EMPLOYMENT APPLICATION FORM

Vitahealth Malaysia Sdn Bhd

Instructions: All applications for employment must be submitted using this application form. Your application must be Affix
completed, dated and signed, and returned to the HR. Your application must be completed in sufficient detail to allow A Recent
comprehensive review and evaluation of your qualifications for the position applied for. Passport Size Photograph
Here
POSITION APPLIED FOR:

AVAILABILITY: FT PT hours per week

if Part Time, please specify how many hours do you want to work.

PERSONAL INFORMATION
Name: Alias: Chinese Name:

NRIC Number: Age: Gender: M F

Marital Status: Single Married Widowed Divorced No. of Child:

Date of Birth: Place of Birth:

Nationality: Religion:

Contact Detail: Home Mobile

Email Address:

Present Address:

Hometown Address:

Declaration of Pregnancy: Yes if Yes, month(s) No

FAMILY, SPOUSE & CHILDREN DETAILS

Relationship Name Age Occupation

Please indicate 2 persons to contact in the event of emergencies:-

Relationship Name Contact Number

Family

Friend

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EDUCATION RECORDS
Completed
Name of School/ College/ University From To Qualification Obtained
Yes No

Are you currently undertaking study/training? Yes No

If yes, please provide the detail below:
Course Name:

Tick one: FT PT Others:

List special accomplishments: Yes No

Provide additional information you would like us to consider:

LANGUAGES / DIALECTS
Spoken Writen
Languages / Dialects
Excellent Good Fair Excellent Good Fair

ADDITONAL RELATED DETAILS

Do you possess a driving liciense Yes No
Do you own a car? Yes No
Are you able / willing to travel? Yes No

Expected Salary: Date of Commence:

What you expect to gain in this new role?

Answer:

What is your career objective?

Answer:

REFERENCES
Do you agree to have referees contacted in relation to this application? Yes No
if yes, please provide details of two people who can speak on your behalf regarding your work history.
Name Position Years Known Contact No. Checked

Reference checks will be conducted legally in an ethical manner and all information derived will remain confidential.

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EMPLOYMENT RECORDS [Most Recent first, list every job you have had]
Name of Company Date From

Position held Date To

Duties Starting Salary

Status FT PT Others: Last Drawn Salary

Reason for Leaving

Office use: check initial/date/detail Updates:

Name of Company Date From

Position held Date To

Duties Starting Salary

Status FT PT Others: Last Drawn Salary

Reason for Leaving

Office use: check initial/date/detail Updates:

Name of Company Date From

Position held Date To

Duties Starting Salary

Status FT PT Others: Last Drawn Salary

Reason for Leaving

Office use: check initial/date/detail Updates:

Name of Company Date From

Position held Date To

Duties Starting Salary

Status FT PT Others: Last Drawn Salary

Reason for Leaving

Office use: check initial/date/detail Updates:

Name of Company Date From

Position held Date To

Duties Starting Salary

Status FT PT Others: Last Drawn Salary

Reason for Leaving

Office use: check initial/date/detail Updates:

Name of Company Date From

Position held Date To

Duties Starting Salary

Status FT PT Others: Last Drawn Salary

Reason for Leaving

Office use: check initial/date/detail Updates:

Name of Company Date From

Position held Date To

Duties Starting Salary

Status FT PT Others: Last Drawn Salary

Reason for Leaving

Office use: check initial/date/detail Updates:

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DECLARATION

Have you ever suffered from any allergy, illness, injuired and / or treated with medication or
1 hospitalised during the past 36 months other than minor ailments or sickness? Yes No
(If you are not sure please indicate so)

Details :

Have you ever taken or file any action against your past employer(s) for any civil or industrial
2 Yes No
relations action in any court or labour office?

Details :

3 Have you ever been dismissed / terminated by any of your previous employers? Yes No

Details :

Have you ever been declared BANKRUPT or charged under BANKRUPTCY ACT in Malaysia or
4 Yes No
elsewhere?

Details :

Have you ever been charged / convicted of any criminal offences other than minor traffic violation in
5 Yes No
Malaysia or elsewhere?

Details :

Are you related to anyone previously / curently working in this Company or its subsidiaries /
6 Yes No
branches?

Details :

Do you currently engaged yourself or hold any ownership / directorship in any work or business in
7 Yes No
Malaysia or elsewhere?

Details :

I hereby certify and declare that the above information, the supporting documents enclosed and those attached in separate sheets (if
any) given by me is complete, accurate and true to the best of my knowledge and belief.

I understand and accept that should I be found to have witheld any information required or provided any false, inaccurate, incomplete
or misrepresented in any respect of information / documents for whatever reasons either verbally or in writing, any employment which
may be offered to me, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me
from the employer’s service without prior notice or salary-in-lieu of my notice when it is discovered.

Signature of Applicant Date of Application

-The End -

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FOR OFFICE USE ONLY
DOCUMENTS CHECKLIST
Photocopy of IC / Passport Certificate / Transcript
Latest Resume Driving License
3 Months Latest Payslip Background Check
Personality Test Result Others:

INTERVIEW EVALUATION FORM

Kindly appraise based on the candidate's appearance & grooming, characteristic, job related experience, communication skills, problem solving skills, job
expectation, etc.

Interviewer 1
Name: Position Title:

Comments:

Signature: Date:

Interviewer 2
Name: Position Title:

Comments:

Signature: Date:

Interviewer 3
Name: Position Title:

Comments:

Signature: Date:

RESULT
OFFER KIV REJECTED

Date of Commence
Company
Position Offered:
Department
Position
Work Location
Full/ Part Time
Probation Period
Package Offered:
Basic Salary
Allowance
Others

Remarks

Approved By: Verified By:

Name: Name:
Date: Date:

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