EMPLOYEE APPLICATION FORM

Instructions:
• Applicant must complete each section in the form and only using capital letters
• Kindly ensure all information are correct as verified of original documents (e.g.,
NRIC, certifications, etc.)
• Below are the required documents to be submitted together with this application Affix Picture Here
form. Copies of any relevant documents must be attached to this application form.
Please tick (✓) the necessary in the appropriate space

Latest copy of Resume Copy of latest 3 months payslip

Copy of certificate(s) Copy of your NRIC

POSITION APPLICATION
Company:
Position Applied:
Available Start Date: Notice Period:
Expected Salary: RM ( Negotiable / Non-Negotiable )

PERSONAL INFORMATION
Name:
MyKad / Passport No.: Age:
Date of Birth: Place of Birth:
Gender: Male Female Race:
Religion: Nationality:
Marital Status Single Married Divorced Widowed
Correspondence Address

Postcode: City:
State: Country:
Permanent Address

Postcode: City:
State: Country:
Phone Number 1: Personal Email
Contact Details
Phone Number 2:

FAMILY DETAILS
Spouse Name: Profession:
NRIC: Company:
Please provide details of your child, parents and siblings.
No. Name Age Relations Profession & Company

Page | 1
 ACADEMIC/PROFESSIONAL EDUCATION INFORMATION
Education Period (Year)
Institution Qualification Result
Level From To

SKILLS & TRAINING INFORMATION

Year(s) of Proficiency
Skills/ Training Attended
Experience Excellent Good Average Poor

LANGUAGE AND SKILLS PROFICIENCY

Written Spoken
Language
Excellent Average Poor Excellent Average Poor
English
Bahasa Malaysia
Mandarin
Others:

CURRENT/PREVIOUS EMPLOYMENT HISTORY

Please provide details of the past 3 previous employment held – starting from the most recent.
Employer Name
Position
Position Summary
Year(s) of Service Start date: End date:
Remuneration Starting: Ending:
Reason for leaving
Employer Name
Position
Position Summary
Year(s) of Service Start date: End date:
Remuneration Starting: Ending:
Reason for leaving
Employer Name
Position
Position Summary
Year(s) of Service Start date: End date:
Remuneration Starting: Ending:
Reason for leaving

REFERENCES
Please provide details of the 2 relevant references which may be contacted by the company. The period of
acquaintance is a minimum of 2 years – Immediate relatives are not considered.

Position & Known

Company Name Contact No. Email
Relationship Period

Page | 2
 OTHER EMPLOYMENT DETAILS
Details Yes/No If Yes, please clarify
Have you ever applied for any job with us before?
Do you have any friends/relatives working with us?
Do you have any independent source of income besides your
current employment?
Are you presently in debt or declared bankruptcy?
Have you ever been convicted of an offence?
Do you willing to relocate to another location?
Do you willing to work beyond working hours for completing task?

HEALTH DECLARATION
Health Condition Yes/No If Yes, kindly clarify details
Any physical/mental disabilities?

Have you ever diagnosed with serious illness? (Cancer,

HIV, Diabetes, or others)

Do you require a long-term medication/treatment?

How many years:
Are you a smoker?
How many months/weeks:
For Female applicant, are you currently pregnant?

COVID-19 VACCINATION DECLARATION

Details Yes/No
Have you been vaccinated?

If no, have you registered to get vaccinated?

If no, kindly state your reason:
If no, do you wish to get vaccinated?

I, hereby declare that all the information given in this application form is true and not misleading and there is no omission
therefrom. I understand that should the Company discover subsequently that any of the information provided by me is
false, misleading or inaccurate, the Company has the right to reject my application for employment or bring disciplinary
action against me during my employment with the Company (as the case may be).

I consent to the Company to submit or release the information provided (or any part of it) to any person, firm,
corporation, body, bureau, department, police officials and Police Record Bureau for the purpose of any investigation
which the Company may deem necessary or appropriate.

I am aware the Company may conduct professional reference checks and background checks (criminal records, drug
test, etc.) to confirm my suitability for employment.

I agree to indemnify and keep indemnified the Company from all liabilities, demands, claims, suits, proceedings, costs,
and expenses of any nature that the Company may suffer or incur as a result of any information provided by me in this
application form which is not true, misleading or contains omission.

_____________________________ ________________
(Signature) (Date)

Page | 3
 FOR MANAGEMENT USE ONLY
Area Characteristic Excellent Good Average Poor
Dress and grooming
Appearance
Body language and eye contact
Manners, voice, bearing, gaze, etc
Speech and persuasive
Sincerity
Enthusiasm and professional
Characteristics Initiative and self-assertion
Reasoning and judgement
Assertive
Achieved-oriented
Maturity and ability to learn
Goals / Self - Realistic appraisal of self and career
Perceptions goals and reason for interest in field
Remarks:

Status: Hired KIV Reject Probation Salary: RM

Require 2nd Interview: Yes No Confirmation Salary: RM

2nd Interview Date & Time: Starting Date:

Approver Name & Signature Date

Interviewed By:
Verified By:
Approved By:

Page | 4