Employment Application Form

Position applied ________________________________ Date ________________________________

Name ______________________________________________________________________________________________

Present address _____________________________________________________________________________________

Telephone_____________________________________ Mobile_____________________________________

Are you 18 years of age or older? _____ Yes _____ No Date of Birth_____________________________________

Gender _____________________________________ NRIC No. _____________________________________

Race _____________________________________ Religion _____________________________________

Marital Status ______________________________ Name of Spouse (if married) _____________________________________

No. of Children (if married) ______________________________ Income Tax File no. __________________________________

EPF no. ______________________________ SOCSO no. __________________________________

Do you have reliable transportation to and from work? _____ Yes _____ No

Class of vehicle __________________________________

HAVE YOU EVER (1) been convicted of or pled guilty to a felony or (2) been released from prison after having served a sentence for a
felony or (3) arrested, held for investigation, questioning or charged by any Law Enforcement Authority? A past conviction will not
necessarily disqualify you from employment.  Yes  No

If yes, please explain __________________________________________________________________________________________

Education background
School/College Attended Year Examination passed

Language ability
Language Understanding Speaking Writing
V. Good Good Fair V. Good Good Fair V. Good Good Fair
Bahasa Malaysia

English
Mandarin

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Employment Application
WORK EXPERIENCE Please list information for the past two positions held

Name of employer Employment dates Your last job title

From

To

Address , Phone number Reason for leaving

Name of employer Employment dates Your last job title

From

To

Address , Phone number Reason for leaving

Have you previously been employed at Engineered Medical Systems Malaysia Sdn Bhd? Yes No

If yes, when? ____________________________ Position _______________________ Reason you left _________________________

Do you know anyone working with Engineered Medical Systems Malaysia Sdn Bhd? If Yes, Please indicate name and designation.

________________________________________________________________________________________

May we contact your past/present employer(s)?  Yes  No

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below
to summarize any additional information necessary to describe your full qualifications for employment at Engineered Medical Systems
Malaysia Sdn Bhd or you feel may be relevant to other positions as they may be come available. Please include certifications, licenses,
special training, etc.

Please list two references other than relatives or previous employers.

Name ________________________________________ Name ____________________________________________

How do you know this person? How do you know this person?

_______________________________________________ _______________________________________________

Address ______________________________________ Address __________________________________________

______________________________________ __________________________________________

Telephone ___________________________________ Telephone ___________________________________

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Employment Application
Did you complete this application yourself  Yes  No

If not, who did? ______________________________________________________________________________________

Date available for employment ________________________________

Expected salary____________________________________________

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Engineered Medical Systems Malaysia Sdn Bhd., I agree that: Neither the
acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any
other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like
as they may exist from time to time, or other EMS-M practices, shall serve to create an actual or implied contract of employment, or to
confer any right to remain an employee of EMS-M, or otherwise to change in any respect the employment-at-will relationship between
EMS-M and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President or Vice
President or Managing Director of EMS-M. Both the undersigned and EMS-M may end the employment relationship at any time, without
specified notice or reason. If employed, I understand that EMS-M may unilaterally change or revise their benefits, policies and
procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called
for is cause for dismissal at any time without any previous notice. I hereby give EMS-M permission to contact schools, previous
employers (unless otherwise indicated), references, and others, and hereby release EMS-M from any liability as a result of such contact.

I also understand that (1) EMS-M has a drug and alcohol policy that provides for pre-employment testing as well as testing after
employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on
the successful passing of testing under such policy. I further understand that continued employment may be based on the successful
passing of job-related physical examinations.

I HAVE READ, REVIEWED, and UNDERSTAND the contents of this application AND AGREE TO THE TERMS SET FORTH IN THIS
APPLICATION AND THE ABOVE STATEMENTS.

Signature of applicant_______________________________________________________________ Date: ___________________

EMS-M is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race,
color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment
with EMS-M depends solely on your qualifications.

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Employment Application