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EMPLOYMENT APPLICATION FORM

PLEASE PRINT ALL INFORMATION REQUESTED EXCEPT SIGNATURE APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS PLEASE COMPLETE PAGES 1-5 Name as in NRIC: Izzati Abd Malik Present Address: 561 Jalan Tunku Putra Teluk Air Tawar 13050 Butterworth Penang Home Tel: 04-3514609 Position Applied For:
Care Line Executive RM1800++

Date: 11th May 2011 NRIC No.: 870211-075088

Post Code: 13050 Mobile phone: 019-4543374 Salary Desired Can you work nights? Yes

State: Spouse Tel No: -

When available for work? 1st June 2011

Employment Desired:
TYPE OF SCHOOL

FULL-TIME ONLY
NAME OF SCHOOL

PART-TIME ONLY
NO. OF YEARS COMPLETED MAJOR & DEGREE

EDUCATION & OTHER INFORMATION

LOCATION (Complete mailing address)

High School

SMKA Al-Irshad

Pokok Sena, 13220 Kepala Batas

5 years

SPM (8A1 4B3)

College

Center for Foundation Studies Of International Islamic University

2 years

Bus. or Trade School Kuliyyah of Science Jalan Sultan Ahmad Shah, 4 years Biomedical Science International Islamic 25200 Kuantan, Pahang University of Malaysia

Professional School Have you been convicted of a crime? Do you have a drivers license? Typing

Yes

No
Transportation to work? Word Processing

Yes No

Car Public _____

Yes No

_____ WPM Other Skills:

Yes No

Personal Computer No

Yes

Please list two references other than relatives

EXIMIUS MEDICAL ADMINISTRATION SOLUTIONS SDN BHD., Megan Avenue 1, Block D 8-2, 189, Jalan Tun Razak, KUALA LUMPUR, 50450, TEL: 0321610440 FAX: 0321610431, www.emastpa.com Page 1

Name: Dr. Rosliza Salim Position: Coordinator for Industrial Training Company: Kulliyyah of Science, International Islamic University Malaysia,

Name: Assoc. Prof. Dr. Mohammed Tariqur Rahman Position: Final Year Project Supervisor Company: Kulliyyah of Science, International Islamic University Malaysia,

Address: Address: Jalan Istana, Bandar Indera Mahkota, Jalan Istana, Bandar Indera Mahkota, 25200 Kuantan, 25200 Kuantan, Pahang. Pahang. Tel: Tel: +609-5716400 extn 2865 +609-5714000 extn. 2805 An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to add any additional information necessary to describe your full qualifications for the specific position for which you are applying.

I am currently a graduating student in Bachelor of Biomedical Science (Hons) with concentration in Environmental Health. During my undergraduate years, I have been involved in teaching and educating school children also being a biochemistry tutor for first year student. Apart from my teaching experience, I have acquainted myself with my involvement in extracurricular outside of the academic circle has served me well in nurturing my leadership and communication skill. This also includes my involvement in business related field which enhance my level of confidence in dealing with other people. My working experience as a trainee in health related field also has given me wide exposure in giving a comprehensive knowledge in real world application.
Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary. Job One Name of Employer: Name of Last Supervisor Employment Dates Salary IIUM SLEU UNIT Dr. Ahmad Aidil Arafat From: Start: bin Dzulkarnain July 2010 Complete Address: Assistant Professor/Deputy Head of SLEU (Kuantan Final: To: Campus) RM80 (8 hrs x Dept. of Audiology & Speech-Language Pathology, November 2010 RM10) Kulliyyah of Allied Health Sciences, International Islamic University Malaysia Phone Number: Your Last Job Title: Ph: 09-571 6400 ext 2648 Biochemistry Tutor Fax: 09-571 6776 Work Experience Reason for Leaving (be specific): The subject taught was offered in one semester only per year. List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
-plan, prepare and deliver instructional activities that facilitate active learning experiences -develop schemes of work and lesson plans -establish and communicate clear objectives for all learning activities prepare classroom for class activities -provide a variety of learning materials and resources for use in educational activities

EXIMIUS MEDICAL ADMINISTRATION SOLUTIONS SDN BHD., Megan Avenue 1, Block D 8-2, 189, Jalan Tun Razak, KUALA LUMPUR, 50450, TEL: 0321610440 FAX: 0321610431, www.emastpa.com Page 2

