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PINTARAS GROUP

8, Jalan Majistret U1/26, Hicom-Glenmarie Industrial Park 40150 Shah Alam, Selangor Darul Ehsan

Photograph

APPLICATION FORM
Position Applied For :
PERSONAL PARTICULARS
Name (In block letter & underline surname) :

Tel No. :

(Home)

Present address :

Tel No. :

(H/P)

Tel No. :

(Off)

Permanent address:
NRIC No.:

(new)

Date of Birth :

Place of Birth :

Race:

Income Tax No. :

Branch :

EPF No.

Weight :

kg

Height :

Marital Status (delete where necessary) :

cm

(old)

Gender :

Age :

Nationality:

Religion :

Single / Married / Divorced / Widowed

Name of Spouse :

Spouse : Working / Not Working

Spouses NRIC No.:

Spouses Occupation:

No. of Children :

Children Ages :

In the event of emergency, notify


Name :

Relationship :

Contact No.:

(H/P)

Address :

HEALTH
Any major illness or accidents suffered since birth (please give approximate date) :
Physical disabilities or handicap (please specify) :

EDUCATION (Please attach all relevant certificates)


Type of School

Name of School

From

To

Courses Majored In

Degree/Diploma/Certificate
Completed

Secondary School
Commercial/Tech. Inst.
University
Professional Institution
Are you now enrolled in any course? If yes, name of the institution :
Name of Course (s) :
Doc. Ref. : PJB/HRM/AF

Duration :
Rev. No. : 1

Issue Date: 01/07/2014

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LANGUAGES
Please state level of proficiency Excellent / Good / Fair
Language

Spoken

Written

Read

Bahasa Malaysia
English
Mandarin
Other, please state

SKILLS
Computer Used :

Other skills

Computer Software :
Possess Driving Licence:

Yes

No

If yes, please specify the class :

EXTRA CURRICULAR ACTIVITES (Athletics, Clubs, etc.)


In School / Institute / Elsewhere

Position Held

Approximate Dates

EMPLOYMENT HISTORY (Please start with current or last employment )


Have you worked in Pintaras Group before?

Yes

No

Date Joined :

Position :

Department :

Last Salary :

Name of Company

Position Held

Periods (mm/yyyy)
From
To

If yes, please provide the following details:

Basic Salary
per month

Reason for Leaving

Job Responsibilities :

Job Responsibilities :

Job Responsibilities :

Job Responsibilities :

Doc. Ref. : PJB/HRM/AF

Rev. No. : 1

Issue Date: 01/07/2014

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REFERENCES
Name of Referees

Contact No.

Occupation

Years Known

OTHER INFROMATION
If your application is considered favourably,
- what is your expected salary ? (RM)
- when will you able to start work? (dd/mm/yyyy)
- how many month(s) notice do you need to give your present employer? (months)

DECLARATION
1 Are you suffering from any illness, mental disorder or physical impairment?
2 Are you being or have you been sued in any Court of Law?

Yes
Yes

No
No

Yes

No

4 Have you been dismissed or suspended from the service of any employer?

Yes

No

5 Have you been convicted for any criminal offence in any Court of Law in any country?
6 Have you received any medical treatment from any hospital(s) and/or medical specialist(s)
during the last three (3) years? (If Yes, please give details)

Yes

No

Yes

No

Are you presently / have your ever been under investigation for fraud or any misconduct
whatsoever by your current or past employer?

Name of Hospital :

Nature of illness :

7 Do you have any relatives or friends currently employed at Pintaras Group?


(If Yes, please give details)
Name :

Relationship :

Department :

Company :

Yes

No

PERSONAL DATA PROTECTION ACT 2010


The personal data collected in this Application Form will be used by the Company/Group for purposes on relation to your job
application. These purposes include, but are not limited to the following:
to assess your suitability to the job position applied for;
to conduct reference and background checks;
to verify information provided in the application form; and
if selected and employed, to process / use your personal data within the meaning of the Personal Data Protection Act
2010.

DECLARATION
I hereby declare that all the above particulars and answers given by me are true and correct in every aspect to the best of my
knowledge. I authorized verification of all statements, answers and personal data to questions herein contained for
consideration of employment and if employed, I agree and authorize the Company to process, use & disclose my personal data
on any issue related to my employment within the meaning of Personal Data Protection Act 2010. I understand that any false
declaration, misrepresentation, misleading statements, or omission of facts called for herein will render the contract of service
between us void to no legal effect and cause for termination.

Date :

Doc. Ref. : PJB/HRM/AF

Signature of Applicant :

Rev. No. : 1

Issue Date: 01/07/2014

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FOR OFFICE USE ONLY


Is the candidate competent?

Yes / No / partial (please delete as appropriate)

Interviewers Comments :

Decision : Recruit / Reject (please delete as appropriate)

Signature :
Name :
Position :

Date of Interview :
Reviewing Officers Comments :

Date of Review :

Name of Reviewing Officer :

To be completed by HR Dept.
Hired for Post of

Company

Salary to be offered

Recruiting Department

Allowance (if applicable)

Date Joined

Doc. Ref. : PJB/HRM/AF

Rev. No. : 1

Issue Date: 01/07/2014

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