Position Applied for : ……………………………………………

Date & Time: ……………………………………………

Please tick & state how you know about this job opportunity.

 Job Portals :_______________________  Social Media:  Career Fair:

 Internal Referral, Staff Name:  Walk in:  Others:

APPLICATION FORM
SECTION A – PERSONAL PARTICULARS
Name (As per
NRIC/Passport)
Old NRIC/Passport
NRIC/Passport no.
no.
Date of Birth
Age (years)
(dd/mm/yy)
Place of Birth Nationality

Gender Race

Religion Marital Status

Current resident address:
Postcode: Province: Country:

Permanent address (Expatriate to provide home country address):

Postcode: Province: Country:

Email
Contact number
Address
Mode of travelling □ Train (LRT, MRT) □ Bus □ Car □ Motorcycle

SECTION B – FAMILY PARTICULARS

Spouse Name (As per
NRIC/Passport no.
NRIC/Passport)
 Yes
Is your Spouse working?
 No ( if yes please provide information below)
Company Name Company Contact no.

Position held
Different Please explain
Gender Date of Birth Cert/
Children Age abilities the different
(M/F) birth NRIC No.
(Y/N) abilities

If any of your children have different abilities, are they registered by Social Welfare Department
Y/N
(JKM)?

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SECTION C – CURRENT/PREVIOUS EMPLOYMENT DETAILS

Month/Year
Other variables
Company Position Held Reason for leaving Basic Salary
(Allowance, benefits etc)
From To

SECTION D – REFERENCES (Please provide two referees from your previous employment and they must be your
superior / supervisory level)
Years known each
No Name Company Name Relationship Contact Numbers
other

SECTION E – EDUCATION BACKGROUND (From highest to lowest)

Year
No Name of University/College/School Qualification Field of Study Grade/CGPA
From To

SECTION F – LANGUAGE PROFIENCY (Please tick where applicable)

Language 1: Language 2: Language 3: Language 4:
Language
Poor Fair Fluent Poor Fair Fluent Poor Fair Fluent Poor Fair Fluent

Speak

Read

Write

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SECTION G – WORK RELATED DECLARATION Yes/No Remarks

Do you have any friends/relatives working in Aegis BPO

1 Malaysia Sdn Bhd? If yes, please provide details (Name
& Department

Have you worked in Startek/Aegis Global? If yes, please

2
provide details

Have you been terminated from employment before? If

3
yes, provide details

Do you hold a directorship in any company? Does your

4 family has own business? Are you involve? If yes, please
provide details

Are you doing part time job after working hours or on

5
weekends? If yes, please provide details

a) Have you been declared BANKRUPTCY and/or

defaulted in any payment? If yes, please provide details

b) Have you ever convicted for any CRIMINAL

6
OFFENSES? If yes, please provide details

c) Do you have any FINANCIAL ISSUES with any

financial institution? (PTPTN, MBSB etc…) If yes,
please provide details

SECTION H – HEATH RELATED DECLARATION Yes/No Please give details

Do you have any health related issues? (Alcohol, drugs

1
etc) If yes, please provide details

Do you have Mental illness and/or stress related

2 problems? (Anxiety, Depression etc) If yes, please
provide details

Have you consulted a specialist or needed any operations

3
other than already stated? If yes, please provide details

Are you receiving medical treatment at the present time?

4
If yes, please provide details

6 Are you pregnant? If yes, please provide details

Have you take sick leave within the last 1 year of your
7
employment? If yes, please provide details

Have you been hospitalized within the last 2 years? If yes,

8
please provide details

Do you have any follow up medical checkup? If yes,

9
please provide details

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SECTION I – BACKGROUND SCREENING
Yes/No Please give details
QUESTIONS
Have you applied for any other jobs? If yes, please
1
provide details
Have you attended any interviews in the last 1
2
month? If yes, please provide details
Do you have any of your family members admitted
3 in hospital or they are very ill? If yes, please
provide details
Are you planning to further your studies/ get
4 married near future (within 1 year)? If yes, please
provide details
Do you have any pre planned leave? If yes, please
5
provide details

