TOP GLOVE SDN BHD (Company No.

220483)
GOOD HEALTH, SAFETY FIRST & BE HONEST
Affix Photo
A member of Top Glove Corporation Bhd, Public Listed Company on Bursa Malaysia & Singapore Exchange. Here
Head Office : Lot 4969, Jalan Teratai, Batu 6, Off Jalan Meru, 41050 Klang, Selangor D. E., Malaysia
(Factory 9) Tel: 603-3392 1992 / 1905 Fax: 603-3392 8410 / 1291
Email : [email protected] Website: www. topglove.com.my

EMPLOYMENT APPLICATION FORM

FOR OFFICE USE ONLY
POSITION APPLIED: Internship

1. NAME AND ADDRESS Associate

Source *: _________________________

a) Full Name : Muhammad Hadi Ihsan Bin Mohamad Rosli Badge No.:

b) Other Name: None c) Name in Chinese : None Factory :

d) Address: Lot 8594 Desa Seri Iskandar, Jalan Kati, e) Home Tel. No. : +605-7762232
33600, Enggor, Perak. f) Office Tel. No. : None
g) Email Address: muhammad.mohamadrosli@student h) Handphone No. : +44 7565004273
.manchester.ac.uk
2. PERSONAL DETAILS

a) Gender: Male b) Age: 23 c) Date of Birth: 6 May 1996

d) Place of Birth: Kuala Kangsar, Perak e) Nationality : Malaysian
f) Race: Malay g) Religion : Islam
h) NRIC No.: 960506-08-6285 (New) i) EPF No. : None
(Old)

j) Working Permit (If any): None k) Socso No. : None

l) Marital Status: Single m) Driving License ✔ D ✔ B2 Others:

n) Income Tax No. : None o) Height: 168cm p) Weight: 63kg

q) Have you been charged or convicted for any criminal, if yes, please state the case No

3. FAMILY DETAILS

a) Name of Spouse: None Occupation : None

b) No. of Children : None Son: None Daughter : None
c) i. No. of Children Currently in School : None

ii. No. of Children Currently Working : None

d) Name of Father : Mohamad Rosli Bin Mohd Hussin Occupation : Retiree

e) Name of Mother: Zaiton Zabidah Binti Ayob Kamaruddin Occupation : Retiree
f) Father’s Address: Lot 8594 Desa Seri Iskandar, Jalan Kati, 33600, Enggor, Perak
g) Contact Person (In Case of Emergency) : Azraie Handphone No. : +6016-2216004

4. LANGUAGE ABILITY
Speaking Writing
Language
Moderate Good Excellent Moderate Good Excellent

1. Malay ✔ ✔
2. English ✔ ✔
3. Arabic ✔ ✔
4.

*State how you know about this vacancy.

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5. HEALTH

a) Health Status : Healthy b) Any Disability : None

c) Do you smoke (including vape and/or any other form)?

Previous Present

Yes No ✔ Yes No ✔
d) If previously you were a smoker when did you stop this habit? No
e) Are you currently pregnant? Yes No ✔

6. EDUCATION DETAILS

Highest Certification Grade /

Education Details Name From To Majoring
Obtained CGPA
1. SM Sains Teluk Intan 2009 2013 SPM 9A
School 2.
3.
1.Kolej Teknologi Timur 2014 2016 A-Level 2A 1B
College or
2.University of 2016 2020 Degree 56 %
University Manchester (UoM)
3.

Additional 1.
Professional 2.
Qualification
3.
(Attended or
currently pursuing) 4.
1.
Membership of 2.
Professional Body
3.

7. STATE ANY AWARDS OR ACHIEVEMENTS RECEIVED AT SCHOOL, COLLEGE, ETC.

Half Colours Award (SBP) 2013

Bronze Awards in Volunteering (Manchester Leadership Program)

8. ACTIVITIES
a) Games/Sports/Hobbies:
In School In College/University Current Activities
1) Hockey 1) Hockey 2) Football
2) Athletics 2) Football

b) State the post you held at School/College/University

House Leader & Prefect, SM Sains Teluk Intan (2013)

Head of Logistics, Manchester Intellectual Debate (2017/2018)

c) State if you are a Member in Society, Club and Post Held

Active member of Manchester University Law Society (MULS) Hockey 2018/2019

Committee of Manchester Intellectual Debate 2017/2018
Active member of Witworth Park Hockey Society 2017/2018

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9. PREVIOUS EMPLOYMENT (Beginning with the most recent)

Employer / City Designation Date Start / End Salary Reason for Leaving
a)
b)
c)
d)
e)
f)
g)

10. PRESENT EMPLOYMENT

a) Employer:

b) Address:

c) Date Joined:

d) Designation:

e) Starting Salary:

f) Present Salary:

g) Yearly Bonus:

h) Fringe Benefits:

i) Reason(s) for leaving:

j) Expected Salary:

k) Notice Period / Earliest Joining Date:

11. IN WHAT AREAS THAT YOU THINK YOU CAN CONTRIBUTE MOST TO TOP GLOVE AND WHY
YOU SHALL BE OFFERED THIS JOB?
Engineering and safety. Because I want to apply the knowledge that I have learnt during my time in the

university. Plus,I believe that I have the capabilities to do the internship here since I’m hardworking and

fast learner kind of person.

REFERENCE (IN RELATION TO WORK PERFORMANCE - PREFERABLY EX-SUPERIOR)

Name : Mr Simon Perry (Academic Advisor) Name : Mr Roger Morton

Occupation : Senior Lecturer Occupation : Engineer
Address : Room B5, The Mill, Address :
University of Manchester
Tel. No. : [email protected] Tel. No. : [email protected]

Relationship : Academic Advisor Relationship : Design Project Supervisor

Can we contact the listed referee for reference purposes? ✔ Yes No

I hereby declare that I am above 18 years old and all information provided is valid and true. I also consent and authorise all my
personal data stated in this form, cover letter, resume / curriculum vitae and other related documents to be processed for the
purpose of recruitment, in accordance with the Personal Data Protection Act 2010.
Saya dengan ini mengakui bahawa saya telah mencapai umur 18 tahun & keatas dan mengesahkan bahawa segala maklumat yang
diberikan diatas adalah benar. Saya juga membenarkan semua data peribadi saya yang dinyatakan didalam borang permohonan ini
bersama surat lampiran dan resume/ kurikulum vitae untuk diproses bagi tujuan pengambilan kerja adalah mengikut Akta
Perlindungan Data Peribadi 2010.

Name : Muhammad Hadi Ihsan Signature : Date : 25th June 2019

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