Photo

Position applied: ___________________________________

Interview date: ______________________ Time:
________________

APPLICATION FORM
SECTION A - JOB EXPECTATIONS
Allowance/Other
Benefits
Full-Time
Contract: ___________ (Duration)
Internship
Part time

Expected Base Salary

Preferred Job Type(s)
Notice to current employer
(duration)

___________
months

Ability to work on Rotation shift

Yes / No

Earliest availability to
join Aegis (mm/dd/yy)
Able to work on
weekends & public
holidays

Yes / No

SECTION B PERSONAL PARTICULARS

Name (As per
NRIC/Passport)
Old NRIC/ Passport
no.
Date of Birth
(dd/mm/yyyy)

NRIC/Passport no.
Age (years)
Place of Birth

Nationality

Gender

Race

Religion

Marital Status

Current residential address:

Permanent address (Expatriate to provide home country address):
Mobile
Contact number

Email Address

Landlin
e

Next Of Kin (To be contacted in case of emergency)

No

Name

Relationship

Contact no.

1
2
Mode of travelling to work
(tick)

Motor
Others:

Train (LRT, MRT)

Bus

Car

Preferred Work Location

(tick)

Monthly financial
commitments (MYR)

Menara 238 (KL)

Symphony House (PJ)

Hous
e

Family

Car

Educati
on

Others:

How did you know about this job opportunity?

Career website
jobstreet.com
Career Fair
Aegis employee

EE ID:

Social Media
Facebook,
Newspaper, etc.
Walk-in
SECTION C FAMILY PARTICULARS
Spouse Name (As
per NRIC/Passport)
Is your Spouse
working?

NRIC/Passport no.
Yes

No (if yes please provide information below)

Company Name

Company Contact
no.

Position held

Children you are responsible for

Are any of your children OKU?

Name

Yes / No

Age

If yes, are they registered by Social Welfare Department

(JKM)? Yes / No
Gender
(M/F)

Birth Cert / NRIC

No.

Date of
Birth

Disability

Name of Beneficiaries (For insurance purposes)

Name

Relationship

NRIC / Passport No.

SECTION D EMPLOYMENT HISTORY

LATEST / CURRENT EMPLOYMENT DETAILS
Company
Company Specialization
Position Title
End date
(mm/dd/yyyy)

Start date (mm/dd/yyyy)

Reason for unemployment
Reason for resignation
Base Salary

Commission

Yes / No

Allowance
Medical

Optical

Dental

EPF/ SOCSO

Benefits:
Others
Annual leave

Medical leave
No. of months
unemployed

Salary Increment period (month)

What do you like about your
previous job

What do you dislike about your

previous job

1)
2)
1)
2)

Yes / No

PREVIOUS EMPLOYMENT HISTORY

Employers Name

Month/Year
From
To

Position Held

Reason For Leaving

Base
Salary

SECTION E REFERENCES (Please provide three referees from you previous employment)
N
o

Name

Position title

Contact No.

No. of Years
Known

1
2
3
SECTION F SALARY CREDITING AND STATUTORY CONTRIBUTION / DEDUCTION
EPF no.

Income Tax no.

Bank Name

Bank Account no.

SECTION G EDUCATION BACKGROUND (From highest to lowest)

No.
1
2
3
4
5

Name of University /
College/School

Qualification

Year
From

To

Field of Study

Grade /
CGPA

SECTION H LANGUAGE PROFIENCY (Pease tick where applicable)

No

Language

Poor

Speak
Fair

Fluent

Poor

Read
Fair

Fluent

Poor

Write
Fair

Fluent

1
2
3
4
5
SECTION I MEMBERSHIP OF PROFESSIONAL INSTITUTES
No.

Name of Professional Institute

Professional
Designation
Obtained

Year
From

To

Membership
Status

1
2
3

SECTION J WORK RELATED DECLARATION

1

Do you have any friends/relatives

working in Aegis BPO Malaysia Sdn Bhd
(previously known as Symphony BPO
Solutions Sdn Bhd)?
Have you worked in Aegis Global? If
yes, please provide below information
Project
Start date
Reason to
leave
Have you been terminated from
employment before? If yes, provide
details
Company
Name
Have you been absent from work
before? If yes, please provide details
Company
Name

Have you been late for work in the past

3 months? If yes, please provide details
How many times

Yes /
No

Please give details

Position held
End date
Reason to rejoin

Reason for
termination
Number of
times
Reason for
absenteeism
Company
name
Reason for lateness

Do you hold a directorship in any

company? if yes, please provide details
Company
Name

Specialization

Does anyone in your family carry out

own business? If yes, please provide
details
Company
Name
Are you involved in your family or part
time business? If yes, please provide
details
Owner of
Business
Do you work
Yes / No
full time
Are you doing any part time job after
working hours or on weekends? If yes,
please provide details

Specialization

Your role in company

Your salary from
company

Position

Company
name
Salary

Work schedule
10

11

12

Have you been declared BANKCRUPT

and/or defaulted in any payment? if yes
please state when
Have you ever been convicted for any
CRIMINAL OFFENSES? If yes please
state details
Do you have any court / legal
appointment to attend / settle? If yes,
please state the reason and date.

13

Do you have any financial issues with

any financial institution (PTPN, MBSB,
bank etc...)

14

Are you willing to travel/relocate?

