Application / Personal Record

APPLICATION & PERSONAL RECORD

PRIVATE & CONFIDENTAL

A. APPLICATION
For Position Of :

Date :

Name :

Ref. No. :

Address (Local) :
(Hometown, if any) :
Residence :

Telephone No :
Business :
Mobile :

B. PERSONAL DATA

EPF No.

Income Tax No :

Date of Birth :

Socso No :

Place of Birth :

Nationality :

Birth Cert No :
Age :

Race :

Sex :

I/C No. (old/ new) :

Marital Status :

No. of Children :

Languages Spoken (Underline Main Dialect) :

Languages Written :
Hobbies / Interest :

C. EDUCATION BACKGROUND
Name

Year

Qualification

School

University / College

Other Courses Completed

Currently Studying

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Currently Studying
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Application / Personal Record

D. OTHER TRAINING / SKILLS / PROFESSIONAL QUALIFICATIONS

Enclosures
Please enclose :
a. 1 passport size photograph
b. Photocopies of detailed professional, university, "O" & "A" level results
c. Photocopies of other references
d. Any other Training / Skills / Professional Qualification

E. WORKING EXPERIENCE
PRESENT EMPLOYMENT
Name of Company :
Address :
Tel:
Type of Business :
Capacity in which employed and to
whom responsible :
Brief description of duties and
responsibilities :
Date Joined :
Last Drawn Salary :
Reason/s for seeking new
employment :

F. PREVIOUS EMPLOYMENT (In Chronological Order)

Name of Company

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Position

Basic
Monthly

From
(Year)

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To
(Year)

Reason(s) for Leaving

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G. FAMILY DETAILS (Spouse, children, details of immediate family or parents, brothers and sisters)
Name

Age

Occupation

Note : Successful applicant are required to submit a copy of your last 3 months drawn salary slip, a photostat copy of your NRIC
and your birth certificate for our files.

How soon would you be able to take up a new appoinment?

Salary required?

Have you been dismissed or suspended from any position?

No

Yes

If so, state when, where and the cause :

Please draw an organization chart of previous / present employer indicating your position in the organization
and staff directly supervised

You

Any additional information you consider relevant

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MEMBERSHIP / AFFILATIONS OF PROFESSIONAL BODIES, CLUBS, VOLUNTARY, ORGANIZATIONS

Organizations

Membership No.

Year Obtain

REFEREES
Employment References from past and present employment
(Information provided will be used solely for the purpose of reference check)

Name

Position

Address

Tel. No.

Period
know

Relationship

Address

Tel. No.

Period
know

Personal Reference
Name

In event of this application being unsuccessful may we retain your name in our confidential file?
Yes

No

Yes

No

Are you addicted to any narcotics or illegal subtances

Yes

No

Have you ever been convicted of felony (other than traffic offences)?

Yes

No

Yes

No

Yes

No

Are you suffering from any illness or disablement such as mental

illness, Cancer, Aids, Tuberculosis

(Yes, does not automatically disqualify applicant)

Do you have any relatives or friends currently or previously working in Profitera?
If yes, please state the name of person :
Have you apply for any post in Profitera?
Declaration

I hereby affirm that all the information that I have included in this job application form is truthful and accurate. I understand
that the company also has a right to verify with any third parties any of the information I have included in this job application
form. Furthermore, I understand that the company has a right to summarily dismiss me from service where it is discovered I
have misrepresented or omitted any pertinent facts pertaining to my work experiences and qualifications. I also understand
that the company will have a right to recover any monies paid to me during my course of employment for any
misrepresentation/omission of information or facts.

Signature of Application
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Date
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