3ecent Photo

BakesIsMukargar
EMPLOYMENT APPLICATION FORM

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muxtMENgesIsMu
Position applying for:

R)ak;ebovtS kEngeFVI r_EdlrMB g kar !uk Location:

Expected Salary: /M

1.

!"nn#$%a&l;x'n(PERSONAL DATA

)*+(Ex( !IkEngkMen sBa-at"((#ationality: ,aMkMeNIt Date of It((Place of Birth: Phno" $h"er

Birth:20-Fe -!! Penh
o

elx.t/sBa0aNb#N1(( elxl"x"t,gEdn((Passport # :
%D &ard #o:

s2an3aB.aBa4_B"Ba4_((Marital stat's: en5lIv((Single erobkar((Married o .as$d6anb789b:n(( .as$d6an.7")Rn/$_( Present address: 0sMrab;Etbu<=l"kbre!s (2)* Street 20)* Sang+at Phsar Doe'" ,h+o-* $han &ha"+a"orn* Phno" Penh &ity bMeB>1(Per"anent /ddress 0For 2-erseas E"ployee 2nly1 elx!;rs#B&((,elephone #o.
016586376 E-"ail /ddress: ouch.then !hot"#$%.co"

elx!;rs#B&((,elephone #o.
E-"ail /ddress:

B?tman.MBIsma@"kR<Asar((Fa"ily "e" er infor"ation:

eBCaD((
#a"e &hhi" 2'ch $ann 7y 2'ch ,hea 2'ch 7'thy 2'ch Leng

!Mnak;!M muxtMENg elx!;rs#B B'siness Position ng(( &((

3elationship Father Mother Sister 2nd rother 9th rother ,elephone #o. 6or+er Seller #o ha-e 6or+er St'dent 0)58!59:5

kar!Mnak;!MngeBlman.asn((%n case of e"ergency contact: eBCaD(( !Mnak;!M muxtMENg elx!;rs#B #a"e B'siness Position ng &((
3elationship ,elephone #o.

etI.kman!Mnak;!Mng@amA$bu<=l"kEdrrEe !F(Do yo' ha-e any relationship ;ith staff< )a!((=es e!((#o o Rbs"nebImans;m%/l;B?tmanxageRkam(if the ans;er is
>yes>* gi-e the follo;ing infor"ation:

eBCaD((
#a"e

)*+(Ex( muxtMENg !Mnak;!M Position ,aMkMe ng 3elationship NIt

Date of irth

&o D#%$n

7MeNDd g!;e!5(((ENERAL ED)CATION s;m%/l;B?tmanlM."t s;m%/l;eBCaDmuxv"@ -an"g(kMr"ts"kSae.a$)an7:as;las; Please gi-e f'll details
'. exact titles or degrees.

BI(Fro" dl;(,o eBCaDsaklv"! Ex( Ex( kMr"tEdl! muxv"@ Month/ Month/ al#$( !Al)an( -a( ,a ,a Degrees o tained #a"e 0?ni-ersities or E@'i-alent1 MaAor of st'dy M(=ear M(=ear

#ational ?ni-ersity of Manage"ent #orton ?ni-ersity

Oct*'013

P+e,ent

M#,te+

M&A

B. &o'rses.

v<=bN/9DbNa/l(rE(v<=s"kSaxIG((For"al ,raining or Short

BI(Fro" dl;(,o sBa0ab Ex( Ex( #Rt(rE( eBCaDR< Hs2 Rbe3!mu Month/ Month/ l"x"tbBa ans"kSa( xv"@-a ,a ,a -ak;kars" #a"e of instit'tion ,ype of s' Aects M(=ear M(=ear kSa
&ertificates or Diplo"as o tained

3.

