SP MENON DIALYSIS CENTRE SDN BHD

No 108 & 106 Jalan Jed 4, Bandar Parkland, 41200 Klang Selangor
Tel : (603) 3319 0835 Fax : (603) 3319 0837

PHOTO
EMPLOYMENT APPLICATION FORM
1. Complete this form in BLOCK LETTERS.

2. All sections must be completed and where applicable, circle/mark off opposite or state NIL.

POST APPLIED FOR

PERSONAL PARTICULARS

FULL NAME

(According to NRIC/Passport

and underline surname)

PERMANENT ADDRESS Tel. (House)

Tel. (Office)

Tel. (Mobile)

MAILING ADDRESS Tel. (House)

(if different from above)

E-MAIL ADDRESS

MARITAL STATUS DATE OF BIRTH SEX

NRIC/PASSPORT NO. NATIONALITY RACE

DRIVING LICENCE YES NO CLASS :

EDUCATION (please state with most recent qualification)

NAME OF SCHOOL FROM/TO QUALIFICATION OBTAINED

PROFESSIONAL MEMBERSHIP
YEAR OF
NAME OF INSTITUTION(S) ADMISSION MEMBERSHIP STATUS

Page :1
Page :2
HOBBIES, SPORTS, MEMBERSHIP OF SOCIETIES

SPECIAL AWARDS/ ACHIEVEMENTS YEAR

LANGUAGES (Spoken and Written, tick "√ " where necessary )

SPOKEN WRITTEN
LANGUAGE
Fluent Slight Knowledge Good Average

English

Bahasa Malaysia

Others

WORKING EXPERIENCE (begin with the present or most recent employment)

SALARY
NAME OF COMPANY POSITION HELD FROM/TO REASON FOR LEAVING
DRAWN

1
Basic :
Allow :
Bonus :

2
Basic :
Allow :

Bonus :

3
Basic :
Allow :
Bonus :

4
Basic :
Allow :
Bonus :

5
Basic :
Allow :
Bonus :

COURSES ATTENDED/CURRENTLY PURSUING YEAR

OTHER SKILLS (please state extent of skill - good/fair/poor)

COMPUTER

(state program used)

Page :3
Others

Page :4
Please give details of relative or friend currently under the employment of TSA/MAX

NAME OF FRIENDS/RELATIVES POSITION HELD RELATIONSHIP

FAMILY PARTICULARS (please state clearly the full particulars of your immediate family - Spouse/ Children/ Parents)

NAME RELATIONSHIP OCCUPATION AGE

REFERENCES - Please provide at least 2 references ( not relatives or family members)

NAME OCCUPATION CONTACT NO E-MAIL ADDRESS YEARS KNOWN

Please answer the following questions

1. Have you been convicted of any criminal offences (if yes, pls elobrate)

2. May enquiries be made to your present/ previous employers ?

3. Why are you considering another job?

4. Why do you choose the career you have followed up to now and what intentions or ambitions do you have for the future ?

5. Are you required to give termination notice to your present employer ? If Yes, pls indicate termination notice period.

6. What is your minimum expected salary? When you can start to report duty?

DECLARATION

I hereby declare that to the best of my knowledge and belief, the information given in this application is correct. I also understand that if it is
subsequently disclosed that I have willfully given incorrect information or withheld information, my application will be disqualified or if I
have been appointed, the company may terminate my employment without any prior notice.

SIGNATURE OF APPLICANT
DATE :

Page :5