APPLICATION FORM

Employee No. (No. Pekeria)

PERSONAL PARTICULARS (MAKLUMAT PERIBADI) E.rpected salary RN43,,i00

Full Name (Nama Penuh seperti di K/P) Sex Male Female

Muhamrnad Faizolmi Bur Abu Hassan (.lantina) I-elaki Perempuan
Position Applied {br Personal Email Address
Assernbly Engineer [email protected]
(Jawalan) (Al;urat Emel peribadi )

I/C No. (uld) (l-ama) 90 t 0060-151 23 Date ofBirth 6th Octoher 1990
( No.K/P) O{ew) (flaru) Omikh Lahir)
Marital Status lncome Tax File No. & Branch :
Married
('faraf Perl<ahrvinan) (No-!ail Cukai PendaBatat 644 gawatgaq)
EPF No. SOCSO No.
20463 r r r 901006035 i23
(No. AhliKWSP) (No. SOCSO)

Account No. and "t'1'pe of A/C ?nAOQ/ (A7O Name of Bank and Address
CIMB
(Akaun No. dan Jcnis Akaun) Savins Accounl (Narna Bank dar Alamat)

Home Address No 447. Seri Mahkota 9/2,

Rumah Sekarang) Taman Seri Mahkota, Kulim, Kedah
(Poskod) 9000 Telephone No. (No. 'I'elefbn) 019-47 1257 |

Address
Tetap)

Postcode (Poskod) Telepht'rne No.(No.'f elelbn)

PARTICULARS OF SPOUSE (MAKLUMAT SUAMI/ISTERI)

Name ol Spouse (as in I/C) VC No. Old & Nerv Income Tari File No. Date of llirrh Occupation
(Nama Suami/lsteri spt di K,P) (No.KP) Lama & Banr (No.!.ail Cukai Pendapatan) (Tadkh Lahir,) (Pekeriaan)

Nur Atilah Binti Zainul Abidin 88080508-s856 5th August 1988 [)lanner

Name of Llhildren (natural. adopted or step-children) Sex Date of Bifth llC No.or Birth Cert. No.
(lrIama z\nak-anatri kandung. anak angkatranak tiri) (Jantina) (Tarikh Lahir) (No. IUP atau No. Siiii Kelahran)

I ) Zaim Danial Bin Muhammad Faizolmi Male l2th March 2018 I 803 I 2070245

3)
4)
5)

EDITCATTON I{TSTORY (SEJARAH PANDDT}i{N)

NAVTg OF SCTIOOL FROM TO .{{-HIEVING CRADI] CER'TIFI{--\TE

Universiti Malaysia Perlis 2009 2013 Mechatronic Engineering 2.59 Ilachelors Degree
Kedah Matriculation College 2008 2009
SM] Alor Setar 2006 2007 M echanical Engileering 7A, 28" IC

E,IITPLOYIIENT IITSTOR\', (StrJARAH PE KEII.|AAN )

NAI{E OT COMPAI{Y FROM TO POSITION SALARY REASON TOR LEAVING

Tcknomatrik Sdn Bhd .Iun- l 8 Sep-20 R&D Engineer 3500 Company's l-rnancial di I fi culties

ldaman Pharma Manuf-actruing Aug-16 May-18 Equipnrcnt Elgineer 2700 Salary increment
Sophic Automation Feb-14 Jul-16 Support Enginecr 2240 Sa1ar1. increment

LANGLTAGE SPOKEN English. L.4a1a1,

I,ANGUAGE \YRITTEN English, Malay

Efiective date: l/021202i F-HR-003 Rev 0

Page 1 of2
 QUESTTONS (SOALAN)
Are you a smoker? \TS f] Nom
Do you have health problems? YES fJ N(]m
If 'YgS'please give details
Have you commited an offence? YES fl N0m
If 'YES'please give details
Have you been declared a bankrupt? YES I Nom
If 'YES'please give details
Are you currently pregnant (Female)? YES tr No fl
If 'YES'please state the due dale
Do you have &iend/relative here? YES T Nom
If 'l-ES'please state their name
Are you prepared to serve in overse? YES N0m
If T.lo'please speri$: No if permanantlv stal oversea, but i don't mind if fbr outstalion or training.

coN rAC'r PERSON DURTNG ENTERCENCY {ORANG YANG DAP.Ar'DrHtiBUNGr SEMASA KECEMASAN)

I) Main Contact Person 2) Other Contart Person

Lain
Abu Ilassan Ilin Saad
Name (Narna) Nur Atilah Binti Zainul Abidirr
l**,",**,,
I{elationship lRelationship Father
Wife
(Hubungan Persaudaraan) :
I
ttirUrng* Persaudaraar ):

Address (Al:rmat) No.t47, Lorong Seri N{ahkota 9/2. (Alamat) Lot 924, Jalan Kg Huma
Taman Seri Mahkota Simpang Empat Ku:u
Alor Janggus. Kedatr
Postcode(Poskod) 09000 I
Postcoilet Poskod) 6254
Io'"vn/ClityiState Kuliur, lforrlCityfst t" Alor Janggus, Kedah
(PekanlBandar,4\egeri) Kedah
lGehnmandar/Neeeri)
Telephone No. lTelephone No. 019-4405485
0t l-32719948
(No.'lelefon) l{Nn.'r"t.ton)

Employee's llecrlaration (Perakuan Pekerja):

I trereby confirnr thal rhe above irrformalion is true and correct and I rvill provide in a timely manner
(in any case rot later than 7 rlays ol'an er'ent). Iniormation relating to any change in thc particulars
provided herein.

The company reserves thc right to terminats my ernplol'rncnt should the informatinn given above is lbund to be fhlse.

(Saya dengan in rnengesahkan bahawa rnaklumat-maklunrat yang diberi di atas adalah benar dan betul.
Sebarang perLrbahar nraklumat peribadi akan diberitahLr dengan segera clalain rnasa iidak melebihi 7
hari)
Pihak syarikat trerhak untuk menamatkan perkhidmatan saya seandainy-a maklumat-
makltmrat din-r-atalian dirtas adaiah tidsk hcnar:

lird June 202 I

Signature of ernployee Date

(T'andatangan pekeqi a) (Tarikh)

FOR OF'FTCE USE ONLY

Klv I Immediate Supervisor:
REJECT n
ACCEPT il Date.ioin:

BASIC S.ALARY

POSITION Department Head Acknowledgment / Date

INTER.VIF,WE,D BY: HR Manager Acknowledgrnent / Date

Etrectrye dr*.: 1/O2/2O21 F-HR{03 Rev0
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