For HR only:

EMPLOYMENT APPLICATION FORM Hire:

Position Applied For : Agency:

Personal Details

Full Name Date of Birth

Gender Age

Present Salary NRIC No

Notice Period Medical History

(e.g.asthma, cancer,
Marital Status sinus, pregnant,etc)

Citizenship Mode of transport

Present Address
Contact Telephone
Emergency Contact Tel. Expected Salary

Education
Schools/Universities Attended Year Qualification

Employment History (Most recent job first, please)

Date of Employment
Name of Employer Position Held
From To

Employment History with VADS Contact Center / BPO

Date of Employment Project Position Held Reason of Leaving
From To

Language Proficiency Written Language Spoken Language

(Pls tick) Poor Fair Good Poor Fair Good
Bahasa Malaysia
English
Others (indicate dialect)

REFEREES :Please provide name and telephone number of one previous employer or one private referee who can be contacted by us.

Name of Referee Relationship (Pls Indicate Employer or Friend) Contact Number

I certify that the above information is, to the best of my knowledge, correct. I understand that I am liable for dismissal if it is found that I have
obtained employment by falsely representing the facts.
Signature Date
COMPETITIVE ADVANTAGE

Commitment
( Pls tick )

Punctuality Yes No I am able to come to work on time and will adhere to break time management

I am able to attend training for 3 weeks without taking leave in order to graduate
Training Yes No
from training and hit the operations floor

Service Yes No If I am offered the job, I will be part of the Contact Centre for at least one year
unless I breach the contract of service

Emergency Yes No I am aware that I work on shift and Emergency Leave is not an entitlement. I will
ensure I call my Team Leader to inform my whereabouts on the day I am
rostererd to work

Personal Declaration
( Pls tick )
Yes No Have you ever been convicted in a court of law or are you involved in any legal dispute

Have you ever been dismissed, or asked to resign, or subjected to disciplinary action of any
Yes No kind while in the service of any organization

Yes No Are you a bankrupt or a discharged bankrupt?

Yes No Do you take alcohol / drugs? If yes, to what extend?__________________________

Study

1. Are you currently study? YES / NO If yes : PART TIME / FULL TIME Target completion date: ____________

2. Any plan to continue study? YES / NO If yes, when? ___________________ ; Part Time or Full Time? _____________

I T Advantage (Optional)

( Pls tick )
( If Yes, please complete the blanks )
Streamyx Yes No I am a TMNet Streamyx user. The account is registered under the name of
__________________________. Login I/d : _________________ Date of
registration: _________________ Outstanding bill amount :
RM_____________________

I am a TMNet Dial-up (1515) user. The account is registered under the name of
Dial-up Yes No
__________________________. Login I/d : _________________ Date of
registration: _________________ Outstanding bill amount :
RM_____________________

Certificate (Word) Yes No I have attended and received a certificate of attendance for Microsoft Word

Certificate (Excel) Yes No I have attended and received a certificate of attendance for Microsoft Excel

Type of Operating System used:

Signature : I certify that the above information provided is valid & correct

HR Use only:
Name of Team Leader & HR :

Reasons for hire/rejection

Knowledge :
Personality :
Commitment :
Others
 PERSONAL DATA DECLARAT

I understand and voluntarily consent to the collection and processing of my

physical or mental health information, political opinions, religious beliefs, a
offenses – provided by myself in the application, or obtained through referen
Group (“CXL”).

I authorize CXL or any party as appointed by CXL to showcase my profile,

consent to CXL transferring my relevant data to CXL offices or to any proje

I understand that under the 2010 Personal Data Protection Act, if, at any
consent to it being processed, or correct any error found within this data, tha

I acknowledge and accept the above terms and condition.

Name:

NRIC:
Signature:

Date:
TA DECLARATION

and processing of my personal data – potentially including sensitive personal data su

ons, religious beliefs, and/ or information relating to the commission or alleged comm
btained through reference or background checks, for the purpose of employment with

o showcase my profile, based on my personal data submitted, to the client(s) of CXL. I

L offices or to any projects under CX account.

ection Act, if, at any time, I wish to access my personal data held by CXL, withd
nd within this data, that I may do so in writing directly to CXL.

ion.
ersonal data such as
alleged commission of
ployment with CXL

nt(s) of CXL. I further

by CXL, withdraw my
 COVID-19 DECLARATION FOR

NAME:

NRIC:

PHONE NUMBER:

CURRENT ADDRESS:

1. Have you had any of the symptoms below in the last 14-days?

SYMPTOMS

i- Fever

ii- Cough
iii- Running nose

iv- Sore throat

v- Difficulty breathing

vi- Diarrhea

2. Have you been in close contact with anyone suspected or have been tested positive

YesNo:

If yes, please indicate when:

3. Travel history in the year 2020 or 2021:

Country:

Date:

**DECLARATION: I herby certify that the above iformation is true and complete. I u
to dismissal and actions subject to Section 22(c) and (d) of Prevention and Control of
Date
LARATION FORM
 have been tested positive for Covid-19?

on is true and complete. I understant any failure to answer to any false information provided by m
Prevention and Control of Infectious Disease Act 1988 (Act 342).
Signature
YES/NO
on provided by me can lead
 EMPLOYEES IMMEDIATE FAMILY D
 
NAME

*Note : Immediate family refers to the following – parent, spouse, parents in law, grandparents, children & siblings
Please write in CAPITAL letters

NO NAME (AS PER NRIC) AGE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

** Please note that application for emergency leave (EL) due to death of immediate family members must come with death certificate. Failure to
Staff are not allowed to apply for EL due to death of non-immediate family members.
EDIATE FAMILY DATA

NRIC OR BIRTH CERT (FOR CHILDREN

RELATIONSHIP
BELOW 12 YEARS OLD)

come with death certificate. Failure to do so will result in stern disciplinary action be taken against you including termination of service for any fraud application.
 TEL NO.

you including termination of service for any fraud application.

Pre Employment Health Declaration Form

WORK RELATED HEALTH HISTORY

a. Have you ever left, or been denied a job on health grounds? YES NO

HEALTH RELATED HISTORY

Do you have or have you had in the past:

a. Conditions of the heart?

YES NO
High blood pressure? Heart attacks? Angina?
b. Migraine or persistent headaches? YES NO
c. Eye conditions?
YES NO
Restricted vision? Glaucoma? Iritis? Any other condition?
d. Ear conditions?
YES NO
Restricted hearing? Tinnitus? Ear infections?
e. Alcohol or drug problems?
YES NO
Problems related to alcohol or drug usage or dependency?
f. Mental illness and/or stress related problems?
Nervous breakdown? Mental fatigue? Anxiety? Depression? Panic attacks? YES NO
Significant sleep disturbance? Stress related problems? Eating disorders? Self harm?
Any other conditions?

g. Have you consulted a specialist or needed any operations other than already
YES NO
stated?

h. Have you spent any time in hospital other than already stated? YES NO

i. Are you receiving medical treatment at the present time? YES NO

j. Do you take any regular medication? YES NO

k. Have you any other health issues that have not been mentioned above or
YES NO
about which you would like to provide further details?

L. Are you pregnant ? if yes, how many months ? YES NO

DECLARATION – To be completed by applicant
I declare that all the above declaration is accurate and to my best knowledge. If I’m found providing false info, the co
has the right to terminate my employment.

Name (BLOCK CAPITALS):

Signature: Date:

Last update : 3rd Dec 07

If YES, give details and
dates

If YES, give details and

dates
providing false info, the company