Application For Employment

APPLICATION FOR EMPLOYMENT
FULL TIME POSITION PART TIME POSITION

________________________________________________________________________________
Please fill up this form legibly. All details MUST be provided.
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1. POSITION APPLIED FOR:
Here
NAME OF FACUTY /DEPT/
COMPANY :
EXPECTED SALARY :
NOTICE PERIOD :
2. PERSONAL PARTICULARS
Full Name as per IC/Passport
Correspondence Address
Post Code Contact No.
Home Address
Post Code Contact No.
E-mail Address
Date of Birth Age Gender (Male/Female)
Citizenship Marital Status Malaysian (Yes/No)

(M=Married / S=Single / W=Widowed / D=Divorced)
Race Religion
(M=Malay / C=Chinese / I=Indian / O=Others) (I=Islam / B=Buddhism / H=Hinduism / C=Christianity /
O=Others / NA=Not Applicable)
IC No (New) Passport No.

(Old) (non-citizens only)
Effective date: 22/06/2010 Page 1 of 7 FORM/GHRO-01/06

UCSI GROUP
UCSI Education Sdn. Bhd. (185479-U) UCSI Food Technology Sdn. Bhd. (497978-U) UCSI Child Development Center Sdn. Bhd. (618913K)
UCSI University Kuala Lumpur Campus Laurent Bleu Sdn. Bhd. (807150-P) UCSI-Christienlavin Sdn. Bhd. (805397-M)
UCSI University Terengganu Campus UCSI Extension Sdn. Bhd. (533426-U) UCSI Blue Ocean Strategy
UCSI University Sarawak Campus Sekolah Sri Sedaya Sdn. Bhd. (174088W) Regional Centre Sdn. Bhd. (774433W)
UCSI Communications Sdn. Bhd. (574382V) UCSI Computech Sdn. Bhd. (760062X) UCSI Professional Academy Sdn. Bhd. (463226-T)
3. FAMILY PARTICULARS
Spouse’s Full Name

Citizenship
Occupation
Employer
Father’s Full Name
Occupation
Mother’s Full Name
Occupation
Please provide the following details of all your siblings.

Name of Employer
No Name Relationship Age Occupation
(if employed)
Please provide the following details of all your children.

No Name Age Form or Class Level / Occupation Name of School/Employer
4. ACADEMIC AND PROFESSIONAL QUALIFICATION
Certificate / Diploma / Twinning / Distant Year

Name Of School / College / CGPA / Grade
Degree / Professional Learning / Full Time Attained
University
Qualification Attained

UCSI GROUP
5. PROFESSIONAL MEMBERSHIP LICENCE
Please indicate professional body memberships / license

Name Of Professional Bodies Type of Membership / License Year attained
6. LANGUAGE PROFICIENCY
No Languages Written Spoken Reading
* 1- Fair 2- Average 3- Fluent
7. COMPUTER LITERACY
Please indicate types of programme / software application
No Programme Software Elementary Intermediate Advanced

1 MS Word
2 MS Excel
3 MS PowerPoint
4
5
6
7
8
9
10
11

UCSI GROUP
8. PRESENT EMPLOYMENT
Date Of Employment (For Company Use)
Company’s Name &

Address
Position Held
Starting Basic Salary
Current Basic Salary
Allowance / Incentive /
Commission payable, if any
Total Monthly Earnings

(inclusive of allowance)
9. PAST EMPLOYMENT
Dates Name Of Position Basic Salary Reason For
From To Employer Held Starting Last Drawn Leaving
10. EXTRA CURRICULAR ACTIVITIES
State participation in extracurricular activities, position of responsibility held, games played at school / university and hobbies
School/University Hobbies

UCSI GROUP
11. ACHIEVEMENTS
State participation in extracurricular activities, position of responsibility held, games played at school / university and hobbies
No Year Awards/Achievement
12. REFERENCES
Please list at least two (2) referees (preferably previous superiors)
Years
Name Relationship Occupation / Employer Contact No & Email
Known
Do you have any objections for us to contact your referees and/or former employers YES NO
should the need arise?
(Please state reason) ___________________________________________________________________________________
13. OTHER INFORMATION
Please state if you have a friend or relative working in UCSI Group? YES NO
(If yes, fill in the table below) ______________________________________________________________________________
Name Company Name & Location Department Position Relationship
Have you applied to any of the UCSI Group of Companies before? YES NO
(If yes, state position, date & name of company) ______________________________________________________________
Position Date Name of Company

UCSI GROUP
Have you been declared a bankrupt, charged in court and/or convicted YES NO
in any criminal court of law?
(If yes, please provide details) ____________________________________________________________________________
Are you currently being investigated for fraud / corruption / civil case YES NO
by the relevant authorities, ie MACC, police, etc?
(If yes, please provide details)
____________________________________________________________________________________________________
Do you have any cases with the Labour Office / Industrial Relations Office / Court? YES NO
(If yes, please provide details)
____________________________________________________________________________________________________
Have you ever been dismissed by your former employers? YES NO

