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PositionPhoto

applied: ___________________________________
Interview date: __29th November 2016__ Time: 0900am___
APPLICATION FORM
SECTION A - JOB EXPECTATIONS

Expected Base Salary Allowance/Other Benefits

Preferred Job Type(s) Full-Time Contract: ___________ (Duration) Internship Part time

Earliest availability to join


Notice to current employer (duration) ___________ months
Aegis (dd/mm/yyyy)
Able to work on weekends
Ability to work on Rotation shift Yes / No Yes / No
& public holidays

SECTION B PERSONAL PARTICULARS


Name (As per
Tan King Ho
NRIC/Passport)

NRIC/Passport no. 941125-10-6015 Old NRIC/ Passport no.


Date of Birth
Age (years) 23 25-11-2016
(dd/mm/yyyy)
Place of Birth Klang Nationality Malaysian

Gender Male Race Chinese

Religion Buddhism Marital Status Single


Current residential address: 6 , lorong sanggul 4b, bandar puteri,klang , 41200, selangor

Permanent address (Expatriate to provide home country address):

Mobile 016-3648123
Contact number Email Address Tan1125@live.com.my
Landline

Next Of Kin (To be contacted in case of emergency)

No Name Relationship Contact no.

Train (LRT, MRT) Bus Car Motor


Mode of travelling to work (tick)
Others:
Preferred Work Location (tick) Menara 238 (KL) Symphony House (PJ)

House Family
Monthly financial commitments
(MYR) Car 450 Education
Others:

How did you know about this job opportunity?


Career website
Ricebowl
jobstreet.com
Career Fair

Aegis employee EE ID:


Social Media Facebook,
Newspaper, etc.
Walk-in

SECTION C FAMILY PARTICULARS


Spouse Name (As per
NRIC/Passport no.
NRIC/Passport)

Is your Spouse working? Yes No (if yes please provide information below)

Company Name Company Contact no.

Position held Children you are responsible for

Are any of your children OKU? Yes / No If yes, are they registered by Social Welfare Department (JKM)? Yes / No

Gender Date of
Name Age Birth Cert / NRIC No. Disability
(M/F) Birth
Name of Beneficiaries (For insurance purposes)
Name Relationship NRIC / Passport No. %

SECTION D EMPLOYMENT HISTORY

LATEST / CURRENT EMPLOYMENT DETAILS

Company

Company Specialization

Position Title

End date
Start date (mm/dd/yyyy)
(mm/dd/yyyy)

Reason for unemployment

Reason for resignation

Base Salary Commission Yes / No

Allowance

Medical Optical

Dental EPF/ SOCSO Yes / No


Benefits:
Others

Annual leave Medical leave

No. of months
Salary Increment period (month)
unemployed

1)
What do you like about your previous job
2)

1)
What do you dislike about your previous
job
2)
PREVIOUS EMPLOYMENT HISTORY
Month/Year
Employers Name Position Held Reason For Leaving Base Salary
From To
Sakae sushi Waiter 2011 2012 study 1200

Roichen kitchen club promoter 2016 2016 study 10 per hour

SECTION E REFERENCES (Please provide three referees from you previous employment)
No. of Years
No Name Position title Contact No.
Known
1

SECTION F SALARY CREDITING AND STATUTORY CONTRIBUTION / DEDUCTION


EPF no. Income Tax no.

Bank Name Bank Account no.

SECTION G EDUCATION BACKGROUND (From highest to lowest)


Name of University / Year
No. Qualification Field of Study Grade / CGPA
College/School From To

1 Segi university Diploma 2012 2014 Diploma in Marketing 3.5

Degree in General
2 Degree 2015 2016 3.0
Management

5
SECTION H LANGUAGE PROFIENCY (Pease tick where applicable)
Speak Read Write
No Language
Poor Fair Fluent Poor Fair Fluent Poor Fair Fluent
1 Mandarin yes yes yes
2 Cantonese yes yes yes
3 English yes yes yes
4 Malay yes yes yes
5

SECTION I MEMBERSHIP OF PROFESSIONAL INSTITUTES


Professional Year
No. Name of Professional Institute Membership Status
Designation Obtained From To
1

SECTION J WORK RELATED DECLARATION Yes / No Please give details


Do you have any friends/relatives working in
1 Aegis BPO Malaysia SdnBhd (previously known as No
Symphony BPO Solutions SdnBhd)?
Have you worked in Aegis Global? If yes, please
provide below information
2 Project Position held
Start date End date
Reason to leave Reason to rejoin
Have you been terminated from employment
3 before? If yes, provide details
Company Name Reason for termination
Have you been absent from work before? If yes, Number of
4 please provide details times
Company Name Reason for absenteeism
Have you been late for work in the past 3
Company name
months? If yes, please provide details
5
How many times Reason for lateness

Do you hold a directorship in any company? if


6 yes, please provide details

Company Name Specialization


Does anyone in your family carry out own
7 business? If yes, please provide details
Company Name Specialization
Are you involved in your family or part time
business? If yes, please provide details
Owner of
8 Your role in company
Business
Do you work full
Yes / No Your salary from company
time
Are you doing any part time job after working
hours or on weekends? If yes, please provide Company name
details
9
Position Salary

Work schedule
Have you been declared BANKCRUPT and/or
10 defaulted in any payment? if yes please state
when
Have you ever been convicted for any CRIMINAL
11
OFFENSES? If yes please state details
Do you have any court / legal appointment to
12 attend / settle? If yes, please state the reason
and date.

