Employment Application Form

How did you know about this vacancy? (Tick where applicable)

Online job portal (please specify) Advertisement Recruitment agency Referral Others
Affix photo
here
……………………………………..

Position applied: …………………………………………………………………………………………………………………………………………………

Name: Mr. / Mdm / Miss ………………………………………………………………………………………………………………………………………..

(As in MyKad) (CAPITAL LETTERS)

NRIC (New): ……………………………..…………………………… (Old): …………………….…………………………………...Gender: Female Male

Date of birth: …………………..…………… Place of birth: ….....…………………………………….. Marital status: Single Married Others

Nationality: ……………………………..……………………... Race: ………………………………………….…………… Religion: …………………….………………..….….

Address: ………………………………………………………………………………………………………………………………………………….………………….……………………….

……………………………………………………………………………… Postcode: ………………………………..………..… City: ……………………………………………………………………….

Mobile no: …………………………………………………. Tel (H): ………………………………………………… Email: ……………………………………………….……..……………………..

Spouse information

Name

NRIC (new) Relationship

Gender Contact no.

Job title Employer

Alternative contact person

Name

Address

Relationship Contact no.

Education information

Three (3) highest educational Name of institution Duration Results obtained

qualifications (in chronological order)
From To

Delivering Growth – in Asia and Beyond.

Language proficiency

Proficiency indicators: Basic, Fair, Good and Excellent

Languages/dialects
Spoken Written

Computer skills and other relevant qualifications

Skills/qualifications Year achieved Years of experience

Previous and most recent employment information

Name of three (3) previous Duration Last position held Last drawn salary Reason for
employers (MYR) leaving
From To

Details of present employment (or most recent employment)

Name of employer and

address

Industry (e.g. banking / Position held

retail / consumer goods) upon hiring

Contact no. Starting basic salary Date appointed

Other fixed
Current salary (MYR) Bonus (MYR)
allowances

Immediate manager’s
Job title Contact no.
name

Brief description of the job

Professional referees (please provide two (2) non-related referees)

Name Address and contact details Occupation Years known

Other information

Expected monthly salary (MYR)

Notice period

Possess own car Yes / No Possess a valid driving license Yes / No

1. Have you ever been convicted by a court of law? If yes, please elaborate;

2. Have you been declared a bankrupt? If yes, please elaborate;

3. Have you ever been dismissed or suspended from any employment? If yes, please elaborate;

4. Do you suffer from any physical disability, chronic ailment, handicap or major illness? If yes, please elaborate;

5. Do you have any siblings, relatives or friends working at our DKSH offices or branches? If yes, please provide details;

6. Have you previously applied for employment at any DKSH offices or branches? If yes, please state the position applied for,
when and the outcome.

7. Do you have any restrictions on travelling? If yes, please elaborate;

8. If you have been referred to DKSH by an existing employee, kindly provide the referral’s full name and Business Unit.

9. If you have been referred to DKSH by a recruitment agency, kindly provide the recruitment agency name and contact person.

10. Have you worked in DKSH previously? If yes, kindly state the business unit and position you were previously holding.

11. Are you currently an owner or hold any directorship or shares in a company? If yes, please provide details;
 12. Are you a fresh graduate who has not been working for at least 12 months or more? If yes, kindly please state your graduation
date, month and year.

13. Are you a mother/woman who has left the workforce and not been working for at least 12 months or more? If yes, kindly please
state your last employment information.

Declaration

“The Company and/or DKSH Group would be required to obtain, store and process your personal data (including any sensitive
personal data) for the purposes of processing and considering your employment application. By signing this application form, you
hereby consent to the Company and/or DKSH Malaysia Group to:

1. store and process your Personal Data;

2. disclose your Personal Data to the relevant governmental authorities or third parties where required by law or for legal purposes;
and
3. storing your personal data for a period up to seven (7) years from the date of this application of employment.

In addition, your personal data may be transferred to any company within the DKSH’- Group which may involve sending your data to
a location outside Malaysia. For the purpose of updating or correcting such data, you may at any time during to the course of your
employment apply to the Company to have access to your personal data which are stored by the Company.

For the avoidance of doubt, Personal Data includes all data defined within the Personal Data Protection Act 2010 including all data
you had disclosed to the company in this form or your employment application letter.

I declare that I have provided all required information in this application form and that all information provided herein is true
and correct. I fully understand and accept that any information given by me which is incorrect or false may render me liable
to summary dismissal. I also authorize DKSH or any of its officers, employees, or authorized agents to conduct the
necessary background and reference checks with third parties by contacting any person or entity whom they deem to be an
appropriate reference. I also understand and accept that questions asked for reference purposes may include but not
limited to my educational background, attendance, personal history, character, personality, disciplinary information and
reason for separation from my former employment. I also hereby release DKSH from all liability for damages or claims,
which may arise or result from any reference information gathered pursuant to this authorization.

________________________________ _____________________________________

Date: Signature of applicant

For DKSH use only

Feedback by immediate manager/interviewer

Employment type Commencement date: ……………………………………………….

Full time Part-time …………… (%)
Probationary period: …………… Notice period: ………………..
Employment category
Administrative reporting
Permanent Temporary (duration: …………………)
Position: ……………………………………………………………... Name (as per MyKad): ……………………………………..……………
Location: ……………………………………………………………..
Position: …………………………………………………………………
Gross remuneration
Functional reporting (if any)
Basic salary
Name (as per MyKad): …………………………………….....................
Monthly: MYR ………............ Daily: MYR ……………..
Position: …………………………….……………………………………
MBO / MBO flex Performance bonus

If MBO / MBO Flex,

Annual Target Earning (ATE): MYR ……………….

Annual Fixed Salary (AFS): MYR ……………….

Signature: …………………………………………….…………………
Annual Variable Pay (AVP): MYR ……………….
(Interviewed by)
Fixed allowances
Name: ……………………….…………………………..………………
1. ………………………………… 3. …………………………….. Position: ……………….…………………………..……………………

2. ………………………………… 4. .……………………………. Date: ………..……………………………………………..…………….

Feedback by Human Resources Business Partnering Feedback by Human Resources Director

Position ID:………………..…. Personal area:…………………..

Personal subarea:…………… BU/BS/BL:……………………….
Employee subgroup:…………. Personnel Segmentation: ……..
For re-joiner, state latest previous personnel no: ………………..

Insurance plan : GHS Plan no: …………….

GTL

Signature: …………………………………………….………………
Signature: …………………………………………….……………….
Name: ……………………….…………………………..…………….
Date: ………..……………………………………………..…………..
Position: ………………..…………………………..…………………
Date: ……..……………………………………………..……………..

For Recruitment team use only

Application form fully completed and signed Call candidate to confirm commencement date:

Attachments with application Remarks: ………………………………………………

Approved job requisition Job requisition no: ……………….
JTS & CTOS Photocopy of MyKad Call candidate to arrange for medical check-up:
Resume Interview feedback form Remarks: ………………………………………………
Latest pay slips Photocopy of academic certificates
For DKSH use only

Feedback by Head of Department Feedback by Head of Division

Signature: ……………………………………………………………… Signature: ……………………………………………………………..

Name: …………………………….……………………………………. Name: …………………………..……………………………………..
Position: ………….………….…………………………………………. Position: ……………….…..………………………………………….
Date: ……………………………………………………………………. Date: …………………………….…………………………………….

Feedback/approval by Head of Business Unit Comments/approval by Head of Country Management

Signature: ………………………………………………………………
Name: ……………………….…………………………..…….……….. Signature: ……………………………………………………………..
Date: …..……………………………………………………….………. Date: ………..………………………………………………….………