SECTION K - HEALTH RELATED DECLARATION

1

Have you ever resigned, or been denied a

job on health grounds?

Do you have high Blood Pressure/Heart

Attacks/Angina/Diabetes/Asthma?

Migraine or persistent headaches?

Eye conditions, restricted vision/Glaucoma

/Iritis /any other related condition?

5
6

Ear conditions, restricted

conditions/Tinnitus/ear infection/any other
related conditions?
Problems related to alcohol or drug
abuse/usage or dependency?
Mental illness and /or stress related
problems? Nervous breakdown / Mental
Fatigue / Anxiety / Depression / Panic
Attacks / Significant Sleeping /
Disturbances / Stress Related Problems /
Eating Disorders / Self Harmful / Suicidal /
Any other conditions

Y/N

Please give details and date of last

occurrence

8
9
10
11
12

13

14

15

Have you consulted a specialist or needed

any operations other than already stated?
Are you receiving medical treatment at the
present time?
Do you take any form of regular
medication? For what health purpose?
Do you any other health issues that have
not been mentioned above or about which
you would like to provide further details?
Are you pregnant? If yes, how many
months?
Have you take sick leave within the last 1
How many
year of your employment? If yes, please
sick leave
provide below details
Top 3 reasons for
1. _______________________ 2. _______________________ 3.
sick leave
___________________
Have you been hospitalized within the last
2 years? If yes, please provide below
details
Reason for
hospitalization
Duration of
hospitalization
Reason
Do you have any follow up medical
How
checkups? If yes, please provide details
frequent

SECTION L - BACKGROUND SCREENING

QUESTIONS
Have you applied for any other jobs? If
yes, please provide details
1
Company Name
Company Name

Yes /
No

Additional Information

Position applied
Position applied

Have you attended any interviews in the

last 1 month? If yes, please provide details
2

Company Name
Company Name

Do you have any of your family members

admitted in hospital or they are very ill? If
yes, please provide details
Hospital name

4
5

Are you planning to get married within the

next 1 year? If yes, please indicate the
date.
Are any of your family members getting
married in the next 1 year? If yes, please
indicate the date.

Expected / offered
salary
Expected / offered
salary
Relationshi
p
Reason for
hospitalization

Are you planning to further your studies in

1 year time from now? If yes, please state
what course and when will you start.
Course taken

Name of
institute
Start date of course

Do you have any pre planned leave? If

yes, please indicate when and how long?
Have you applied for any government jobs
within the past 6 months? If yes provide
details
Position applied

Interview
date
Interview result

DECLARATION
CTION K - DECLARATION
I hereby acknowledge that:1

3
4

Consent is given to the Company or its duly appointed agent to collect, record, store, use and process Personal
Data, as defined by the Personal Data Protection Act 2010 (PDPA), concerning and relating to myself, including
any sensitive personal data, for the purposes of processing this employment application for the Companys
consideration, and if successful, would form part of the employment records with the Company (Purpose).
Such Personal Data may include, but is not limited to the following:a Information provided via forms required by the Company
b Information from any pre-employment checks, such as medical, bankruptcy, credit and criminal checks deemed
necessary by the Company in relation to the Purpose
c Information regarding any family members, referees and/or any such other person(s) deemed necessary by the
Company in relation to the Purpose
d Records of any correspondence and/or communication with representatives of the Company
All Personal Data provided is accurate, complete, not misleading and up-to-date and Personal Data of third parties
provided is given with the prior consent from the relevant parties, failing which I indemnify the Company against
any claims.
Consent is given to the Company to disclose any such Personal Data to any third party including the Companys
duly appointed agent, relevant authorities, subsidiaries, insurers, hospitals, clinics and/or any such person(s) as
deemed necessary by the Company in relation to the Purpose.

I hereby declare that the information given by me in this form is correct and true to the best of my knowledge. I fully
understand and accept that if at any time after employment engagement with the Company, it is found that false
declarations have been made in this form, the Company has absolute right to terminate my employment forthwith.

Signature of
applicant:

NRIC number:

Name of applicant:

Date:

INTRODUCE YOUR FRIENDS TO US!!!

Name
Contact
No.
No Friend Name

Contact No

Email

1
2
3
4
5
CONSENT FOR REFERRALS - PERSONAL DATA PROTECTION ACT 2010
The above matter refers.
I have provided Aegis BPO Malaysia Sdn. Bhd. (Aegis) with names and contact details (Personal
Data) of potential candidates, for employment purposes with Aegis.
I hereby represent, warrant and covenant that I am authorised to disclose all Personal Data that I have
provided to Aegis and I have obtained all consents, permits, authorizations and notice necessary from
these potential candidates to permit such disclosure and transfer to Aegis and use thereof by Aegis as
required by the Personal Data Protection Act (PDPA) 2010, for the purposes abovementioned.
All the Personal Data acquired by Aegis from me shall only be used for the purposes of hiring new
employees (Employee Referral Program).
I hereby fully indemnify Aegis for any breach of the PDPA 2010 legislation on my part which may
render Aegis liable for any costs, claims or expenses, howsoever arising.
I hereby declare that the information given by me in this form is correct and true to the best of my
knowledge. I fully understand and accept that if at any time after employment engagement with the
Company, it is found that false declarations have been made in this form, the Company has absolute
right to terminate my employment forthwith.
Name of Applicant:

Signature of Applicant:

NRIC:

Date: