PHILIPS ELECTRONICS SINGAPORE PRIVATE LIMITED

CANDIDATE INFORMATION FORM

Name:

__________________________________________________________

Position Applied:

__________________________________________________________

Please complete the following salary details. If there are fields which are non-applicable to you, please indicate N/A.

PART I:

MONTHLY REMUNERATION

Base Salary: _______________________

Fixed Allowance:
(e.g. transport, mobile, shift, meal,
standby)

(type: ________________) Amount: ________________

(type: ________________) Amount: ________________
(type: ________________) Amount: ________________
(type: ________________) Amount: ________________

Note: Monthly fixed allowance does not include allowances that are of reimbursement nature, overseas travel allowance and car loans.

PART II:

ANNUAL WAGE SUPPLEMENT (AWS)

Amount: _____________________
Date of last AWS received: _________________ (mm/yy)
Date of next AWS payout: __________________ (mm/yy)

PART III:

VARIABLE BONUS (VB)

Please provide the VB received for the last 3 years in your current or last employment, where applicable.
Year 20___:

Amount: ____________________

Percentage: ____________________

Year 20___:

Amount: ____________________

Percentage: ____________________

Year 20___:

Amount: ____________________

Percentage: ____________________

Date of last variable bonus received: ___________________ (mm/yy)

Date of next variable bonus payout: ____________________ (mm/yy)
Payout frequency: monthly / quarterly / yearly (please circle where applicable)

STRICTLY CONFIDENTIAL

PART IV:

PERFORMANCE BONUS (if different from Variable Bonus)

Please provide the performance bonus received for the last 3 years in your current or last employment, where applicable.
Year 20__:

Amount: ____________________

Percentage: ____________________

Year 20__:

Amount: ____________________

Percentage: ____________________

Year 20__:

Amount: ____________________

Percentage: ____________________

Date of last performance bonus received: ___________________ (mm/yy)

Date of next performance bonus payout: ____________________ (mm/yy)
Payout frequency: monthly / quarterly / yearly (please circle where applicable)

PART V:

OVERTIME

Please provide average overtime earned per month.

PART VI:

STOCK OPTIONS

Please provide details like no. of shares owned, current price of share, date of maturity and payment date. Please attach a copy of the latest stock
statement for verification.

PART VII:

SALARY

Last Salary Review Amount: _________________

Date of Next Salary Review: _________________
Expected Salary: ________________

PART VIII:

BOND

Are you bonded by the company? If yes, please indicate how much is the bond amount and last day of bond.

PART IX:

NOTICE PERIOD

_________________ (pls also state no. of Annual leave days available to offset, if any)
Earliest Available date: ____________________

PART X:

ANY OTHER FIXED REMUNERATION OR SPECIAL REMAKRS

________________________________________________________________________________________________________
________________________________________________________________________________________________________

STRICTLY CONFIDENTIAL

PART XI :

CHARACTER REFEREES (only Immediate Managers or Supervisors)

Name:

Name:

Occupation:

Occupation:

Company Name:

Company Name:

Contact No.:

Contact No.:

Relationship :

Relationship :

GENERAL INFORMATION

Yes

No

Have you ever applied for any job in Philips?

If yes, please provide date, business unit and post applied for.

Yes

No

Are you currently serving any bond with your present employer?
If yes, please give details.

Yes

No

Do you have any handicaps/limitations (physical, mental, others),

illness, medical problems or are under any long-term medication
(hyper-tension, diabetes, others)?
If yes, please provide details.

Yes

No

Have you ever been discharged or dismissed from service of

past employers? If yes, please give details.

Yes

No

Have you ever been declared a bankrupt?

If yes, please give details.

Yes

No

Have you ever been convicted of any criminal offences?

If yes, please provide details.

Yes

No

PART XII:

Do you have any friends / relatives working in Philips?

If yes, please provide name, division and department.

Where did you learn about the position you are applying for?
Philips Career Center

News Paper

Internet Jobs Site

Philips Employee Referral (Name of Referrer:

PART XIII:

Others:
; Employee No. of Referrer:

PRE-EMPLOYMENT STATEMENT

I consent to taking the pre-employment physical examination and any future physical examinations as may be required by the Company. I agree to wear or use
protective clothing or devices as required by the Company and to comply with all the safety rules and regulations as are in force. I agree that the entire contents
of this form, as well as the report of any such examination, may be reasonably used by the Company at its discretion. I agree to abide all rules, regulations and
polices of the Company, if successful in securing employment with the Company.
I acknowledge and agree that any false declaration, answer or statement made by me on this form or any supplement thereto, will render me disqualified and/or,
will be sufficient grounds for immediate dismissal.

Applicants Signature:

STRICTLY CONFIDENTIAL

Date :