MSD GROUP OF COMPANIES

MSD Digital Intelligence Sdn Bhd (761551-T)

I-Fabulous Art Media & Event Sdn Bhd (904973-U)
Ingeniworks Sdn Bhd (1000895-P)
Intelligence Net Care Sdn Bhd (709524-D)
Future Automation Services Sdn Bhd (762582-P)
Nilai Lavenda Sdn Bhd (916760-M)
Innovative Learning Network Sdn Bhd (1104006-U)

No. 13 Jalan Puteri 5/20, Bandar Puteri, 47100

Puchong,
Selangor
Tel: 03-8068 2300 Fax: 03-8068 2400
Website: www.msd.net.my /hr_ jobs@msd.net.my

STRICTLY PRIVATE & CONFIDENTIAL

EMPLOYMENT APPLICATION FORM
Please read the instruction cafefully:
1. This form is to be completed before interview session.
2. Do not leave any item blank. If it is not applicable to you, please indicate "NA".
3. Please attached a copy of your IC or passport showing all relevant details.
4. Please attached photocopies of all your educational certificates & your comprehensive
resume during interview.

AFFIX RECENT
PHOTOGRAPH
PASSPORT SIZE

A) POSITION APPLIED FOR

Vacancy known from

! Advertisement

! Website

! Newspaper

! Friends

! Others:_____________________

B) PERSONAL DETAILS
Full Name (as per NRIC) :
Permanent Address:

Correspondence Address:

Date of Birth:
Age:

:
:
:

NRIC No
Passport No
Nationality

:
:
:

Home Tel
Handphone
Email

Sex: ! Male ! Female

Place of Birth:
years

Race:

Religion:

Height/Weight:_____cm/____kg

Marital Status : ! Single ! Married ! Divorced ! Separated ! Widowed

EPF No:

SOCSO No:

Bank:

Siblings:
Incom Tax No:
Driving License: ! Yes ! No ; Class: A / B2 / C / D

Acc. No:

C) EDUCATION BACKGROUND (List School,Institutions and Universities attended)

Year
From

Schools / Institutions / Universities

Location

To

Qualifications Attained*
(Please attached copy of certificates)

D) LANGUAGE PROFICIENCY (Please tick at the specified column)

No Written & Spoken

Fluent

Good

Fair

Advance

Moderate

Basic

1
2
3
E) SKILLS (Please tick at the specified column)
(Computer/Professional/Others)

Page 1 of 3

F) OTHER QUALIFICATIONS /COURSES ATTENDED

Year
Name of Course

Institution/College/University

G) FAMILY PARTICULARS
No Name

Age

Relationship

Occupation

Employer Name

Contact No

1
2
3
4
5
6
H) SPOUSE PARTICULARS (if married)
Name :

Date Married :

Employer Name & Address:

Position :

No. of Children :

Total Earning per month (RM) :

Office No. :

Handphone No. :

I) PRESENT EMPLOYMENT
Year
From

Name of Company / Telephone No.

Type of Industry/Business

Position Held

To

Areasof Specialization / expertise

Current Salary (RM) :

Notice Period:
/month

1
2
3

Current Benefits:
Bonus:

Expected Salary (RM):

Allowances:
/month

4
5
Reason for Leaving:

Others; please specify:

_________________________
_________________________

J) PAST EMPLOYMENT
Year
Company Name
From
To

Telephone No.

Page 2 of 3

Position Held

Last Drawn
Salary (RM)

Reason for leaving

K) RELATIVES / FRIENDS KNOWN IN THIS COMPANY

No Name

Position

Relationship

Period Known

Relationship

Address

Contact No.

2
L) EMERGENCY CONTACT
No Name

2
M) REFERENCES
No Name

Address

Contact No

Occupation

2
N) OTHER RELEVANT INFORMATIONS (Have you ; if Yes please provide details)
1 Any physical disability or handicap?
! Yes ! No

(If Yes please specify)

2 Suffered from any major/long illness and/or drug additions?

! Yes ! No

(If Yes please specify)

3 Ever been hospitalised?

! Yes ! No

(If Yes please specify)

4 Ever held any responsible position in a club, trade union or associations?

! Yes ! No

(If Yes please specify)

5 Any friends or relatives working in this company or its subsidiaries?

! Yes ! No

(If Yes please specify)

6 Ever applied to this company or any of its subsidiaries?

! Yes ! No

(If Yes please specify)

7 Ever been a bankrupt?

! Yes ! No

(If Yes please specify)

8 Ever been convicted of a criminal offence?

! Yes ! No
(If Yes please specify)
9 Do you own a vehicle?
! Yes ! No

(If Yes please specify)

DECLARATION

I declare that the information given above is to the best of my belief, true and correct
and that i have not suppressed any fact. I understand that any mispresentation or
falisification of any fact will be sufficient cause for the cancellation of consideration for
employment or immediate termination (if i have been employed).
Page 3 of 3

Signature
Date:

Period Known