Company No.
: 622961-W
EMPLOYMENT APPLICATION FORM
Important: The information collected in this form is for the purpose of assessing your suitability for employment with the Company. If your
application is successful, this form together with its attachments/documents shall be retained in your personal file with the Company. If your
application is unsuccessful, this form together with its attachments/documents may be retained for a reasonable time frame not exceeding
twelve (12) months in our application file. Your application is subject to the Declaration and Consent signed below this form.
Penting: Maklumat yang dikumpul dalam borang ini adalah untuk tujuan menilai kesesuaian pekerjaan dengan Syarikat, Jikalau permohonan anda berjaya, borang ini berserta lampiran/dokumen-
dokumen berkenaan akan disimpan dalam fail peribadi anda dengan Syarikat. Jikalau permohonan anda tidak berjaya, borang ini berserta lampiran/dokumen-dokumen berkenaan akan disimpan
untuk satu jangka masa yang tidak melebihi dua belas (12) bulan dalam fail permohonan ini. Permohonan anda adalah tertakluk kepada Pengakuan dan Persetujuan yang ditandatangani di
bawah borang ini.
PERSONAL DETAILS
FULL NAME (as per NRIC) :
PRESENT/CORRESPONDENCES ADDRESS : PERMANENT ADDRESS :
(Leave blank if same as present/correspondences address)
TELEPHONE NUMBER : MOBILE NUMBER :
E-MAIL ADDRESS : NRIC NO (NEW) :
NRIC NO (OLD) :
DATE & PLACE OF BIRTH : NATIONALITY :
GENDER : Male Female RACE & RELIGION :
MARITAL Single Married Divorced Widow NO OF CHILDREN :
STATUS :
ALTERNATIVE CONTACT PERSON DETAILS
NAME :
CONTACT NO :
RELATIONSHIP :
EDUCATION RECORD
CERTIFICATE/DIPLOMA/ OVERALL FROM TO
SCHOOL/COLLEGE/DEGREE COURSE/DEGREE
DEGREE AWARDED GRADE (CGPA) (YEAR) (YEAR)
FORM NO.: F-APPLICATION-HR REV.3 ISSUED DATE: 11.02.2022
EMPLOYMENT RECORD
CURRENT EMPLOYER’S NAME, TYPE OF BUSINESS : POSITION :
ADDRESS & TEL NO:
PERIOD COVERED : MAY WE CONTACT THE COMPANY :
From : To : Yes No
CURRENT SALARY : OTHER ALLOWANCES :
NOTICE PERIOD : REASON FOR LEAVING :
FORMER EMPLOYER’S NAME & ADDRESS: TYPE OF BUSINESS : POSITION :
PERIOD COVERED : REASON FOR LEAVING :
From : To :
SALARY : OTHER ALLOWANCES :
FORMER EMPLOYER’S NAME & ADDRESS: TYPE OF BUSINESS : POSITION :
PERIOD COVERED : REASON FOR LEAVING :
From : To :
SALARY : OTHER ALLOWANCES :
FORMER EMPLOYER’S NAME & ADDRESS: TYPE OF BUSINESS : POSITION :
PERIOD COVERED : REASON FOR LEAVING :
From : To :
SALARY : OTHER ALLOWANCES :
FORMER EMPLOYER’S NAME & ADDRESS: TYPE OF BUSINESS : POSITION :
PERIOD COVERED : REASON FOR LEAVING :
From : To :
SALARY : OTHER ALLOWANCES :
FORM NO.: F-APPLICATION-HR REV.3 ISSUED DATE: 11.02.2022
ADDITIONAL INFORMATION
Please include any other information you think would be helpful to us in considering you for employment, such as additional experience,
activities, accomplishment, skills, etc.
GENERAL INFORMATION
ARE YOU APPLYING FOR A FULL TIME OR A TEMPORARY POSITION? Full time Temporary
EXPECTED SALARY : WHEN WILL YOU BE AVAILABLE TO START WORK :
DO YOU HAVE ANY RELATIVE WORKING FOR THE COMPANY? HAVE YOU PREVIOUSLY APPLIED FOR EMPLOYMENT WITH
If yes, please give details of name, department and relationship : THE COMPANY?
Yes No
NAME :
If yes, when and what position? _______________________
DEPARTMENT :
____________________________________________________
RELATIONSHIP :
ARE YOU A BONDED WITH ANY INSTITUTION/ORGANIZATION/ENTITY? Yes No
If yes, please attach relevant agreement and documents/details.
