Human Resources

Employment Application Form

Swinburne Sarawak collects personal data that is necessary for recruitment related activities, leading to employment offer to be made for selected
candidates.

Personal data that you provide to the University may be processed, used and disclosed for purposes that the University considers necessary for
administration of the recruitment, selection and hiring process.

The University is committed to ensuring that the privacy of employee records and personal data is protected and consistent with the Personal Data
Protection Act (PDPA) 2010.

CHECK LIST
Please ensure that the following documents are enclosed or have been submitted
☐ Attached passport-sized photograph
☐ Copy of academic certificates and transcripts
☐ Copy of most recent salary slip
☐ Copy of COVID-19 vaccination certificate/card (including any latest
booster shot taken)
☐ A write-up addressing the Key Selection Criteria stated in the Position
Description
(for Academic Positions and Administration Positions at Assistant Manager level
or above)

POSITION APPLIED FOR Click here to enter text.

How did you find out about our vacancy?

☐ Direct mailing to the University ☐ Word of mouth or informed by family / relative / friend
☐ Careers@Swinburne webpage ☐ Newspaper advertisement
Job portal (e.g. LinkedIn, Indeed, etc.)
☐ (please specify): Click here to enter text. ☐ Others (please specify): Click here to enter text.

All fields are mandatory to be completed as required – for each applicable section.

SECTION 1: PERSONAL DETAILS

Full Name
Click here to enter text. Salutation
(as per MyKad or Passport and
(i.e. Prof., Assoc. Prof., Dr., Mr., Ms.)
Click here to enter text.
please underline surname)

Gender ☐ Female ☐ Male Date of Birth Click here to enter a date.

Marital Status ☐ Single ☐ Married ☐ Widowed ☐ Divorced

State of Origin other than
Nationality Click here to enter text. Sarawak Click here to enter text.
(Malaysian only)
Current / Correspondent Click here to enter text. Mobile Telephone Number
address: Click here to enter text.

Home Telephone Number Click here to enter text.

Personal e-mail address Click here to enter text.

COVID-19 Vaccination Status ☐ Completed full vaccination: Click here to enter text. (specify number of doses completed)
☐ Completed booster shot
Incomplete vaccination (Reason: Click here to enter text.)
☐
Not vaccinated (Reason: Click here to enter text.)
☐

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SECTION 2: ACADEMIC QUALIFICATION
Starting with the most recent, please give details of your education at or above degree level.
Start End
(Month/Year) (Month/Year)
Awarding Institution Qualification (full title)
Click here to Click here to
enter a date. enter a date. Click here to enter text. Click here to enter text.
Click here to Click here to
enter a date. enter a date. Click here to enter text. Click here to enter text.
Click here to Click here to
enter a date. enter a date. Click here to enter text. Click here to enter text.
Click here to Click here to
enter a date. enter a date. Click here to enter text. Click here to enter text.

SECTION 3: PROFESSIONAL MEMBERSHIP

Membership
Name of Professional Body Type of Membership Role / Position Held
From To (if applicable)
(Month/Year) (Month/Year)

Click here to enter text. Click here to Click here to

enter a date. enter a date. Click here to enter text. Click here to enter text.
Click here to enter text. Click here to Click here to
enter a date. enter a date. Click here to enter text. Click here to enter text.
Click here to enter text. Click here to Click here to
enter a date. enter a date. Click here to enter text. Click here to enter text.
Click here to enter text. Click here to Click here to
enter a date. enter a date. Click here to enter text. Click here to enter text.

SECTION 4: EMPLOYMENT HISTORY

List all prior work experience starting with the current or most recent employer.
Employment Period Current / Last
Employer’s Name and Address From To Role / Position Held Drawn Monthly Reason for Leaving
(Month/Year) (Month/Year) Salary

Click here to enter text. Click here to Click here to Click here to enter Click here to enter Click here to enter
enter a date. enter a date. text. text. text.
Click here to enter text. Click here to Click here to Click here to enter Click here to enter Click here to enter
enter a date. enter a date. text. text. text.
Click here to enter text. Click here to Click here to Click here to enter Click here to enter Click here to enter
enter a date. enter a date. text. text. text.
Click here to enter text. Click here to Click here to Click here to enter Click here to enter Click here to enter
enter a date. enter a date. text. text. text.