(If yes, please provide details) ___________________________________________________________________________
Do you have a driving license? YES NO

(If yes, please list the driver’s license category. E.g. Class D)____________________________________________________
Do you possess a car/ transport? YES NO

(If yes, please state your car/ transport’s plate number)__________________________________________________________
14. MEDICAL AND PHYSICAL CONDITION
a. Have you suffered from or are you currently suffering from illness requiring YES NO
regular medication?
(If yes, please provide details) ________________________________________________________________________
b. Are you currently pregnant? YES NO

(If yes, please provide details) _________________________________________________________________________
(Female applicant only)
c. Are you suffering from any physical disabilities? YES NO

(If yes, please provide details) ________________________________________________________________________
I declare that the information given in this application is true and accurate. My employment may be based on receipt of
satisfactory information from former employers, schools and other references. Enclosed are copies of my education /
professional qualification certificate / diploma / degree and / recent pay slips/ or appropriate recommendation letters. If I
am selected / employed, I will report to the Group Human Resource Office the changes or additions taking place from time to
time. I understand that any misrepresentation of facts given herein (including any uninformed changes) will be sufficient cause
for denying employment or summary dismissal from the company’s services if I have been employed.
I authorize the company to conduct relevant background checks, without liability, in consideration of my application for
employment.
Any other information that you would like to disclose to support your application:
Date : ___________________________ Signature : __________________________

UCSI GROUP
15. FOR GROUP HUMAN RESOURCE USE ONLY
SOURCE OF REFERRAL : Newspaper Company’s Website Internet Other (please specify)

___________________
First Interview on: Interviewer :

Second Interview on: Interviewer :
Third Interview on: Interviewer :
Selection Committee Interview on: Chairman :
Status (based on Interview Evaluation Summary) : Hired Potential for Hiring Not Hired Keep on File
Position Offered : Basic Salary :
Housing
Name of Company / Dept / Branch : Allowance(s) :
Headship
Clinical
Specialist
Commencement Date : Total Salary
Recommended By : Approved By :
.........................……...........………..……………......... ..........................……...........…………………….……….....
(Signature) Head, Group Human Resource
Name :
Designation :
Date : Remarks : ...............................……………....................
Remarks : ................................…….......................
Final Disposition No Offer Made Accepted Offer Rejected Offer
16. EMPLOYMENT BENEFITS SUMMARY (for Letter of Appointment)
Grade
Annual Leave
Medical
Dentist

UCSI GROUP

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FULL TIME POSITION PART TIME POSITION

Full Name as per IC/Passport

Post Code Contact No.

Post Code Contact No.

Date of Birth Age Gender (Male/Female)

Citizenship Marital Status Malaysian (Yes/No)

IC No (New) Passport No.

Effective date: 22/06/2010 Page 1 of 7 FORM/GHRO-01/06

Spouse’s Full Name

Please provide the following details of all your siblings.

Please provide the following details of all your children.

4. ACADEMIC AND PROFESSIONAL QUALIFICATION

Certificate / Diploma / Twinning / Distant Year

Effective date: 22/06/2010 Page 2 of 7 FORM/GHRO-01/06

Please indicate professional body memberships / license

No Languages Written Spoken Reading

* 1- Fair 2- Average 3- Fluent

Please indicate types of programme / software application

No Programme Software Elementary Intermediate Advanced

Effective date: 22/06/2010 Page 3 of 7 FORM/GHRO-01/06

Date Of Employment (For Company Use)

Company’s Name &

Starting Basic Salary

Current Basic Salary

Total Monthly Earnings

Dates Name Of Position Basic Salary Reason For

From To Employer Held Starting Last Drawn Leaving

10. EXTRA CURRICULAR ACTIVITIES

Effective date: 22/06/2010 Page 4 of 7 FORM/GHRO-01/06

Please list at least two (2) referees (preferably previous superiors)

13. OTHER INFORMATION

Name Company Name & Location Department Position Relationship

Position Date Name of Company

Effective date: 22/06/2010 Page 5 of 7 FORM/GHRO-01/06

Have you ever been dismissed by your former employers? YES NO

Do you have a driving license? YES NO

Do you possess a car/ transport? YES NO

14. MEDICAL AND PHYSICAL CONDITION

b. Are you currently pregnant? YES NO

c. Are you suffering from any physical disabilities? YES NO

Date : ___________________________ Signature : __________________________

Effective date: 22/06/2010 Page 6 of 7 FORM/GHRO-01/06

SOURCE OF REFERRAL : Newspaper Company’s Website Internet Other (please specify)

First Interview on: Interviewer :

Selection Committee Interview on: Chairman :

Position Offered : Basic Salary :

Commencement Date : Total Salary

Final Disposition No Offer Made Accepted Offer Rejected Offer

16. EMPLOYMENT BENEFITS SUMMARY (for Letter of Appointment)

Effective date: 22/06/2010 Page 7 of 7 FORM/GHRO-01/06

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Date : _ Signature :