PLEASE TAKE NOTE :- REGENCY SPECIALIST HOSPITAL SDN BHD

SILA AMBIL PERHATIAN:- (Co. No. 767174-W)

Only shortlisted candidate will be called for No. 1 Jalan Suria, Bandar Seri Alam
interview. 81750 Masai. Johor
Hanya pemohon yang layak dan dipilih sahaja Tel: +607-3817700 Fax : +607-3887666
dipanggil untuk temuduga
Private & Confidential
INCOMPLETE FORMS WILL
NOT BE PROCESSED
BORANG YANG TIDAK LENGKAP
TIDAK AKAN DIPROSES
APPLICATION FOR EMPLOYMENT Affix
Photograph
Here
POSITION APPLIED FOR :

PERSONAL DETAILS / DATA PERIBADI

Full Name (as given in IC) Other Names (if any) Sex Date of Birth Age Place of Birth Nationality
Nama Penuh Name Lain Jantina Tarikh Lahir Umur Tempat Lahir Warganegara

Home Address / Alamat Rumah Present Address if different from home address
Alamat kini jika berlainan dari alamat rumah

House Tel : Handphone No: House Tel : Office Tel:

NRIC No : Race : Religion : Marital Status : Name of Spouse’s I/C No:
Married / Single / Spouse :
Widow

If you have a relative employed in RSH, please state : Next of Kin: Occupation of Spouse: Spouse’s Date of
birth :
Name : Name :

Department: Address :
No of Children :
Relationship : Relationship :

Tel No:

Please give details and dates of any serious illnesses/operations/allergies Please give details of any previous convictions (including traffic offences)

EPF NO: SOCSO NO: INCOME TAX NO :

Driving License No : Class :

Date Expired : Years of driving experience:

SECONDARY EDUCATION / PENDIDIKAN MENENGAH

Schools attended (name and type) Examination passed From To

FURTHER EDUCATION (including part-time) / PENDIDIKAN LANJUTAN (termasuk separuh masa)

University/College/Institute Attended Examination Passed From To

Computer Software Knowledge:

EMPLOYMENT HISTORY / PENGALAMAN KERJA

Date Salary
Name and address of employer Position Reason of Leaving
From To Start Finish

FAMILY BACKGROUND / LATAR BELAKANG KELUARGA

Please give details of members of your immediate family (i.e. Parents / Brothers / Sisters / Children )
Sila beri maklumat mengenai keluarga (seperti ibu, bapa, abang, kakak, adik, anak)

Name Relationship Occupation Name & address Employer

Nama Hubungan Pekerjaan Nama & alamat majikan

Remarks (if any)

TRAINING / LATIHAN
Apprenticeship, articles, management, technical, accountancy or date processing training, with dates and locations:

Professional qualifications : Date of Membership Date Qualified :

Written & Spoken languages / dialects – degree of proficiency

Details of any articles/papers/books published :

REMUNERATION / GAJI

State current salary and detail of fringe benefits :

State salary expected :

LEISURE ACTIVITIES / AKTIVITI MASA LAPANG

Hobbies, Sports, Interest Membership of Societies and Clubs and offices held :

PAST DISCIPLINARY ACTIONS / TINDAKAN DISIPLIN OLEH MAJIKAN LEPAS

Please use this space to state details of past warning letters/demotion/disciplinary actions (include reason) by past employers:

PRE EXISTING ILLNESS / MEDICAL CONDITION (PENYAKIT/KEADAAN KESIHATAN SEDIA ADA)

Please use this space to state your pre existing illness/medical conditions:

FURTHER INFORMATION / MAKLUMAT LANJUT

Please use this space to give any additional information in support of your application (e.g. aims, ambitions, special aptitudes) :
REFEREES / RUJUKAN

Please give name and address of 2 referees. We will not contact them without your prior consent.
1) Previous employer 2) Private Referee

APPLICATION / PERMOHONAN AVAILABILITY / TARIKH MULA KERJA

Date of previous application and position applied for with this Company When would you free to join this Company?
(Approximate date)

I CERTIFY THAT THE ABOVE INFORMATIONS TO THE BEST OF MY KNOWLEDGE CORRECT AND I AM AGREEABLE TO THE
COMPANY TAKING DISCIPLINARY ACTION AGAINST ME IF ANY INFORMATION IS FOUND TO BE FALSE IN DUE COURSE.

SAYA MENGESAHKAN BAHAWA SEMUA MAKLUMAT YANG DIBERIKAN DI ATAS ADALAH BENAR ATAS PENGETAHUAN SAYA
DAN SAYA SETUJU BAHAWA PIHAK SYARIKAT AKAN MENGAMBIL TINDAKAN DISIPLIN TERHADAP SAYA SEKIRANYA DIDAPATI
MAKLUMAT-MAKLUMAT YANG DINYATAKAN ADALAH PALSU.

Applicant’s Signature : ………………………… Date : …………………….

________________________________________________________________________________________________

FOR OFFICE USE ONLY

Interview Date : __________________________________________ Interviewed By : __________________________________________

Job Title : _______________________________________________ Job Grade : ______________________________________________

Commencing Salary : ______________________________________ Allowances (if any) : ______________________________________

Starting Date : ____________________________________________ Company : ______________________________________________

Section : _________________________________________________ Department : ____________________________________________

Reporting To : _______________________________________________________________________________________________________

Remarks (if any) : ____________________________________________________________________________________________________

____________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

Signature of Interviewer : ______________________________________________________________________________________________

APPROVAL : ______________________________________ Date : ___________________________________________