AFFLUENT OASIS SDN.BHD.

(CompanyNo: 1242574-T)

EMPLOYMENT REFERENCES
Name . Title / Position
Company Relationship
Contact Number . E-mail

Name . Title / Position

Company : Relationship

Contact Number • E-mail •

Name . Title / Position .

Company . Relationship

Contact Number : E-mail •

REFERENCE CHECKING CONSENT AND AUTHORIZATION FORM
 AFFLUENT OASIS SDN.BHD.
(CompanyNo: 1242574-T)
Disclosure
Please read the information on this form carefully and completely
I have applied for employment with Affluent Oasis Sdn.Bhd and have provided information about my
previous employment. I authorize Affluent Oasis Sdn.Bhd to conduct a reference check with my previous
employer(s). I understand that reference information may include, but not be limited to, verbal and
writeen inquiries or information may include, but not be limited to, verbal and written inquiries or
information about my employment performance, rehire potential, dates of employment, salary and
employment history.
My signature below authorizes my former employers and reference to release information regarding my
employment record with their organizations and to provide any additional information that may be
necessary for my application for employment to Affluent Oasis Sdn Bhd, whether the information is
positive or negative. I knowingly and voluntarity release all former employers, references, and Affluent
Oasis Sdn Bhd from any and all liability for arising of their giving or receiving information about my
employment history, my academic credentials or qualifications, and my suitability for employment with
Affluent Oasis Sdn Bhd
This form may be photocopied or reproduced as a facsimile, and these copies will be as effective as a
release or consent as the original which I sign.
Name • Signature .
IC No: Date .

Driving Lisence
gk
Interest HYobbies or Sport
*f:
LANGUAGE PROFICIENCY (Please tick)
Spoken Good f Fair N/A

Bahasa Malaysia y *
Written
 AFFLUENT OASIS SDN.BHD.
(CompanyNo: 1242574-T)
Spoken
English -ki#
Written

Spoken
Mandarin
Written

Spoken
Other (PleaseSpecify)
Written

I hereby authorize AFFLUENT OASIS SDN.BHD. ("The company") to collect, store or process any information
(including personal data) concerning me, including information provided in this application, to asses my
suitability to assume the works or duties of the position for which I have applied and to determine the
remuneration and benefits package subject to selection of the Company for the position. I understand that
the personal data collected, stored or processed may be retained by the Company limited to my tenure of
employment only and I agree to authorizesuch retention of such personal data because it is the Company's
policy to retain the personal data of unsuccessful applicant for future recruitment purpose.

I here declared that all the particulars provided are true to the best of my knowledge and that I have not
suppressed any material fact. If after engagemenr of employment, it is found above that I have made a
false declaration or this form, the Company reserves the right to terminate my service without any notice
and compensation

Signature Of AppliCant . Date

EDUCATION HISTORY
YEARS
EDUCATION INSTITUTION NAME FROM QUALIFICATION
COMPLETED
SECONDARY SCHOOL

COOLEGE OR
UNIVERSITY
OTHERTRAINING/COUR
SES/COMPLETED/CURR
 AFFLUENT OASIS
SDN.BHD.
(CompanyNo: 1242574-T)

ENTLY/PURSUING

PREVIOUS & PRESENT EMPLOYMENT (be

START DATE END NAME OF COMPANY, LAST POSITION DESCRIPTION
DATE ADDRESS & TELEPHONE DRAWN TITLE/ OF DUTIES
NUMBER SALARY DUTIES
SKILL

Reason for Leaving

Reason for Leaving

Would you give your consent to os to refer to your

previous employers? Yes No
APPLICATION OF EMPLOYMENT
Date El Time
The information given to us in thisfrom will be kept strictly confidential

Position Applied For

Current Salary Expected Salary

Date Available E] Interview By

PERSONAL PARTICULARS
 AFFLUENT OASIS
SDN.BHD.
(CompanyNo: 1242574-T)

Name (as per IC) Alias

IC No
Address
Post Code . Contact No +81
E-mail
Gender Male } Female k
Marital Status Single Married Divorced Widowed
NO Of Child Below 18 Years ( Above 18 Years
Date of Birth El Place of Birth E]
Race Malaysia Chinese India ÉP Other
Muslim Buddhist
Regilion Hindu Christian Other
Nationality Malaysia Permanent Resident Non-Permanent Resident
Spouse Particular
Name Occupotion 4R±lk:

Have you ever claimed compensation for any injury before? If yes, when and where:
YES NO
? , ,fEJ

Please give details of any disability, impairment , disease or serious illness that you suffer from
now or have been afflicted with previously: 4th (h, YES NO

Have you ever been charged and/or prosecuted for any criminal act before? If yes, what was the
charge(s) and the outcome of the case: YES NO

Have you ever been declared bankrupt by the court? If yes, what was the charge(s) and
YES NO
the outcome of the ép kf ,
Do you have friends orrelative(s) working with Affluent Oasis If yes, please state name and
position: if YES NO
 BORANG MAKLUMAT PENGAMBILAN PEKERJA

PERMOHONAN JAWATAN MASA :

NAMA WARGANEGARA UMUR

JANTINA PERKAHWINAN No. TELEPON

KETINGGIAN KESIHATAN ICNo.

PROFESIONAL KOLEJ TAMAT PENGAJIAN E-

MAIL
SIJIL KELAYAKAN STATUSKESIHATAN
iiE -9

AGAMA ISLAM BUDHA INDIA EP KRISTIAN

KAUM MELAYU INDIA EP CHINA # A LAIN
Pernyataan: kewarganegaraan yang bukan Malaysia dengan pasport yang sah dan salinan Visa

ALAMAT

PENGALAMAN
PENDIDIKAN

PENGALAMAN
BERKERJA

NAMA KENALAN KECEMASAN NOMBOR

TELEPON

PENTADBIRAN f rk*ß PENGURUS PENGURUS SYARIKAT

KILANG r k BESAR
TANDATANGAN TANDATANGAN
JABATAN
TANDATANGAN KETI-JA SYARIKAT