SECTION J – JOB EXPECTATIONS

Expected Basic Salary Allowance/Other Benefits
Preferred Job Type(s) Able to travel/relocate Yes / No
Earliest availability to join Startek
Notice to current employer (duration)
(dd/mm/yy)
Able to work on weekends & public
Ability to work on Rotation Shift Yes / No Yes / No
holidays

DECLARATION
I hereby acknowledge that:-
1. Consent is given to the Company or its duly appointed agent to collect, record, store, use and process “Personal Data”, as defined by the Personal Data Protection Act 2010
(“PDPA”), concerning and relating to myself, including any sensitive personal data, for the purposes of processing this employment application for the Company’s consideration,
and if successful, would form part of the employment records with the Company (“Purpose”).
2. Such Personal Data may include, but is not limited to the following:-
a. Information provided via forms required by the Company
b. Information from any pre-employment checks, such as medical, bankruptcy, credit and criminal checks deemed necessary by the Company in relation to the Purpose
c. Information regarding any family members, referees and/or any such other person(s) deemed necessary by the Company in relation to the Purpose
d. Records of any correspondence and/or communication with representatives of the Company
3. All Personal Data provided is accurate, complete, not misleading and up-to-date and Personal Data of third parties provided is given with the prior consent from the relevant
parties, failing which I indemnify the Company against any claims.
4. Consent is given to the Company to disclose any such Personal Data to any third party including the Company’s duly appointed agent, relevant authorities, subsidiaries, insurers,
hospitals, clinics and/or any such person(s) as deemed necessary by the Company in relation to the Purpose.

I hereby declare that the information given by me in this form is correct and true to the best of my knowledge. I fully understand and accept that if at any time after employment
engagement with the Company, it is found that false declarations have been made in this form, the Company has absolute right to terminate my employment forthwith. I agree to
inform Human Resource Department (HR) if there is any change to the current information provided by me in this form.

Signature of applicant:
NRIC number:
Name of applicant:
Date:

Employee onboarding Information

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 NEXT OF KIN (To be contacted in case of emergency) – Please ensure you provide 2 names
No Name Relationship Contact No.
1
2

NAME OF BENEFICIARIES (For insurance purpose)

No Name Relationship NRIC / Passport No. %
1
2

Mandatory Information for salary credit and Statutory Contribution.

EPF No. Income Tax No.
Bank Name* Bank Account No.*

*Please share your latest bank statement for evidence of the above.

I hereby declare that the information given by me in this form is correct and true to the best of my knowledge. I fully understand
and accept that if at any time after employment engagement with the Company, it is found that false declarations have been made
in this form, the Company has absolute right to terminate my employment forthwith. I agree to inform Human Resource
Department (HR) if there is any change to the current information provided by me in this form.

Name of Applicant: Signature of Applicant:

NRIC: Date:

INTRODUCE YOUR FRIENDS TO US!!!

Name  
EE ID
Contact No.  

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No Friend Name Contact No Email
1      
2      
3      
4      
5      

CONSENT FOR REFERRALS - PERSONAL DATA PROTECTION ACT 2010

The above matter refers.

I have provided Startek (formerly known as Aegis BPO Malaysia Sdn. Bhd.) with names and
contact details (“Personal Data”) of potential candidates, for employment purposes with
Startek.
I hereby represent, warrant and covenant that I am authorised to disclose all Personal Data
that I have provided to Startek and I have obtained all consents, permits, authorizations and
notice necessary from these potential candidates to permit such disclosure and transfer to
Startek and use there of by Startek as required by the Personal Data Protection Act (“PDPA”)
2010, for the purposes abovementioned.
All the Personal Data acquired by Startek from me shall only be used for the purposes of
hiring new employees (Employee Referral Program).
I hereby fully indemnify Startek for any breach of the PDPA 2010 legislation on my part
which may render Startek liable for any costs, claims or expenses, howsoever arising.

I hereby declare that the information given by me in this form is correct and true to the best
of my knowledge. I fully understand and accept that if at any time after employment
engagement with the Company, it is found that false declarations have been made in this
form, the Company has absolute right to terminate my employment forthwith.

Name of Applicant: Signature of Applicant:

 
NRIC: Date:  
   

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