HRA-H-850-001-QR02 Job Application Form
No. 45, 45-1, & 45-2, Jalan USJ 21/10
USJ 21, 47640 Subang Jaya, Selangor . Tel: 03-8081 6150
E-mail:
[email protected] EMPLOYMENT APPLICATION FORM Attach
Photograph
Position Applied For :
PERSONAL INFORMATION
Full Name :
Address :
I/C No : Nationality :
Age : years old Race :
Mobile Phone No : Religion :
EPF No : SOCSO No :
Income Tax No : E-mail Address :
Marital Status : Single Married Divorced
Gender : Male Female
Driving License : Yes No Class :
SKILLS AND LANGUAGE PROFICIENCY
Language Spoken Good Fair Bad Language Writing Good Fair Bad
Skills Acquired (please specify)
EDUCATION BACKGROUND
Year
University/College/School Course Result / CGPA
From To
OTHER COURSES / TRAINING ATTENDED
Year
Course / Training Attended Organized by
From To
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HRA-H-850-001-QR02 Job Application Form
CURRENT EMPLOYMENT
Name of Company :
Nature of Business : From : to :
Position Held : Department :
Duties Performed :
Reason of Leaving : Salary :
EMPLOYMENT HISTORY (1)
Name of Company :
Nature of Business : From : to :
Position Held : Department :
Duties Performed :
Reason of Leaving : Salary :
EMPLOYMENT HISTORY (2)
Name of Company :
Nature of Business : From : to :
Position Held : Department :
Duties Performed :
Reason of Leaving : Salary :
EMPLOYMENT HISTORY (3)
Name of Company :
Nature of Business : From : to :
Position Held : Department :
Duties Performed :
Reason of Leaving : Salary :
FAMILY PARTICULARS
Name Age Occupation Relationship
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HRA-H-850-001-QR02 Job Application Form
EMERGENCY CONTACT (1)
Person Name Relationship
Mobile Phone No Office No
EMERGENCY CONTACT (2)
Person Name Relationship
Mobile Phone No Office No
EMPLOYMENT REFERRAL
Full Name 1) 2)
Company
Designation
Years Known
Office No
Mobile Phone No
Do you have any relationship, contact or recognize any person in this company? Yes No
If Yes, please specify: _________________________________
HEALTH DECLARATION
Question Yes No If yes, please specify
1. Are you at present suffering from any physical disability, disease,
serious illness, or have been afflicted with any previously?
2. Do you have any existing medical condition, physical impairment
or substance dependence?
3. Any major illness or accident?
4. Have you been medically examined including x-ray within the past 3 months?
Are you on long term medication?
5. For female application only: Are you pregnant at present time?
CRIMINAL RECORDS
Question Yes No If yes, please specify
1. Have you been convicted in a court of law or are there any pending cases
against you in Malaysia or overseas?
2. Are you currently under police investigations in Malaysia or overseas?
3. Are there any other legal proceedings currently taken against you?
FINANCIAL OBLIGATIONS AND EMBARRASSMENTS
Question Yes No If yes, please specify
1. Do you have any obligations to your present/past companies in terms of
bonds, study loans, or etc?
2. Have you broken any bond, left an employer without serving your period of
moral obligatory service or are currently serving any bond or moral obligatory
service? (e.g. bonds associated with scholarships or obligatory service related to
training awards or no-pay leave, etc)
3. Have you signed a promissory note or have any unsecured debts for which
the outstanding amount has not already been fully repaid? (This excludes
overdrafts approved by recognized banks, hire purchases agreements, sums
borrowed from insurance companies; co-operative societies or sums borrowed on
securty of land charged or mortgaged, and pawn shop payment).
4. Have you ever been declared a bankrupt?
5. Are you an undischarged bankrupt or in default under any agreement to
which you are a party or by which you may be bound and there is pending
litigation, arbitration or administrative proceedings, as the case may be, that
might materially affect your solvency?
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HRA-H-850-001-QR02 Job Application Form
OTHERS
1. Add here anything which you consider important and helpful to us in assessing your suitability position you have
applied for
2. Expected salary RM 3. Date can start work
THIS APPLICATION IS NOT COMPLETE UNTIL THE FOLLOWING HAS BEEN READ AND SIGNED :
I declare that all the information given by me in this application for employment and any additional documents attached
hereto are true to the best of my knowledge and that I have not wilfully suppressed any material fact. I accept that if any
of the information given by me in this application is in any way false or incorrect, my application may be rejected, any
offer of employment may be withdrawn or my employment with the Service may be terminated summarily or I may be
dismissed from the Service.
Signature,
Name: Date
I/C No.:
FOR OFFICE USE
Interviewer's Comments
Recommendation :
Employ as : Commencing Date :
Location : Basic Salary : Allowance :
Interviewer's Name : Department :
Signature : Date :
HR's Comments
Name : _________________________________________________________ Signature : Date :
COO's Comments
Name : HARITH ASYRAF BIN DATUK ASRI Signature : Date :
MD's Comments Approved Not Approved Salary : RM
Name : DATUK ASRI BIN ABU SHARI Signature : Date :
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