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Employment Application Form
Employment Application Form
Employment Application Form
Referred by :________________________________________________________________________________
___________________________________________________________________________________________
Employment Desired
Quality Engineer RM8800
Position :_________________________________________ __ Expected Salary :___________________
___ Full- Time ___ Part- time (If part-time, note the hours you can work)_________________________
YES
Are you 18 years or older? _____ Yes ____ No
Do you have any relatives who are currently employed at Molex? Relatives include parents, spouse, children, sibling,
NO
grandparents, aunts, uncle, cousin, in-laws, domestic partners or significant others. _____ Yes_____ No
Molex Malaysia is an equal opportunity employer and does not discriminate in hiring or employment based on race, color,
religion, sex, national origin, ancestry, age, gender identify, citizenship status, sexual orientation, marital status, parental/
familial status, pregnancy, military discharge, genetic information, mental or physical handicap or disability, veteran status or
any other basis prohibited by state or local law. Molex Malaysia will not refuse to hire a disabled applicant who can perform
the essential functions of the job with reasonable accommodation. No question on this form is intended to secure information
to be used for such discrimination.
I certify that all my statements on the above applications and resume (if any) are accurate and complete. I understand that
that my employment will be contingent upon the accuracy of such information and that any misstatements, omissions or false
statements in this application will be sufficient cause for disqualification or immediate dismissal even if uncovered after
commencement of employment. I hereby grant Molex Malaysia permission to investigate all of the statements contained in
this application for the purpose of verification, and I agree to release Molex Malaysia and any parties the contact from any
liability arising from such investigation. I understand that my present employer will not be contacted unless my consent has
been obtained or I have accepted an offer of employment with Molex Malaysia, which would be contingent on that contact.
I have read the above paragraph and accept the same as a condition of my employment with Molex Malaysia.
25/10/2023
Signed: ______________________________________________________ Date: __________________________
Please provide us with 3 professional references that we may contact in an effort to proceed in our application
process. Please be advised that all offers of employment are contingent upon satisfactory background and
reference checks.
I have provided the above references to Molex Malaysia and am in full knowledge and agreement that Molex
Malaysia may contact these references as part of its application process.
QUALITY ENGINEER
______________________________ ____________________________
Candidate Acknowledgement Position Applied For
Employment Dates (Month and Year) Name and Title of Immediate Supervisor
From : 05/2022 To : 10/2023 AS LOO, QUALITY DIRECTOR
Previous Employer
Name of Employer JABIL CIRCUIT
Telephone No. if known
Employment Dates (Month and Year) Name and Title of Immediate Supervisor
From : 09/2020 To : 05/2022 JONAS BAUTISTA, QUALITY AM
Previous Employer
Name of Employer KAGA COMPONENT
Telephone No. if known
Employment Dates (Month and Year) Name and Title of Immediate Supervisor
From : 10/2019 To : 08/2020
Starting Base Salary Final Base Salary
Reason for Desiring Change or Leaving RM4300 RM4300