SECTION 5: ADDITIONAL INFORMATION

What is your expected monthly salary? (For full-time employment only) Click here to enter text.

If offered employment, the most convenient date to commence work is: Click here to enter a date.

Current notice period required: Click here to enter text.

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SECTION 6: PROFESSIONAL REFERENCES (For full-time employment only)

For the personal data you provide of your referees, please ensure that the other individual is informed about our Privacy Collection Notice and the terms of which
would also apply to such other individuals. Please also ensure that his or her consent has first been obtained before their personal data is disclosed to us for the
purpose set out in our Privacy Collection Notice.
1. ForAcademic applications, please provide either (i) two work supervisors or(ii) one work supervisorand one post-graduate studies supervisor
as your referees. All referees must have known you for at least 5 years who are not related to you in any way.
2. For non-academic applications, please provide two work supervisors* as your referees who are not related to you in any way.
NOTE: If work supervisors are not applicable (e.g if you are a fresh graduate), please provide academic referee(s) from your education institution or relevant
individual(s) who can provide work or character reference, but who are not related to you in any way.

REFEREE 1 REFEREE 2

Name: Click here to enter text. Name: Click here to enter text.

Position held: Click here to enter text. Position held: Click here to enter text.

Telephone number: Click here to enter text. Telephone number: Click here to enter text.

E-mail: Click here to enter text. E-mail: Click here to enter text.

Relationship to candidate: Click here to enter text. Relationship to candidate: Click here to enter text.

Years acquainted: Click here to enter text. Years acquainted: Click here to enter text.

May we contact this referee during the recruitment process prior to any May we contact this referee during the recruitment process prior to any
offer of employment made to you? offer of employment made to you?
YES ☐ NO ☐ YES ☐ NO ☐

SECTION 7: GENERAL INFORMATION YES NO

1. Has any disciplinary action been taken against you during your employment in any company? If
YES, please provide details: Click here to enter text. ☐ ☐
2. Have you ever been terminated / dismissed from employment due to any disciplinary action or misconduct? If
YES, please provide details: Click here to enter text. ☐ ☐
3. Have you ever been arrested and convicted in a court of law (criminal and civil case)? If
YES, please provide details: Click here to enter text. ☐ ☐
4. Do you have any disabilities (physical, mental or emotional)? If
YES, please provide details: Click here to enter text. ☐ ☐
5. May enquiry be made from your current employer regarding your work performance and employment verification?
If NO, please state your reasons: Click here to enter text. ☐ ☐
6. May enquiry be made from your past employer(s) regarding your work performance and employment verification?
If NO, please state your reasons: Click here to enter text.
☐ ☐
7. May enquiry be made for conducting background checks (e.g academic qualification, criminal history if any)
pertaining to your job application?
If NO, please state your reasons: Click here to enter text. ☐ ☐
8. Are you willing to work overtime?
If NO, please state your reasons: Click here to enter text.
9. Have you previously applied for work at Swinburne Sarawak? ☐ ☐
If YES, please state the position and date: Click here to enter text.
☐ ☐
10. Do you have any relatives working in Swinburne Sarawak?
If YES, provide details: Click here to enter text. ☐ ☐

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SECTION 8: DATA CONSENT & DECLARATION

I understand and consent to the processing of my personal data provided including sensitive personal data – including the collection, use,
disclosure, accessing and retention of the data for recruitment purposes within the University’s Privacy Collection Notice at which is accessible on
our University homepage.
I confirm that the information I have given in this form and any supporting documents is correct. I understand that false or misleading information
can result in refusal of employment or be sufficient cause for disciplinary action which includes dismissal after commencement of employment. I
understand that if I am offered employment and accept the offer of employment, this employment application form becomes part of my
employment records.
I understand that the University may check all or any of the information provided as part of my application or given in references. I hereby
authorize Swinburne Sarawak a thorough investigation of my employment history, educational background, criminal and credit check where
applicable to a position. I agree to cooperate in such an investigation, to execute any consent forms required in connection with those
investigations, and release from all liability and responsibility all persons or entities requesting or supplying such information. I understand that
employment is conditional based on investigation results.

Date: Click here to enter a date. (signature) Click here to enter text.

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