DECLARATION

FORM
NOTES:
1. Complete all required fields. Mark N/A where applicable.
2. Incomplete and unsigned form shall be rejected.
3. False statements may cause rejection of the application or if employed, termination of employment.

PERSONAL DETAILS
1. Full Name (as per NRIC/Passport) : .....................................................................................................................................................................................................................
2. NRIC/Passport Number : ................................................................................. 3. Nationality : ......................................................................................................................
4. Mobile Number : ..............................................................................................

5. Email Address : ...............................................................................................................

EDUCATION DETAILS
Qualification

Program

Institution

Results
Date of Completion
(CGPA/WAM)
(Month/Year)

PhD
Master
Degree
Diploma
SPM/O-Level
1. Have you been awarded a PETRONAS education sponsorship before? ............................................................................................................... YES qNO q
If YES, year awarded : ...................................... Type of sponsorship : .......................................................................................................................................................

2. Have you been awarded an education sponsorship from any organizations (e.g. PTPTN/JPA/MARA)? .................................................. YES qNO q
If YES, name of organization : ............................................................................................................................................................................................................................
Are you contractually bonded with the organization? ............................................................................................................................................... YES qNO q

EMPLOYMENT HISTORY
1. Name of current employer : ..................................................................................................................................................................................................................................
Employment type : Permanent

qContract q

2. Have you been offered an employment/employed by PETRONAS and/or its group of companies?......................................................... YES qNO q

If YES, name of company : ....................................................................................................................................................................................................................................

Type of employment : Permanent

qContract qDuration : ...............................................................................................................................................

3. Current basic salary : ...................................

Expected basic salary : ...................................

ADDITIONAL INFORMATION
1. Area of job interest : 1) ...................................................

2) ...................................................

3) ...................................................

2. Have you participated in any of PETRONAS entry level assessment as below (Fill details where applicable) :
Assessment

Date
(Month / Year)

Phone interview / chit-chat

Name of company : .....................................................................................................................................
Online test
Technical assessment
Final interview
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3. Do you have any relative(s)*, either by blood, marriage or adoption who is/are currently employed by PETRONAS and/or
its group of companies? ................................................................................................................................................................................................... YES qNO q
If YES, kindly list their particulars:
Name

Relation to You

Company Employed

Relative(s) include spouse(s), parents, parents-in-law, siblings, siblings-in-law, aunties, uncles, nieces, nephews, first cousins and fiance / fianc

4. Have you been declared a bankrupt? ........................................................................................................................................................................ YES qNO q

If YES, please state the year of bankruptcy declared upon you : .......................................................................................................................................................

5. Have you even been convicted by any division of criminal court? .................................................................................................................. YES qNO q
If YES, please state at which court : .................................................................. Case : ........................................................... Year of conviction : .....................

6. Has any disciplinary action been taken against you in your previous employment(s)/educational institution(s)? .............................YES qNO q
If YES please state year of action taken : ........................................................ Case : ............................................................................................................................
Name of company/institution : .......................................................................................................................................................................................................................

7. Are you currently an owner/shareholder of an enterprise or private limited company? ........................................................................... YES qNO q
If YES, please state the name of company/enterprise : ........................................................................................................................................................................
Title held in company/enterprise : ........................................................ Nature of business : ............................................................................................................

8. Please provide us with two (2) referrals (Preferably your previous working superior(s) :
Name

Position / Company

Contact Number

DECLARATION
I hereby certify that all the statements made in this declaration are true and correct. I understand that I must demonstrate that I meet the
minimum requirements of the job, and further understand that any exaggerated or false statement(s) or omission of requested information may
be a cause for my application to be rejected; or, if I have been employed may be cause for my termination. By signing this application, I agree to
authorize the use of any information in this application to verify my statements, and I authorize all past employers, past educators and references
to release any/all information concerning my previous employment and educational records.

Signature : ...................................................................................

Date (DD/MM/YY) : .................................................................

Name : ..........................................................................................

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