HOW WERE YOU REFERRED TO THE COMPANY?
WEBSITE ADVERTISEMENT
(Please state publication)
FPSO EMPLOYEE AGENCY
(Please state the name of the Agency)
FRIEND OTHER
(Please specify)
HAVE YOU EVER BEEN CHARGED OR CONVICTED OF A CRIME? Yes No
If yes, please briefly describe the circumstances of your conviction, indicating the date, nature and place of the offence and disposition of the
case. Your answer is looked upon as only of the factors considered in the employment decision and is evaluated in terms of the nature,
severity and date of the offense.
HAVE YOU EVER BEEN THE SUBJECT OF A DISCIPLINARY ISSUE AT YOUR PREVIOUS EMPLOYMENT? Yes No
If yes, please briefly describe the circumstances of the disciplinary issue, indicating the date, nature and place of the offence and disposition
of the matter.
HAVE YOU EVER SUFFERED FROM MAJOR ILLNESS FOR WHICH REQUIRE MEDICAL TREATMENT? Yes No
If yes, please describe on the medical condition and its history. State any major illness you have suffered, any physical impairment of
deformities. The medical condition is not only limited to physical well-being but also include your mental well-being. For female applicant,
please also declare if you are currently pregnant.
HEALTH, SAFETY AND ENVIRONMENT
Are you prepared to abide by health, safety and environmental rules? Yes No
Do you place Health, Safety and Environment as high priority in your current workplace? Yes No
FORM NO.: F-APPLICATION-HR REV.3 ISSUED DATE: 11.02.2022
SPOKEN LANGUAGE : WRITTEN LANGUAGE : COMPUTER SKILL :
REFERENCES
REFEREE 1 : REFEREE 2 :
NAME NAME
POSITION POSITION
COMPANY NAME COMPANY NAME
CONTACT NO CONTACT NO
E-MAIL ADDRESS E-MAIL ADDRESS
DECLARATION AND CONSENT
(Pengakuan Dan Persetujuan)
I declare and confirm that to the best of my knowledge, the answers to the questions and information given in this form are correct and
true. I understand that any misleading, false or inaccurate answers and/or information given, or any material fact suppressed or omitted, I
may not be accepted, or if I am employed, I may be subject to disciplinary action, or I may be dismissed.
I understand that the information and documents collected in this application are for the purpose of assessing my suitability for employment
with the Company and this form together with its attachments/documents will be retained in my personal file with the Company. I have
obtained the consent of my referees and alternative contact person for the use and disclosure of their personal data to your Company. I
acknowledge that I have read and understood the Personal Data Protection Notice (Version 1.0) and hereby expressly provide my consent
to the Company for the purpose of processing my Personal Data and Sensitive Personal Data in accordance with the abovesaid Personal
Data Protection Notice, including its amendments, from time to time.
Saya mengaku dan mengesahkan bahawa dalam pengetahuan saya, jawapan kepada soalan-soalan dan maklumat yang telah diberikan dalam borang ini adalah betul
dan benar. Saya memahami bahawa permohonan saya mungkin tidak akan diterima dan saya adalah tertakluk kepada tindakan disiplin atau perkhidmatan saya boleh
ditamatkan sekiranya terdapat sebarang maklumat yang tidak benar atau palsu, atau apa-apa fakta penting yang disembunyikan atau ditinggalkan.
Saya memahami bahawa borang ini berserta lampiran/dokumen-dokumennya adalah untuk tujuan menilai kesesuaian pekerjaan dengan Syarikat dan borang ini
berserta lampiran/dokumen-dokumennya akan disimpan dalam fail peribadi saya dengan Syarikat. Saya telah mendapatkan kebenaran daripada ‘referee’ dan orang
hubungan alternatif saya untuk menggunakan dan mendedahkan data peribadinya kepada Syarikat anda. Saya mengakui bahawa saya telah membaca dan memahami
Notis Perlindungan Data Peribadi (Versi 1.0) dan memberikan persetujuan saya secara nyata kepada Syarikat untuk tujuan pemprosesan Data Peribadi dan Data
Peribadi Sensitif berdasarkan Notis Perlindungan Data Peribadi tersebut di atas, termasuk pindaan yang dibuat, dari masa ke masa.
SIGNATURE :
(Tandatangan)
FULL NAME :
(Nama Penuh)
NRIC NO. :
(No. Kad Pengenalan)
DATE :
(Tarikh)
FORM NO.: F-APPLICATION-HR REV.3 ISSUED DATE: 11.02.2022
