APPLICATION FORM

Date:

Personal Photograph

Position applied : ..................................................................................................

Other position to be considered : ..................................................................................................
Salary Expectation : ..................................................................................................
Date Available to start : ..................................................................................................

PERSONAL DETAIL
Full Name :
Date of Birth : Place of Birth :

Address :
City : Post Code :
State :
Telephone (Residence) :
(Office) :
(Mobile) :
I.D Card Number : Date of Expiry :
Driving License : Nationality :

Marital Status : Religion :

Height / Weight : Blood Group :

EDUCATION AND TRAINING

Name of School, University or other Years Major Course or Study
Training Institution (From – To)
RECORD OF PREVIOUS EMPLOYMENT

1. Company Name : ________________________________________________________________________

Address : _______________________________________________________________________________
Position : ______________________________ Period From : ___________ To : ______________________
Telephone : _____________________________________________________________________________
Nature of Business : _____________________ Supervisor’s Name : ________________________________
Duties : ________________________________________________________________________________
_______________________________________________________________________________________
Last Salary : _____________________________________________________________________________
Reason for leaving :

2. Company Name : ________________________________________________________________________

Address : _______________________________________________________________________________
Position : ______________________________ Period From : ___________ To : ______________________
Telephone : _____________________________________________________________________________
Nature of Business : _____________________ Supervisor’s Name : ________________________________
Duties : ________________________________________________________________________________
_______________________________________________________________________________________
Last Salary : _____________________________________________________________________________
Reason for leaving :

3. Company Name : ________________________________________________________________________

Address : _______________________________________________________________________________
Position : ______________________________ Period From : ___________ To : ______________________
Telephone : _____________________________________________________________________________
Nature of Business : _____________________ Supervisor’s Name : ________________________________
Duties : ________________________________________________________________________________
_______________________________________________________________________________________
Last Salary : _____________________________________________________________________________
Reason for leaving :

4. Company Name : ________________________________________________________________________

Address : _______________________________________________________________________________
Position : ______________________________ Period From : ___________ To : ______________________
Telephone : _____________________________________________________________________________
Nature of Business : _____________________ Supervisor’s Name : ________________________________
Duties : ________________________________________________________________________________
_______________________________________________________________________________________
Last Salary : _____________________________________________________________________________
Reason for leaving :
REFERENCES (Non – Relatives)

1. Name : Telephone Number :

Occupation : Years known :
Address :

2. Name : Telephone Number :

Occupation : Years known :
Address :

3. Name : Telephone Number :

Occupation : Years known :
Address :

LANGUAGE PROFICIENCY
Language Skill (Language Spoken)
Language Speaking Reading Writing

English Poor Good Excellent Poor Good Excellent Poor Good Excellent

Mandarin Poor Good Excellent Poor Good Excellent Poor Good Excellent

Others Poor Good Excellent Poor Good Excellent Poor Good Excellent
________

FAMILY RECORD

Father’s Name : ______________________ Age : __________ Occupation : ___________________

Mother’s Name : ______________________ Age : __________ Occupation : ___________________
Permanent Address :
City : ________________________________ State : ________________________________________
Telephone : ___________________________
Partner’s Name : ___________________ Birth of Date : __________ Occupation : ______________
Children :
1. Name : _______________________ Birth of Date : __________ Male / Female
2. Name : _______________________ Birth of Date : __________ Male / Female
3. Name : _______________________ Birth of Date : __________ Male / Female
GENERAL INFORMATION

Are you presently employed ? Yes No

Have you ever been discharged from employment ? If yes, Please explain

Have you any objection to our contacting your previous employers ? Yes No
Have you had any serious illnesses, injuries or operations within the last (5) years? If so, please describe

Have you ever suffered from any of the following illnesses?

Tuberculosis Yes ___ No ___ Heart Disease Yes ___ No
___
Hypertension Yes ___ No ___ Diabetes Yes ___ No ___
Venereal Disease Yes ___ No ___ Epilepsy Yes ___ No
___
Hepatitis Yes ___ No ___ HIV / AIDS Virus Yes ___ No
___

Do you have any immediate family members, i.e. husband, wife, parents, child, brother, sister, working
within the company ? Yes No
If yes, who ?

DECLARATION
I certify that all statements made on this application are true and complete to the best of my
knowledge. I understand that misrepresentation or omission when discovered, will subject me to
discharge and I hereby authorize any investigation relating to my work experience, education or
reputation for the purpose of my application for employment.

Applicant’s Signature ________________________ Date __________________________________