速 馬 市 場（馬）有 限 公 司 (1152753-V)

BEXPRESS MARKETING (M) SDN.BHD. (1152753-V)

No: 20, Jalan Anggerik Mokara 31/59, Kota Kemuning, 40460 Shah Alam, Selangor Darul Ehsan.
Tel: +603-5121 0022/ +603-5121 0020 Fax: +603- 5525 8305/ +603-5121 0026
E-mail: admin@bexpress.com.my

Outlet Promoters Application Form Date:

Position Applying For: Outlet Name & Location:

Expected Wages: RM /(day/hour)
Event/ Job Period: -

1) Applicant Information*
Name Sex
(Name) (Jantina)
IC No. Age Date of Birth
(No. Kad Pengenalan) (Umur) (Tarikh Kelahiran)
Marital Status Religion Nationality
(Taraf Perkahwinan) (Agama) (Kewarganegaraan)
Residential Address
(Alamat Rumah)

Mobile No. Bank Account No.

(No. Telefon Bimbit) (No. Akaun Bank)

2) Family Record & Emergency Contact*

Relationship Name Occupation Contact No.

3) Education *
School / College / University From To Qualification

Preferred Language : Mandarin English Bahasa Melayu Others

4) Employment History*
Last Promoter Job Present Promoter Job

Name of Company

Type Of Business/ Products

Accepted Wages

Event/ Job period

 速 馬 市 場（馬）有 限 公 司 (1152753-V)
BEXPRESS MARKETING (M) SDN.BHD. (1152753-V)
No: 20, Jalan Anggerik Mokara 31/59, Kota Kemuning, 40460 Shah Alam, Selangor Darul Ehsan.
Tel: +603-5121 0022/ +603-5121 0020 Fax: +603- 5525 8305/ +603-5121 0026
E-mail: admin@bexpress.com.my

5) OTHER DETAILS*

1) Have you ever been convicted by any Court of Law? Yes No

If “Yes”, please provide details: .…………………………………………………………………………………..

2) Do you have any case(s) pending before a Court of Law? Yes No

If “Yes”, please provide details: .…………………………………………………………………………………..

3) Own Transport available: Yes No

6) HEALTH DETAILS*
Any health or medical condition that requires the attention ?

Have you received minimum 2 shots of Covid-19 vaccines? Yes No

Are you fully vaccinated (after 14-days)? Yes No

**[Please provide vaccination proof (Cert. or screenshot)]

Any symptoms showing signs of Covid-19 positive? Yes No

7) DECLARATION *

I declare that the information I have given on this form is correct and I understand that failure to
complete the form fully and accurately could result in an incorrect assessment of salary, and / or
exclusion from shortlisting, or may, in the event of employment, result in disciplinary action or dismissal.

Signature Date

For Office Use only: Selected / Rejected

Date of Interview Interview by Confirmed Wages

per day/hour

Confirmed Job Period:

Approved by:

Signature Date