-identify and select different instructional resources and methods to meet students' varying needs -observe and evaluate student's performance and development -provide appropriate feedback on work -encourage and monitor the progress of individual students maintain accurate and complete records of students' progress and development -develop and maintain Islamic environment in class Experience gained -Enhance interpersonal skill in delivering information to the student -Able to formulate strategies insisting students to improve their academic achievement -Able to work under limited time

Name of Employer: Employment Dates Salary Klinik Keluarga From: April 2007 Start: Final: RM400 Complete Address: To: June 2007 KLINIK KELUARGA SBTBP, 6288 POKOK SENA KEPALA BATAS 13220 SEBERANG PRAI, PULAU PINANG Phone Number: Your Last Job Title: TEL: (04) 575 9308 60013171 Clinic Assistant Reason for Leaving (be specific): This job was applied during my 2 months break. Therefore, after I have finished semester break, I left the company to continue my 3rd year as undergraduates student. List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
-Dispense medicine to the patient -Assist doctor in taking physical examination towards the patient -Manage cashier and patient registration Experience gained -Enhance interpersonal skill in dealing with patients and customer

Job Two Name of Last Supervisor: Dr. Hassan Ahmad

May we contact your present employer? Did you complete this application you? If not, who did? Personal Particulars Weight: 45 kg No. of Children: Yes________

Yes

Yes No

No

Height: 159 cm . Married:

Height: .

No
Age of Spouse: Age of Children : _______ , _______, _______. _______

If Married, How Long? Full Name of Spouse

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY Name: Abd Malik B. Abu Bakar Telephone: 016-4633866

EXIMIUS MEDICAL ADMINISTRATION SOLUTIONS SDN BHD., Megan Avenue 1, Block D 8-2, 189, Jalan Tun Razak, KUALA LUMPUR, 50450, TEL: 0321610440 FAX: 0321610431, www.emastpa.com Page 3

Address: SB 1183 Permatang Manggis, 13200 Kepala Batas

Relationship Father

EXIMIUS MEDICAL ADMINISTRATION SOLUTIONS SDN BHD., Megan Avenue 1, Block D 8-2, 189, Jalan Tun Razak, KUALA LUMPUR, 50450, TEL: 0321610440 FAX: 0321610431, www.emastpa.com Page 4

PLEASE READ CAREFULLY APPLICATION FORM WAIVER In exchange for the consideration of my job application by Eximius Medical Administration Solutions Sdn Bhd (hereinafter called the Company), I agree that: Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Eximius Medical Administration Solutions Sdn Bhd, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Eximius Medical Administration Solutions Sdn Bhd may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract. I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations. I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act. I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party. Signature of Applicant Date: 11th May 2011

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications. Thank you for completing this application form and for your interest in our business.

EXIMIUS MEDICAL ADMINISTRATION SOLUTIONS SDN BHD., Megan Avenue 1, Block D 8-2, 189, Jalan Tun Razak, KUALA LUMPUR, 50450, TEL: 0321610440 FAX: 0321610431, www.emastpa.com Page 5

TO BE COMPLETED BY APPLICANT Name as in NRIC: Izzati Abd Malik Present Address: 561 Jalan Tunku Putra Teluk Air Tawar 13050 Butterworth Home Tel: 04-3514609 NRIC No.: 870211-07-5088

Post Code: 13050 Home Tel: 04-3514609 STRICTLY TO BE COMPLETED BY EMPLOYER

State: Penang Spouse Tel No:

Position Approved For: Date of Employment: Location:

Salary:

Can work nights? Yes No Job Title: Rate of Pay:

Work Commencement Date Dept.: Full-time Part-time Salaried

Applicants signature acknowledging above information Drug Test Confirmation Number: Name of Person Verifying Information: Name of Person Authorizing Employment:

EXIMIUS MEDICAL ADMINISTRATION SOLUTIONS SDN BHD., Megan Avenue 1, Block D 8-2, 189, Jalan Tun Razak, KUALA LUMPUR, 50450, TEL: 0321610440 FAX: 0321610431, www.emastpa.com Page 6