Application for Employment
Caffe Bene Malaysia Sdn. Bhd. (1045964-A)
(Formerly known as Asia Caffe Bene Sdn Bhd)
No 7, Lorong Teknologi 3/4a, Nouvelle Industrial Park 2, Taman Sains Selangor 1,
Kota Damansara, 47810 Petaling Jaya, Selangor D. E., Malaysia.
Phone: +603-6143 6333 | Fax: +603 6143 7333
http://www.caffebene.com.my
Private & Confidential
Please complete in block letters and attach all relevant certificates and testimonials
Position(s) Applied For
Paste Photo
Here
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(2)
Personal Particulars
Male
Name (as in NRIC/Passport)
Female
Permanent Address
Contact Number(s) Residence
Office
Mobile
NRIC Number (pink/blue) / Passport Number
Nationality
Date of Birth
Place of Birth
Race
Marital Status
Religion
Chinese
Single
Buddhist
Malay
Indian Others (please specify)
Married Divorced Separated Widowed
Christian Hindu Islam
Others
Family Particulars
Fathers Name
Number of Siblings
Mothers Name
Brothers (
Spouses Name
Sisters
Spouses Occupation
Spouses Employer
Number of Children
Ages of Children
Name of Person to Notify in Case Of Emergency
Relationship
Address
Contact Number
Education (beginning with latest qualification, including professional qualifications)
Education Level
Name of Institution
Qualifications
Obtained
Year
Obtained
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Linguistic Ability
Language
English
Mandarin
Malay
Tamil
Spoken
Written
Employment History (Please list showing current or most recent employer first)
Current / Most Recent Employers Name
Designation:
From
To
Summary of job function
Last Drawn Basic Salary
Allowances
Reasons for Leaving
Employers Name
Designation
From
To
Reasons for Leaving
Are you willing to perform shift duties on weekdays and weekends including public holidays?
Yes No
General Declarations
Are you in good health?
Do you suffer from any physical impairment, diseases or mental illness, counseling now or previously?
Are you presently on medication (excluding supplements) as a result of your health condition?
Have you ever been convicted in a Court of Law in any country?
Are you in the midst of or in the process of any arbitration proceedings?
Yes No
Yes No
Yes No
Yes No
Yes No
Are you presently or previously subject to any court assessments/ proceedings specifically arising out of intellectual property,
or propriety of information or breach of trust, not limited to any government agencies, professional bodies
or previous employers
Are you in the process or in the application for any court or civil proceedings?
Are you currently suffering or have you previously suffered any financial embarrassment?
Are you a bankrupt or have you ever been made bankrupt?
Yes No
Yes No
Yes No
Yes No
Have you been the subject for any current or past or pending & / or in-progress investigations, not limited
to government authorities or with past employers?
Have you ever been dismissed or terminated or received any disciplinary action in your previous employment?
Yes No
Yes No
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Is there any other adverse information that we should be aware of in considering your suitability for employment?
If your response is yes, please describe below:
Yes No
Do you have any friends or relatives working in our Company / Group? If yes, please furnish details below
Yes No
Name of Person
Appointment Held
Department
Relationship
References (If you have no objection to us seeking references from your past employers, please furnish details below)
Name of Referee
Profession
Contact No. / E-mail
Years Known
Yes No
Do you give consent to us to write to your previous employers for reference check?
Declaration
I hereby declare to the following declarations.
i.
I declare that all particulars on this application are true and correct to the best of my knowledge. I understand and accept that if
there has been any misrepresentation or omission of facts relating to this application or if I have willfully suppressed any material
facts, the Company reserves the absolute right to take disciplinary action against me including immediate dismissal from the
Companys service even if I have already been employed.
ii. Should there be any change(s) in the status and/or truth of the declarations above, it is my sole responsibility and duty to inform
the Company accordingly at any relevant time whether prior to and/or during my employment with the Company. The Company
reserves the absolute right to take any disciplinary action against me including immediate dismissal from the Companys service
if there should be any change(s) in the status and/or truth of the general declarations made above.
iii. With this application and the declarations I make herein, I accept that it will form an integral part of the Letter of Appointment that
I will be signing and/or have signed.
Date of Application
Signature of Applicant
FOR OFFICE USE ONLY
1. Salary Expected :
2. Notice required :
3. Start Work :
4. Salary Offer :
Interviewed By / Date
Recommended / Not Recommended
for process the Employment
Action :
Exec Director/Chairman
HR Dept. / Date
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