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PUBLIC BANK GROUP APPLICATION FOR EMPLOYMENT

PLEASE NOTE : ALL INFORMATION SUPPLIED WILL BE HELD IN STRICTEST CONFIDENCE DELETE OR WRITE NIL WHERE NOT APPLICABLE ATTACH APPENDIX IF SPACE PROVIDED IS INSUFFICIENT

Please affix recent passport size photograph here (nonreturnable)

I. PERSONAL PARTICULARS Full Name as in I.C. (include aliases, if any) Residential address (include postcode) Postal address (if different from residential address) E-mail address Telephone No: i) iv) House ii) Handphone iii) Office

Other convenient place (Please indicate name of contact person) Income Tax No. Date of Birth Race Weight (kg) Hometown EPF No. Age Height (cm) Religion Place of Birth

Socso No. Sex I.C. No. (Enclose photocopy) Nationality Driving Licence No. & Class

(Please state whether licence is a full or provisional L licence) II. FAMILY PARTICULARS i) Marital Status : Single/Married/Widowed/Separated/Divorced If married, please complete the following : Spouses Name Spouses Occupation I.C. No. Name of Company

(REV 09/12)

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II. FAMILY PARTICULARS, cont. Name of Children Sex Age Date of Birth School/Occupation

ii)

Fathers/Guardians Name Mothers Name Parents/Guardians Address Name of Brothers/Sisters Sex Age Occupation

Occupation Occupation

Name of Firm/School

III. EDUCATIONAL/PROFESSIONAL QUALIFICATIONS (Please attach copies of testimonials/certificates/transcripts) i) Name of School, College and/or University From (Year) To (Year) Qualifications Achieved Grade (include CGPA where applicable)

(REV 09/12)

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III. EDUCATIONAL/PROFESSIONAL QUALIFICATIONS, cont.

ii) PROFESSIONAL/COMMERCIAL COURSES BEING UNDERTAKEN


Name of Course Manner of Study Stage/Sections successfully completed Self imposed target date for full completion of the course

IV. LANGUAGES AND DIALECTS (Please indicate your mother tongue within brackets)

i) Spoken ii) Written


V. EMPLOYMENT HISTORY (List current/latest employment first)
Date From To Name & Address of Employer Position(s) Held Basic Salary & Name, Designation Allowances & Contact No. Of Initial Last drawn Immediate Supervisor Reasons for Leaving

(REV 09/12)

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VI. OTHER INFORMATION i) ii) iii) iv) v) vi) vii) viii) Have you any outstanding loans/credit line? Do you or any of your immediate family members* have any borrowings from any Company in the Public Bank Group? Have you ever been charged or convicted of a criminal offence? Are you a bankrupt? Do you have any independent means of other sources of income? Are you currently holding any directorship in any Company? Do you have any physical disabilities, chronic ailment or handicap? Have you suffered from any major illness, nervous breakdowns or accidents which require hospitalisation? Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

Immediate family members include parents, spouse, children, their spouse, siblings and their spouse.

If you have answered Yes to any of the above, please provide details in the space provided.

vii)

Have you ever applied to or been interviewed by any company in the Public Bank Group? (If yes, please indicate position applied, date interviewed (if any) and name of Company)

Yes/No

VII. RELATIVES List below any of your relatives who are (i) working in the Public Bank Group, or (ii) Unit Trust/Insurance Agents, or (iii) both of the aforementioned. Name of relative Relationship Name of Company/Agency

VIII. SHOULD YOU BE SELECTED PLEASE INDICATE i) ii) iii) Expected Salary (RM) Period of Notice Required Date able to commence duty : : :

IX. DECLARATION I hereby declare that the particulars and answers given in this application form are to the best of my knowledge and belief true and correct. I understand that the company reserves the right to terminate my service without notice or compensation at any time should the company discover that any of the said particulars and answers were false, untrue or incorrect at the time of completion of this form. I hereby undertake to notify the company immediately should the particulars supplied above be changed in any way in future.

Signature of Applicant :
(REV 09/12) -4-

Date :