JOB APPLICATION FORM Position Applied For : _______________________ Date : ________________

a. Personal Particulars

Full Name Please insert recent passport-sized photo Address Tel No (Home) ___________________ Tel No (Office) ___________________ Handphone No ___________________ Email Address ____________________ Do you have a valid driver s license? Yes / No Types of driver s license (please state) __________________________________________ Citizenship Place of Birth Sex *Male / Female Date of Birth (dd/mm/yy) Age Marital Status *Single / Married / Widowed / Divorced Identity Card Number Race Religion

b. Education (List of Schools/Institutions/Universities attended)

From To

Schools/Institutions/Universities Qualifications Obtained

c. Language Proficiency (Please state proficiency, e.g. Excellent, Good, Fair)

Language Written Spoken

d. Past Working Experience (Previous and Present) 1. Date join :

Date left :

Employer :

Location : Industry : Designation :

Salary :

Reason for leaving 2 Date join :

Date left : Employer :

Location : Industry : Designation :

Salary :

Reason for leaving 3. Date join :

Date left :

Employer :

Location : Industry : Designation :

Salary :

Reason for leaving 4. Date join :

Date left : Employer :

Location : Industry : Designation :

Salary :

Reason for leaving

e. Other Information

1. Have you ever been convicted in a court of law of any country? 2. Have you ever been dismissed, discharged or suspended from employment? 3. Are you suffering from handicaps, ailments, disease or is under long term med ication? 4. Have you ever been declared bankrupt? If your answer is Yes to any of the questions above, please provide details:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

*Yes / No *Yes / No *Yes / No *Yes / No

f. References (Previous and Current Employer) Name

Relationship

Address

Designation

Contact No.

Name

Relationship

Address

Designation

Contact No.

g. If Offered Employment: Notice Period Required Earliest Start Date (dd/mm/yy) Salary Expectation (monthly, MYR)

Declaration

I understand that,

This application will be read in conjunction with the information provided above . An application which is not fully completed will not be considered. If, after appointment, it is found that I have made a false declaration in this application, the Company reserves the right to summarily terminate my services.

Signature : _____________________________________

Date : _____________________________________