FRM-HRA-002 Rev 0

Rohrback Cosasco Systems Sdn Bhd 21, Jalan Astaka U8/84 Bukit Jelutong Business & Technology Centre 40150 Shah Alam Selangor Malaysia Employee No.

APPLICATION FOR EMPLOYMENT FORM

STRICTLY PRIVATE & CONFIDENTIAL
Instructions 1. This application form must be completed by the applicant and return to the Human Resource Department. 2. All columns must be filled as detail as possible. If a column is not applicable, please indicate as not applicable (NA). 3. Only copies of certificates and testimonials need to be attached to this form. The original should be produced during the interview. 4. If space on this form is insufficient, please use separate sheet. 5. * Delete as appropriate. 6. Please attach a copy of your recent NR photograph.

Position Applied Applicants Full Name

DECLARATION BY APPLICANT 1. I understand that the statement made by me in this application form are true to the best of my knowledge and belief. If any of the statement is false or misleading, the Company may reject my application or dismiss my employment with the Company. 2. I understand that a medical examination is required as condition for employment and agree to be examined by a company-appointed doctor and to furnish the doctor with full details of my previous medical history. 3. I will, if employed by Foxboro (M) Sdn Bhd, accept all the terms and conditions of employment laid out by the Company.

PERSONAL PARTICULARS Full Name

1

Alias (if any)

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Address

Office Tel Local Tel Home Country Tel Citizenship

Address in Home Country ( for foreigner )

Marital Status Race

Religion Dialect

Sex Place Of Birth

Age Date of Birth

NRIC / Passport No. Account No

FAMILY PARTICULARS (Including parent, spouse, children, brothers & sisters) Name Relationship Age Occupation

SPOUSE EMPLOYMENT DETAILS ( For married applicant only ) Company Name: Position: Company Address:

Telephone: IN CASE OF EMERGENCY, particulars of person to contact: Name Tel Address Relationship

EDUCATION School / Institution

From

To
2

Highest Standard Obtained

For office use Meet Requirement Yes/No

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OTHER TRANING AND SKILLS ACQUIRED

Knowledge of Software Packages:

COURSE/TRAINING PROGRAM CURRENTLY UNDERTAKING

LANGUAGE / DIALECT

PROFESSIONAL MEMBERSHIP

HOBBIES, INTERESTS AND SPORTS

EMPLOYMENT HISTORY Employer Designation

From

To

Last Drawn Salary

Reason of Leaving

TOTAL YEARS OF EXPERIENCE

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Name of Last Employer : Cetco Oilfield Services Company

Designation : Base Technician

Basic Salary : RM 1300 Bonus : NA Allowances :NA

From :13 / JULY / 2012 Reasons for leaving NA To : Present Duties & Responsibilities : - Installation Water Treatment And Well Test Parts (Inverse Flow Vessel, Radial Flow Vessel, Weir Box, Retention Vessel, Desander- KOP, Choke Manifold, Sand Screening Box, Shut Down Valve) - Hydro Test - Service The Valve

PERSONAL REFERENCES References of previous superiors: Name Occupation Sofi Azliyuddin Zakaria Technical Supervisor Muhammad Aizat Ismail Asst. Safety Officer Suhaimi Tahir Base Supervisor

Company Talian Mega Sdn Bhd Kejuruteraan Samudera Timur Berhad Cetco Oilfield Services Company

Tel 012-962 6902 012-913 5711 019-906 5793

GENERAL INFORMATION Do you have any physical, impairment or serious illness? If yes give details. Have you ever been convicted in a court of Law in any country? If yes give details. Do you have any relatives or friends working with us? If yes, state name, relationship and designation. Mohd Azlisham Bin Mohd Yusof, Friend, Service Manager Have you ever applied to work with us before? Position applied: Service Technician If appointed, how soon can you start work? Immediately What is the minimum notice period required by your employer? 1 week What is your current salary? RM1300 What is your expected salary? RM 3000 YES / NO*

YES / NO*

YES / NO*

YES / NO*

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FOR OFFICE USE ONLY Comments ( if any ) Approved / Rejected

Signature / Date

Head Of Department Signature / Date

HUMAN RESOURCE DEPARTMENT

Terms Offered: Position / Grade:

Basic Salary: Transport Allowance: Other Allowance:

Group Human Resource Manager Signature / Date

GM/ED/MD APPROVAL

Comments ( If any ): Approved / Rejected

Signature / Date

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