Do you have any financial issues with any


13
financial institution (PTPN, MBSB, bank etc...)

14 Are you willing to travel/relocate?

SECTION K - HEALTH RELATED DECLARATION Y/N Please give details and date of last occurrence
Have you ever resigned, or been denied a job on
1
health grounds?
Do you have high Blood Pressure/Heart
2
Attacks/Angina/Diabetes/Asthma?
3 Migraine or persistent headaches?
Eye conditions, restricted vision/Glaucoma /Iritis
4
/any other related condition?
Ear conditions, restricted conditions/Tinnitus/ear
5
infection/any other related conditions?
Problems related to alcohol or drug abuse/usage or
6
dependency?
Mental illness and /or stress related problems?
Nervous breakdown / Mental Fatigue / Anxiety /
Depression / Panic Attacks / Significant Sleeping /
7
Disturbances / Stress Related Problems / Eating
Disorders / Self Harmful / Suicidal / Any other
conditions
Have you consulted a specialist or needed any
8
operations other than already stated?
Are you receiving medical treatment at the present
9
time?
Do you take any form of regular medication? For
10
what health purpose?
Do you any other health issues that have not been
11 mentioned above or about which you would like to
provide further details?
12 Are you pregnant? If yes, how many months?
Have you take sick leave within the last 1 year of
How many
your employment? If yes, please provide below
sick leave
13 details
Top 3 reasons for sick
leave 1. _______________________ 2. _______________________ 3. ___________________
Have you been hospitalized within the last 2 years? If
yes, please provide below details
14 Reason for hospitalization

Duration of hospitalization

Do you have any follow up medical checkups? If yes, Reason


15
please provide details How frequent

SECTION L - BACKGROUND SCREENING QUESTIONS Yes / No Additional Information

Have you applied for any other jobs? If yes, please


provide details
1
Company Name Position applied
Company Name Position applied
Have you attended any interviews in the last 1
month? If yes, please provide details
2
Company Name Expected / offered salary
Company Name Expected / offered salary
Do you have any of your family members admitted
in hospital or they are very ill? If yes, please provide Relationship
3 details
Hospital name Reason for hospitalization

Are you planning to get married within the next 1


4
year? If yes, please indicate the date.

Are any of your family members getting married in


5
the next 1 year? If yes, please indicate the date.
Are you planning to further your studies in 1 year
Name of
time from now? If yes, please state what course and
institute
6 when will you start.

Course taken Start date of course

Do you have any pre planned leave? If yes, please


7
indicate when and how long?

Have you applied for any government jobs within Interview


the past 6 months? If yes provide details date
8

Position applied Interview result

DECLARATION
CTION K - DECLARATION
I hereby acknowledge that:-

1. Consent is given to the Company or its duly appointed agent to collect, record, store, use and process Personal Data,
as defined by the Personal Data Protection Act 2010 (PDPA), concerning and relating to myself, including any sensitive
personal data, for the purposes of processing this employment application for the Companys consideration, and if
successful, would form part of the employment records with the Company (Purpose).
2. Such Personal Data may include, but is not limited to the following:-
a. Information provided via forms required by the Company
b. Information from any pre-employment checks, such as medical, bankruptcy, credit and criminal checks deemed
necessary by the Company in relation to the Purpose
c. Information regarding any family members, referees and/or any such other person(s) deemed necessary by the
Company in relation to the Purpose
d. Records of any correspondence and/or communication with representatives of the Company
3. All Personal Data provided is accurate, complete, not misleading and up-to-date and Personal Data of third parties
provided is given with the prior consent from the relevant parties, failing which I indemnify the Company against any
claims.
4. Consent is given to the Company to disclose any such Personal Data to any third party including the Companys duly
appointed agent, relevant authorities, subsidiaries, insurers, hospitals, clinics and/or any such person(s) as deemed
necessary by the Company in relation to the Purpose.

I hereby declare that the information given by me in this form is correct and true to the best of my knowledge. I fully
understand and accept that if at any time after employment engagement with the Company, it is found that false
declarations have been made in this form, the Company has absolute right to terminate my employment forthwith.

Signature of applicant: NRIC number:

Name of applicant: Date:


INTRODUCE YOUR FRIENDS TO US!!!

Name
EE ID
Contact
No.

No Friend Name Contact No Email


1
2
3
4
5

CONSENT FOR REFERRALS - PERSONAL DATA PROTECTION ACT 2010

The above matter refers.


I have provided Aegis BPO Malaysia Sdn. Bhd. (Aegis) with names and contact details (Personal
Data) of potential candidates, for employment purposes with Aegis.

I hereby represent, warrant and covenant that I am authorised to disclose all Personal Data that I have
provided to Aegis and I have obtained all consents, permits, authorizations and notice necessary from
these potential candidates to permit such disclosure and transfer to Aegis and use thereof by Aegis as
required by the Personal Data Protection Act (PDPA) 2010, for the purposes abovementioned.
All the Personal Data acquired by Aegis from me shall only be used for the purposes of hiring new
employees (Employee Referral Program).
I hereby fully indemnify Aegis for any breach of the PDPA 2010 legislation on my part which may
render Aegis liable for any costs, claims or expenses, howsoever arising.

I hereby declare that the information given by me in this form is correct and true to the best of my
knowledge. I fully understand and accept that if at any time after employment engagement with the
Company, it is found that false declarations have been made in this form, the Company has absolute
right to terminate my employment forthwith.

Name of Applicant: Signature of Applicant:

NRIC: Date:

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