Full Name (as given in IC) Other Names (if any) Sex Date of Birth Age Place of Birth Nationality
Nama Penuh Name Lain Jantina Tarikh Lahir Umur Tempat Lahir Warganegara
Home Address / Alamat Rumah Present Address if different from home address
Alamat kini jika berlainan dari alamat rumah
If you have a relative employed in RSH, please state : Next of Kin: Occupation of Spouse: Spouse’s Date of
birth :
Name : Name :
Department: Address :
No of Children :
Relationship : Relationship :
Tel No:
Please give details and dates of any serious illnesses/operations/allergies Please give details of any previous convictions (including traffic offences)
Date Salary
Name and address of employer Position Reason of Leaving
From To Start Finish
Please give details of members of your immediate family (i.e. Parents / Brothers / Sisters / Children )
Sila beri maklumat mengenai keluarga (seperti ibu, bapa, abang, kakak, adik, anak)
REMUNERATION / GAJI
Hobbies, Sports, Interest Membership of Societies and Clubs and offices held :
Please use this space to state details of past warning letters/demotion/disciplinary actions (include reason) by past employers:
Please use this space to state your pre existing illness/medical conditions:
Please use this space to give any additional information in support of your application (e.g. aims, ambitions, special aptitudes) :
REFEREES / RUJUKAN
Please give name and address of 2 referees. We will not contact them without your prior consent.
1) Previous employer 2) Private Referee
Date of previous application and position applied for with this Company When would you free to join this Company?
(Approximate date)
I CERTIFY THAT THE ABOVE INFORMATIONS TO THE BEST OF MY KNOWLEDGE CORRECT AND I AM AGREEABLE TO THE
COMPANY TAKING DISCIPLINARY ACTION AGAINST ME IF ANY INFORMATION IS FOUND TO BE FALSE IN DUE COURSE.
SAYA MENGESAHKAN BAHAWA SEMUA MAKLUMAT YANG DIBERIKAN DI ATAS ADALAH BENAR ATAS PENGETAHUAN SAYA
DAN SAYA SETUJU BAHAWA PIHAK SYARIKAT AKAN MENGAMBIL TINDAKAN DISIPLIN TERHADAP SAYA SEKIRANYA DIDAPATI
MAKLUMAT-MAKLUMAT YANG DINYATAKAN ADALAH PALSU.
Reporting To : _______________________________________________________________________________________________________
____________________________________________________________________________________________________________________
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