PHOTO

EMPLOYMENT APPLICATION FORM

Instruction:
1. Please complete ALL questions using BLOCK LETTERS.
2. Tick (/) the relevant information.
3. Please attach the following items:
a) Photocopy of IC or passport
b) Original & photocopies of educational certificates

POSITION:

PERSONAL PARTICULARS

Name (According to NRIC/Passport)

NRIC / Passport No:

Old IC No:
Residential Address
STATUTORY INFORMATION

EPF No:

SOCSO No:

Date of Birth: Age: Income Tax No:

Gender: Male Female Nationality: EMERGENCY CONTACT

Contact Number: Email Address: Name:
Religion: Race: Contact Number:

Relationship:
Weight: kg Height: cm

Bank: Bank Account Number:

OTHERS

Marital Status: Number of Children: Driving License: Yes No

Single Married Divorced Class: A / B / C / D

DETAILS OF SPOUSE
Name:

NRIC No: Occupation:

Contact Number: Name & Address of Employers:

DETAILS OF CHILDREN

Name Age NRIC / MyKID No School / College

1)

2)
3)

4)

5)

EDUCATIONAL BACKGROUND
Year
School / College / University Qualification Obtained
From To

OTHER QUALIFICATION / TRAINING

Year
Course / Certification / Training Qualification Obtained
From To

IT PROFICIENCY

Programme / Software Beginner Intermediate Advanced

Microsoft Office - Words

Microsoft Office - Excel

Microsoft Office - Power Point

Others, please state:

EMPLOYMENT HISTORY

Last Drawn
From To Company Name Designation Reason of Leaving
Salary
 EMPLOYMENT REFERENCES
Contact No & Email Relationship & No. of Years
Name Occupation & Employer
Address in Contact

LANGUAGES

Written: Malay English Chinese Tamil Others:

Spoken: Malay English Chinese Tamil Others:

OTHER INFORMATION (Please circle at the appropriate answer)

Are you physically handicapped in anyway?

1. YES NO
If YES, please explain:
Are you or any of your family members (Father/Mother/Siblings/Spouse/Children) suffering from

any prolong illness such as colour blindness, cancer, polio, leprosy, kidney problems, heart
2. YES NO
attack or long terms medication i.e diabetes, chronic asthma, hypertension, or other conditions?

If YES, please explain:

Will you or any of your family members be due for any form of surgical procedure /
3. YES NO
operation within the next one (1) year?

4. Are you currently pregnant (female candidate only)? YES NO

5. Are you an abuser of narcotic drugs either in the past or currently? YES NO

Do you have any police records?

6. YES NO
If YES, please explain:

Have you ever been declared bankrupt or charged under the Bankruptcy Act?
7. YES NO
If YES, please explain:

Do you have a Trading or a Central Depository System (CDS) account?

8. If YES, please state the stock broking firm and status of the account.
Active YES NO

Dormant

Are you a member or an officer in any club, association, or political party?

9. YES NO
If YES, please explain:

Are you engaged in any part-time employment currently?

10. YES NO
If YES, please explain:
 Do you have any friend, family members or relatives working in this company?

If YES, please state her / his name and your relationship with her / him:
11. YES NO
Name:

Relationship:

Have you attended other job interview with our company before this?
12. YES NO
If YES, please state the position and interview date:
1313 Y

Have you completed a full vaccination?

If YES, please state your second dose date and type of vaccine:
Y

13. YES NO
Second dose date:
12

13

Type of vaccine:
14

Are you currently facing any financial difficulties? (Eg. high in debt, loss of employment and etc.)
14. YES NO
If YES, please explain:

AVAILABILITY

Period of Notice Required: Available Date: Expected Salary:

Willing To Travel: Yes No Possess Own Transport: Yes No

Willing To Relocate: Yes No Car Model:

DECLARATION

I, hereby declare that all particulars given are true and correct. I understand that I am liable to disciplinary action conducted
against me for falsifying or not declaring any of the above information required. Our company also reserves the right to dismiss
my services without prior notice or compensation.
I, further understand that my employment is contingent upon my satisfactory passing of the pre-employment medical
examination at the expense of the company.

Signature Date

FOR HUMAN RESOURCE USE

DOCUMENT CHECKLIST

1 Resume ( ) Original Documents Sighted By:

2 Latest 3 months payslip ( ) Name:

3 Photocopy of NRIC ( )

4 Photocopy of relevant certificates ( ) Signature:

5 Others: ( )