IMPORTANT:

False information or suppression of material facts will disqualify you and; if appointed,
render you liable to immediate dismissal.
Please use CAPITAL LETTERS.
Position Applied: __________________________________

PHOTO

Salary Expected: MYR _____________________________

PERSONAL PARTICULARS

A)

Kindly underline surname.

Name:

English

(Mr/Mrs/Miss)

Chinese

______________________________________________________
______________________________________________________

IC No./Passport No.:

(New) ____________________________
(Old) ____________________________

Mobile No.: ___________________

Age: ____________

Sex: ________

Permanent Home Address: ______________________________________________________________

____________________________________________________________________________________
______________________

Poscode: _______________

Tel. No.: _________________________

Corresponde Address: __________________________________________________________________

_____________________________________________________________________________________
_____________________

Poscode: _______________

Date of Birth: ______________________

Tel. No.: ______________________

Place of Birth: _______________________________

(please circle the relevant)

Marital Status:
Religion:
Race:

Single / Married / Divorcee

Muslim / Buddhist / Hindu / Christian

Malay / Chinese / India / Other

Citizenship: _____________________
Income Tax No.: __________________

No. of Children (if any): ___________________

(if other, please state: _________________________ )

(if other, please state: ________________________________ )

Height: _________ (cm)
EPF No.: ____________________

Weight: ____________ (kg)

Socso No.: __________

Bank Name: ____________________________________ Bank Account No.: _________________________

NINETY SIX ED CREATIVE AVENUE

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B)

ACADEMIC QUALIFICATIONS

EDUCATION

NAME & ADDRESS

YEAR
FROM

TO

CERTIFICATE
& DATE

SECONDARY
SCHOOL

POST-SECONDARY
SCHOOL

PROFESSIONAL

Indicate below your knowledge in language ( Good, Fair, Poor or Nil )

Spoken:
English ________________

Bahasa Melayu ____________________

Mandarin _________________

Bahasa Melayu ____________________

Mandarin _________________

Written:
English ________________

State other language (if any) and your fluency in written and spoken: ____________________________
__________________________________________________________________________________
Other Skills / Abilities: _________________________________________________________________
____________________________________________________________________________________
If you are hired, when can you commence work? (please indicate exact date) ______________________

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C)

EMPLOYMENT LAST 5 YEARS

(In reversed chronological orders and attachment if necessary)

Present Employer:
Address:

From:

To:

Position:

Salary:

To:

Position:

Salary:

To:

Position:

Salary:

Reason for leaving:

Previous Employer:
Address:

From:
Reason for leaving:
Previous Employer:
Address:

From:
Reason for Leaving:

D)

SOCIAL / POLITICAL ACTIVITIES

Name & Address of Organisation

From

To

Position Held

State name of union / association that you are a member of : _____________________________

Games / Hobbies / Interest : ________________________________________________________

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(Please place a tick in where applicable)

E)

HEALTH

Are you in good state of health?

YES

NO

Are you suffering from any medical problem that require regular treatment?

YES

NO

If yes, please give details : _____________________________________________________________

____________________________________________________________________________________

F)

FAMILY PARTICULAR
Name

G)

Relationship

Age

Occupation

REFEREES

(Do not include relative)

Name & Address

H)
a)

Telephone No:

Occupation

GENERAL

Please note any serious illness or diseases suffered in the last 5 years.

_____________________________________________________________________________________
b)

Have you ever been hospitalised or undergone surgery operation before?

YES

NO

If yes, please explain : __________________________________________________________________

_____________________________________________________________________________________
c)

Have you ever been convicted for any offences?

YES

NO

If yes, please state conviction : ___________________________________________________________

_____________________________________________________________________________________

NINETY SIX ED CREATIVE AVENUE

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I)

OTHER RELEVANT INFORMATION

I hereby certify that the above information given by me is correct and further declare that I have not
suppressed any material facts. I understand that the information contained herein forms an integral
part of my contact if I am employed by the Company.
Dated:

Signature:

..

(FOR OFFICE USE ONLY)

DATE OF COMMENCEMENT: _______________________

DEPARTMENT: __________________

PROBATION PERIOD: ___________

POSITION: ________________________

SALARY: _____________

REMARKS:

APPROVED BY :

Departmental Head

NINETY SIX ED CREATIVE AVENUE

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Personnel Manager

Company Director

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