * Date of Birth *

Religion * Nationality *

Studying? Yes No

Education Level

EMPLOYMENT / STATUTORY PARTICULARS

Bank Account Details (for salary)

Name of Bank *
Account no. *

Bank Branch

Statutory Details

Income Tax No. Tax Office

For tax purpose - If married and / or with dependant(s), please fill in the Spouse Unemployed and/or No. of Dependants.
 Spouse Unemployed? Yes No No. of Dependants

Contribute to SOCSO? Yes No

EPF No. * Employee Contribution %

Note: Please complete KWSP 17A (Pekerja) obtainable from the Management.

EDUCATION
Education Details (* start with most recent)

Start / End Date (year) Education Level Institution Field of Study Course Name

PROFESSIONAL AFFILIATION
Personal Affiliation Details

Start / End Date (year) Name of Organisation Certification (if any)

WORK EXPERIENCE (compulsory if with work experience)

Work Experience Details (* start with most recent)

Start / End Date (year) Company Industry Designation

ADDITIONAL INFORMATION
Additional Information Details (*if applicable)

If you have any health / physical impairment, please indicate

your condition:
For Physical Disability, please specify:

STATEMENT OF DECLARATION

I authorise and consent to the Company collecting, retaining and storing the information provided herein as part of my employment record and
for purposes related to my employment until such time that my personal information is no longer required. I declare that all particulars and
informationprovided by me in this form and the documents attached hereto (if any) are true and accurate in every respect. I have not willfully
suppressed any material fact or made any false declaration or misrepresented any information. I understand that in the event any information
provided by me is found to be false or inaccurate, I may be liable to serve disciplinary action.

Signature:

Name:

Date: