Employment Form Details



FAMILY INFORMATION [Parents, brothers, sisters, spouse, children]

Name Relationship DOB Age Gender Occupation Place Of Work
Note: DOB for children is mandatory to facilitate benefits claim
In the event of emergency, please contact :


Major Social, Leisure and Sporting Activities especially Achievements and Positions of Responsibility


Qualification Institue / Country From To Full Time / Part Time


Qualitfication Institue / Country Commencement Date Expected Date of Completion

LANGUAGES/ DIALECTS [State level of proficiency - Fluent/ Fair/ Slight]

Language / Dialect Spoken Written Read

EMPLOYMENT HISTORY [Please start with current employment & give details of employment including vacation work and industrial training. Use attachments where necessary]

Periods Position Held & Organization Name, Address and Telephone No. Brief Job Description Basic Salary Per Month Reason of leaving
From To


1. Are you suffering from any illness and/or medical condition, mental disorder or physical impairment?
2. Are you bound by any bond to serve the government, or any organization?
3. Have you been charged or convicted in a court of law in any country, or an offence involving fraud or dishonest act or violence or in respect of banking, securities and insurance laws?
4. Have you been charged with any offence in a court of law in Malaysia or any other country for which the outcome is not yet known?
5. Have you engaged in any business practices appearing to be deceitful or oppressive or which otherwise reflect discredit on your method of conducting business?
6. Have you been dismissed or suspended from the service of any employer?
7. Are you presently/have you ever been under investigation for fraud or other dishonest act or misconduct whatsoever by your current or past employer?
8. Are you a bankrupt or a discharged bankrupt, whether within or outside of Malaysia?
9. Do you have any secured and/or unsecured debts?
10. Are you being or have you been sued – in any Court of Law?
11. Are you in default of payment of any debt?
12. Are you or have you been a director, manager, agent or guarantor of any company, including one which has been wound up?
13. Do you have any other sources of income besides your salary?
14. Have you applied to us previously?
If yes to any of the above, please give details here.
15. # May we contact your previous employer[s]?
16. # May we contact your present employer[s]?

# CHARACTER REFEREES [Present, past & immediate superiors]

Name Relationship [Manager/Supervisor] Occupation Telephone Office Address/ Email Address


[Which you may wish to add]: