EMPLOYMENT APPLICATION FORM
PRIVATE & CONFIDENTIAL
POSITION APPLIED : _________________________________________________________
1. PERSONAL INFORMATION
Full Name :
NRIC/ Passport No: Date of Birth:
Address : Tel :
Nationality : [ ] Malaysian [ ] Others, please specify
Race : _________________________ Religion : __________________________
EPF No: SOCSO No: Income Tax No:
2. FAMILY INFORMATION
Name Relation Employer Occupation
No of children : Age of each children :
3. HEALTH
Do you have any serious illnesses we need to take note of?
[ ] No [ ] Yes (please state) ___________________
4. EDUCATION
Year
Education Level Name of Institution Course Name
Completed
5. OTHER TRAINING
Course Institution Qualifications Year
6. LANGUAGES
Please Tick for Slight / Fair / Fluent
Language
Speaking Reading Writing
7. EMPLOYMENT HISTORY
Current/Most Recent Employer First
Company
Position: From To:
Basic: Allowance:
Commission: Type of Allowance:
Bonus:
Other Fringe Benefits/Incentives:
Reason for Leaving
Company:
Position: From: To:
Last Remuneration Package:
Reason for Leaving:
Company:
Position: From: To:
Last Remuneration Package:
Reason for Leaving:
8. REFERRALS
Those acquainted with your work are preferred eg. present & past & immediate superiors)
Name Address Telephone No. Designation Place of Work
1.
2.
3.
9. RECOMMENDATION
Relatives / friends in Company or its subsidiary
Name Relationship
Have you ever been convicted of a criminal offence ?
[ ] No
[ ] Yes (state nature)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Remuneration Expected : ________________________ Earliest available date : _____________________________
I declare that the information provided above is true and complete in all aspects. I understand that any misrepresentation
or omission of information may be considered sufficient for withdrawal of an offer or subsequent dismissal from
employment.
__________________________________ ________________________________
Signature Date