CS-F03

REV.0

CSL TECHNOLOGIES (M) SDN BHD

LRC TECH (M) SDN BHD

Application for Employment

Please read carefully and complete in PRINT or CAPITAL LETTER
Provide all information requested
Mr / Miss

Position Apply

Date of application

(Chinese name if any)

Residential Address

Home telephone
Work telephone
Mobile phone

Postcode
Nationality

City

State

NIRC #
Old

Marital
Status

No. Of
Children

New
Languages / Dialects Spoken

Date of Birth
(DD/MM/YY)

Income Tax File Ref #

Are you a smoker? (Yes / No)

Religion

EPF #

Do you have a driving license?

Sosco #

(Female applicant only) Are you currently pregnant? Pls state your confinement date, if any.

How were you referred to CSL Technologies (M) Sdn Bhd? (Circle One Only)
A

By your
college

Advertisement

Employment
Agency

By an employee. If so, pls give name:

Walkin

Other

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CS-F03
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CSL TECHNOLOGIES (M) SDN BHD

LRC TECH (M) SDN BHD

Application for Employment

Employment Record
Starting with present or the most recent, list all previous employers. Include self-employment and part-time jobs. If
more space is required, please continue on a separate sheet. You may attach a resume, but complete this application as
well.
Last or Present employer

Supervisor Name

Brief description of job duties

Phone #

Type of business
Base Salary

Dates worked
From

To

Reason for leaving

Last or Present employer

Supervisor Name

Brief description of job duties

Phone #

Type of business
Base Salary

Dates worked
From

To

Reason for leaving

Last or Present employer

Supervisor Name

Brief description of job duties

Phone #

Type of business
Base Salary

Dates worked
From

To

Reason for leaving

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CS-F03
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CSL TECHNOLOGIES (M) SDN BHD

LRC TECH (M) SDN BHD

Application for Employment

Educational History

School Name

Location
(City, State)

Major course or
subject

High school

Technical/trade (after high

school)

College (list all attended)

Other education/training

Page 3 of 6

Dates
attended
Fr
To

Graduated
Yes

No

Degree

CS-F03
REV.0

CSL TECHNOLOGIES (M) SDN BHD

LRC TECH (M) SDN BHD

Application for Employment

Outside Activities

Professional memberships, certificates, or licenses held

Past & present civic or cultural activities
Principal hobbies

Special Skills

Typing

yes
no

Words per minute:

Dictation

yes
no

Words per minute:

Computer skills
Hardware

Software

Please list other skills and/or equipment experience you have acquired

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CS-F03
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CSL TECHNOLOGIES (M) SDN BHD

LRC TECH (M) SDN BHD

Application for Employment

Professional/Work References
List two past supervisors and one person who is not related to you who have knowledge of your qualification for the
position for which you are applying.

Name

Title/relationship

May we contact your present employer?

Address

Phone no.

Occupation

(include area
code)

yes
no

Wage or salary required

Date available

I hereby certify that the answers and other information on this application are true and correct and that I understand any
misrepresentation or omission of facts on my part will be justification for separation from the companys service, if
employed. I understand that my employment may be contingent upon receipt of verification of birth and any other
pertinent information bearing upon my employment, and that continued employment depends upon the will of the
company or me.

_______________________________
Date

_______________________________
Signature

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CS-F03
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CSL TECHNOLOGIES (M) SDN BHD

LRC TECH (M) SDN BHD

Application for Employment

FOR OFFICE USE ONLY
Factor to access
1. Experience
2.Language Ability
3. Technical Knowledge of Job
4. Job stability

Grade
Poor
Average
Poor
Average
Poor
Average
Poor
Average

Remarks
Good
Excellent
Good
Excellent
Good
Excellent
Good
Excellent

Comments by interviewer:

Recommendation by Interviewer:
Recommendation for employment
Hold for further consideration/second interview
Reject
Other action: ________________________________________________________________

Recommendation for employment as follows: ____________________________________

Date of Commencement: ____________________________________

Department:

____________________________________

Position:

____________________________________

Salary:

____________________________________

Status: Full Time/Part Time/Temporary/Industrial Training/ Internship

Period:

____________________________________

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