3asabre!s((FOREI(N LAN()A(ES .an((3ead sresr((6rite ex m lI ex m lI 3asa( Sa F Bood Sa F Bood Lang'age $ m $ m

Poor Fair Poor Fair

n"$a$((Spea+ ex m lI Sa F Bood $ m
Poor Fair

s/ab;((Listen ex m lI Sa F Bood $ m
Poor Fair

ExCr(
$h"er

.g;e< s((English 7"n(

Mandarin

Rbvt"/kargar EMPLOYMENT .ISTORY <"t7ab;e%/ImBImuxgarb789b:n( e4I$erobrab;tamlMdab;n;vral;kargarEdl.k) aneFVI(Starting ;ith yo'r present post* list in re-erse order e-ery e"ploy"ent yo' ha-e had.
-.

muxgarb789b:n(0muxgar7ugeRka$( ebIs"n@ab789b:n<aCnkargar1( Present Post 0(Last Post* %f #ot Presently %n E"ploy"ent1 /. muxtMENgB"tR)akd((Exact title of yo'r post: BI((Fro" dl;((,o R)ak;ebovt %lRbe$a@n_e%SgG(2ther Benefits: Sr_Rb7aMEx(
Monthly Basic Salary 0?.S Dollar1

Ex( 7ab;e bBa8 Month/ Month/ %/Im b; ,aM( ,aM( Starting Ending
year year

Ex(

eBCaDRkum4Jun(rE.g=kar &o"pany/2rganiCation #a"e: .as$da6nn"e$a@k /ddress of

e"ployer:

eBCaDRbFan #a"e of
s'per-isor:

m;le4tulaBb;BIkarga r 3easons for lea-ing: karB"B?Nna3ark"78 Description of yo'r d'ties

B.

muxtMENgB"tR)akd((Exact title of yo'r post: BI(Fro" dl;(,o R)ak;ebovt %lRbe$a@n_e%SgG(2ther Benefits: Sr_Rb7aMEx(
Monthly Basic Salary 0?.S Dollar1

Ex( 7ab;e bBa8 Month/ Month/ %/Im b; ,aM( ,aM( Starting Ending
year year

Ex(

eBCaDRkum4Jun(rE.g=kar((&o"pany/2rganiCation #a"e:

.as$da6nn"e$a@k /ddress of
e"ployer:

eBCaDRbFan #a"e of
s'per-isor:

m;le4tulaBb;BIkarga r((3easons for lea-ing: karB"B?Nna3ark"78 Description of yo'r d'ties

Kksare$ag(REFERENCES erobrab;mnusS( Lnak;Edlm"nBak;BnM#@amA$.k( e4I$sa=l;BI7r"tlkNNH( n"g<uNsm:t"/rbs;.k(

5. List three persons* not related to yo'* ;ho are fa"iliar ;ith yo'r character and @'alifications.

eBCaD F'll na"e

.as$d6an( n"gelx!;rsB&#!Mn ak;!Mng

/ddress and contact n'" er

muxtMENg
2cc'pation

6.

.MnH.Mnagrbs;ebkN@n APPLICANT/S DECLARATION

Os;mbBa-ak;*a( ral;B?tman!aMg.s;Edl)an%/l;xagelI( <EB"t@aRt mRt;v(eB>el>( n"g@ak;lak;B"tR)akdEmnP(

% certify that all data and infor"ation ;hich % ha-e pro-ided a o-e are tr'e* co"plete* and correct to the est of "y +no;ledge and elief.

DDDDDDDDDDDD.

DDDDDDDDDDD

4t2elxaebkN@n Signat're of /pplicant kalbr"e7Q!((Date EEE sM<al;(Note0 s;m3-ab;mk@amA$n;vKksar*t7Mlg(d;7@a( .t/sBa0aNb#N1(rE(l"x"t,gEdn( esove35R<Asar(sMbuRtkMenIt(n"gsBa0ab#Rt( rEKksare$age%SgGe!otmk@amA$%gP(
Please attach ;ith a copy of yo'r %D &ard or Passport* Fa"ily Boo+* Birth &ertificate* Ed'cational and 3ele-ant &ertificates or doc'"ent.