PRIVATE & CONFIDENTIAL

Rev: 1.2 - 2021

APPLICATION FOR EMPLOYMENT

AFFIX
PHOTOGRAPH
POSITION APPLIED FOR: ________________________________________
HERE
COMPANY APPLIED FOR: ___________________________________________

Please attach (a) Full resume

(b) Photocopies of academic qualification and training certificates

Please write in BLOCK LETTERS

A. PERSONAL PARTICULARS

1. FULL NAME OF APPLICANT (AS IN NRIC): MR/MRS/MS: ___________________________________

2. PRESENT ADDRESS : _______________________________________________________________

_______________________________________________________________

3. PERMANENT ADDRESS: _______________________________________________________________

_______________________________________________________________

4. HANDPHONE NO: _________________________ HOUSE TEL NO: _________________________

5. PERSONAL EMAIL: ________________________ PERMANENT CONTACT NO: _______________

6. NATIONALITY : __________________________ NRIC/PASSPORT NO: _____________________

7. DATE OF BIRTH : __________________________ PLACE OF BIRTH: ________________________

8. AGE : __________________________ MARITAL STATUS: _______________________

9. RACE : ______________________ ____ RELIGION: _______________________________

10. EPF NO : ______________________ _____ INCOME TAX NO: ________________________

11. SPOUSE’S NAME: ___________________________ HANDPHONE NO: ________________________

12. SPOUSE’S OCCUPATION AND EMPLOYER: ______________________________________AGE:_____

13. NO OF CHILDREN: ___________________________ AGE: ____________________________________

14. FATHER’S NAME: ___________________________ OCCUPATION : ___________________________

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15. MOTHER’S NAME: __________________________ OCCUPATION : ___________________________

B. EDUCATIONAL BACKGROUND
NAME OF SCHOOL / YEAR
COLLEGE / UNIVERSITY HIGHEST QUALIFICATION GRADE
ATTENDED OBTAINED
(in chronological order) FROM TO

C. LANGUAGE PROFICIENCY (Indicate proficiency level: 0 - Poor, 10 - Excellent)

LANGUAGE WRITTEN SPOKEN

BAHASA MALAYSIA
ENGLISH
CHINESE/TAMIL
OTHERS:

D. PREVIOUS EMPLOYMENT (in chronological order)

EMPLOYER PERIOD LAST POSITION LAST REASON FOR
FROM TO HELD SALARY LEAVING

E. CURRENT EMPLOYMENT

1. EMPLOYER: _________________________________________________________________________

2. ADDRESS: ___________________________________________________________________________

3. TELEPHONE NO: _________________________ POSITION HELD: ____________________________

4. BASIC SALARY: _________________________ ALLOWANCES, IF ANY: ______________________

5. DATE APPOINTED: ______________________ REASON FOR LEAVING: ______________________

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F. REFERENCE

NO NAME OCCUPATION COMPANY CONTACT NO YEARS KNOWN

G. GENERAL
1. Are you in good health and free from physical and mental impairment or deformity or allergies? If

1. Are you in good health and free from physical and mental impairment or deformity or allergies that may affect
your job performance? If no, please state:
_____________________________________________________________________________________

2. Have you had any serious illness or undergone any surgery that may affect your job performance? If yes, state
details:
__________________________________________________________________________________________

3. Would you be willing to relocate? Yes No

4. Are you willing to travel? Yes No

5. Do you have any relatives or friends currently working in Kossan Group of Companies? Yes No

If yes, state details: __________________________________________________________________________

6. Have you been convicted for any criminal offence? Yes No

If yes, state details: __________________________________________________________________________

7. Do you possess your own transport? Yes No If yes, state type of transport: ______________________

8. Hobbies and interest: ________________________________________________________________________

9. In case of emergency: Person to contact: ________________________________________________________

Contact no: _________________________ Relationship: _______________________

10. Why do you think you are suitable for this position?

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

11. Availability date: __________________________ Expected salary (RM) _____________________________

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H. PERSONAL DATA & DECLARATION

I hereby agree that the Company may collect, store and process my personal data including but not limited to data
obtained from background checks and pre-employment medical checkups conducted by the Company for the
purposes of processing my application for employment with the Company.

I also hereby certify that the above information is accurate and that no pertinent details have been withheld. If
information given above is subsequently found to be incorrect or incomplete or untrue, the company may
terminate my employment without notice or compensation.

Signature of Applicant: _____________________ Date: _________________________

FOR OFFICE USE

1st Interview by: ________________________________ Date: __________________________

2nd Interview by: ________________________________ Date: __________________________

RECOMMENDED FOR HIRE

NOT RECOMMENDED FOR HIRE KIV

Remarks: ________________________________________________________________________________

________________________________________________________________________________
If candidate is recommended for employment, please complete the following information:

a. DESIGNATION : ________________________________________________________

b. COMPANY & LOCATION : ________________________________________________________

c. DEPARTMENT : ________________________________________________________

d. REPORTING TO : ________________________________________________________

e. BASIC SALARY (RM) : ________________________________________________________

f. ALLOWANCE, IF ANY (RM) : ________________________________________________________

g. DATE OF COMMENCEMENT : ________________________________________________________

h. PROBATION PERIOD : ________________________________________________________

i. REMARKS : _______________________________________________________

RECOMMENDED BY: APPROVED BY: APPROVED BY:

_______________________ ________________________ ________________________

NAME: NAME: NAME:

DATE: DATE: DATE: