Professional Documents
Culture Documents
applied: ___________________________________
Interview date: __29th November 2016__ Time: 0900am___
APPLICATION FORM
SECTION A - JOB EXPECTATIONS
Preferred Job Type(s) Full-Time Contract: ___________ (Duration) Internship Part time
Mobile 016-3648123
Contact number Email Address Tan1125@live.com.my
Landline
House Family
Monthly financial commitments
(MYR) Car 450 Education
Others:
Is your Spouse working? Yes No (if yes please provide information below)
Are any of your children OKU? Yes / No If yes, are they registered by Social Welfare Department (JKM)? Yes / No
Gender Date of
Name Age Birth Cert / NRIC No. Disability
(M/F) Birth
Name of Beneficiaries (For insurance purposes)
Name Relationship NRIC / Passport No. %
Company
Company Specialization
Position Title
End date
Start date (mm/dd/yyyy)
(mm/dd/yyyy)
Allowance
Medical Optical
No. of months
Salary Increment period (month)
unemployed
1)
What do you like about your previous job
2)
1)
What do you dislike about your previous
job
2)
PREVIOUS EMPLOYMENT HISTORY
Month/Year
Employers Name Position Held Reason For Leaving Base Salary
From To
Sakae sushi Waiter 2011 2012 study 1200
SECTION E REFERENCES (Please provide three referees from you previous employment)
No. of Years
No Name Position title Contact No.
Known
1
Degree in General
2 Degree 2015 2016 3.0
Management
5
SECTION H LANGUAGE PROFIENCY (Pease tick where applicable)
Speak Read Write
No Language
Poor Fair Fluent Poor Fair Fluent Poor Fair Fluent
1 Mandarin yes yes yes
2 Cantonese yes yes yes
3 English yes yes yes
4 Malay yes yes yes
5
Work schedule
Have you been declared BANKCRUPT and/or
10 defaulted in any payment? if yes please state
when
Have you ever been convicted for any CRIMINAL
11
OFFENSES? If yes please state details
Do you have any court / legal appointment to
12 attend / settle? If yes, please state the reason
and date.
SECTION K - HEALTH RELATED DECLARATION Y/N Please give details and date of last occurrence
Have you ever resigned, or been denied a job on
1
health grounds?
Do you have high Blood Pressure/Heart
2
Attacks/Angina/Diabetes/Asthma?
3 Migraine or persistent headaches?
Eye conditions, restricted vision/Glaucoma /Iritis
4
/any other related condition?
Ear conditions, restricted conditions/Tinnitus/ear
5
infection/any other related conditions?
Problems related to alcohol or drug abuse/usage or
6
dependency?
Mental illness and /or stress related problems?
Nervous breakdown / Mental Fatigue / Anxiety /
Depression / Panic Attacks / Significant Sleeping /
7
Disturbances / Stress Related Problems / Eating
Disorders / Self Harmful / Suicidal / Any other
conditions
Have you consulted a specialist or needed any
8
operations other than already stated?
Are you receiving medical treatment at the present
9
time?
Do you take any form of regular medication? For
10
what health purpose?
Do you any other health issues that have not been
11 mentioned above or about which you would like to
provide further details?
12 Are you pregnant? If yes, how many months?
Have you take sick leave within the last 1 year of
How many
your employment? If yes, please provide below
sick leave
13 details
Top 3 reasons for sick
leave 1. _______________________ 2. _______________________ 3. ___________________
Have you been hospitalized within the last 2 years? If
yes, please provide below details
14 Reason for hospitalization
Duration of hospitalization
DECLARATION
CTION K - DECLARATION
I hereby acknowledge that:-
1. 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).
2. 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
3. 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.
4. 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.
Name
EE ID
Contact
No.
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.
NRIC: Date: