Position Applied for :

Date & Time: ……………………………………………

Please tick & state how you know about this job opportunity .

 Job Portals :_______________________  Social Media: whatsapp  Career Fair:

 Internal Referral, Staff Name:  Walk in:  Others:

APPLICATION FORM
SECTION A – PERSONAL PARTICULARS
Name (As per
CHONG SHENG JIE
NRIC/Passport)
Old NRIC/Passport
NRIC/Passport no. 990929045159
no. -
Date of Birth
Age (years) 22
(dd/mm/yy) 29/09/1999
Place of Birth MELAKA Nationality
MALAYSIAN
Gender MALE Race CHINESE
Religion BUDDHA Marital Status
SINGLE
Current resident address:
Postcode: 73000 Province: NEGERI SEMBILAN Country: MALAYSIA
4141,TAMAN CLONLEE TAMPIN
Permanent address (Expatriate to provide home country address):

4141,TAMAN CLONLEE TAMPIN Postcode: 73000 Province: NEGERI SEMBILAN Country: MALAYSIA

Email Shengjiechong99@gmail.co
Contact number 01128376598
Address m
Mode of travelling √ Train (LRT, MRT) □ Bus □ Car □ Motorcycle

SECTION B – FAMILY PARTICULARS

Spouse Name (As per
- NRIC/Passport no.
NRIC/Passport)
 Yes
Is your Spouse working?
 No ( if yes please provide information below)
Company Contact
Company Name
no.
Position held
Please
Different
Gender Date Birth Cert/ explain the
Children Age abilities
(M/F) of birth NRIC No. different
(Y/N)
abilities

If any of your children have different abilities, are they registered by Social Welfare
Y/N
Department (JKM)?

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SECTION C – CURRENT/PREVIOUS EMPLOYMENT DETAILS

Month/Year Other variables

Reason for
Company Position Held Basic Salary (Allowance, benefits
leaving
From To etc)

Melaka centre surveyor 01/17 11/17 Study at college Base on -

commission

SECTION D – REFERENCES (Please provide two referees from your previous employment and they must be your
superior / supervisory level)
Years known
No Name Company Name Relationship Contact Numbers
each other

1 -

SECTION E – EDUCATION BACKGROUND (From highest to lowest)

Year
No Name of University/College/School Qualification Field of Study Grade/CGPA
From To

Business information
1 TARC autocount 18 20 2.5
system

SECTION F – LANGUAGE PROFIENCY (Please tick where applicable)

Language 1: mandarin Language 2: english Language 3: Language 4:
Language
Poor Fair Fluent Poor Fair Fluent Poor Fair Fluent Poor Fair Fluent

Speak √ √

Read √ √

Write √ √

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SECTION G – WORK RELATED DECLARATION Yes/No Remarks

Do you have any friends/relatives working in Aegis

1 BPO Malaysia Sdn Bhd? If yes, please provide no
details (Name & Department

Have you worked in Startek/Aegis Global? If yes,

2 no
please provide details

Have you been terminated from employment

3 no
before? If yes, provide details

Do you hold a directorship in any company? Does

4 your family has own business? Are you involve? If no
yes, please provide details

Are you doing part time job after working hours or The previos employment details that I mentioned is my part time job
5 yes
about opinion research
on weekends? If yes, please provide details

a) Have you been declared BANKRUPTCY and/or

defaulted in any payment? If yes, please provide no
details

b) Have you ever convicted for any CRIMINAL

6 no
OFFENSES? If yes, please provide details

c) Do you have any FINANCIAL ISSUES with any

financial institution? (PTPTN, MBSB etc…) If yes, no
please provide details

SECTION H – HEATH RELATED DECLARATION Yes/No Please give details

Do you have any health related issues? (Alcohol,

1 no
drugs etc) If yes, please provide details

Do you have Mental illness and/or stress related

2 problems? (Anxiety, Depression etc) If yes, please no
provide details
Have you consulted a specialist or needed any
3 operations other than already stated? If yes, please no
provide details

Are you receiving medical treatment at the present

4 no
time? If yes, please provide details

6 Are you pregnant? If yes, please provide details no

Have you take sick leave within the last 1 year of

7 no
your employment? If yes, please provide details

Have you been hospitalized within the last 2 years?

8 no
If yes, please provide details

Do you have any follow up medical checkup? If yes,

9 no
please provide details

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SECTION I – BACKGROUND SCREENING
Yes/No Please give details
QUESTIONS
Have you applied for any other jobs? If yes,
1 no
please provide details
Have you attended any interviews in the last 1
2 no
month? If yes, please provide details
Do you have any of your family members
3 admitted in hospital or they are very ill? If yes, no
please provide details
Do you have any pre planned leave? If yes,
4 no
please provide details
Are you currently or have you been in the
5 no
past, a Grab Driver?

SECTION J – JOB EXPECTATIONS

Expected Basic Salary 2000+ Allowance/Other Benefits -
Customer
Preferred Job Type(s) Able to travel/relocate Yes
service
Earliest availability to join Startek
Notice to current employer (duration) anytime
(dd/mm/yy)
Able to work on weekends & public
Ability to work on Rotation Shift Yes Yes
holidays

DECLARATION
I hereby acknowledge that:-
1. Consent is given to the Company or its duly appointed agent to collect, record, store, use and process “Personal Data”, as defined by the Personal Data
Protection Act 2010 (“PDPA”), concerning and relating to myself, including any sensitive personal data, for the purposes of processing this employment
application for the Company’s consideration, and if successful, would form part of the employment records with the Company (“Purpose”).
2. Such Personal Data may include, but is not limited to the following:-
a. Information provided via forms required by the Company
b. Information from any pre-employment checks, such as medical, bankruptcy, credit and criminal checks deemed necessary by the Company in relation to
the Purpose
c. Information regarding any family members, referees and/or any such other person(s) deemed necessary by the Company in relation to the Purpose
d. Records of any correspondence and/or communication with representatives of the Company
3. All Personal Data provided is accurate, complete, not misleading and up-to-date and Personal Data of third parties provided is given with the prior consent from
the relevant parties, failing which I indemnify the Company against any claims.
4. Consent is given to the Company to disclose any such Personal Data to any third party including the Company’s duly appointed agent, relevant authorities,
subsidiaries, insurers, hospitals, clinics and/or any such person(s) as deemed necessary by the Company in relation to the Purpose.

I hereby declare that the information given by me in this form is correct and true to the best of my knowledge. I fully understand and accept that if at any time after
employment engagement with the Company, it is found that false declarations have been made in this form, the Company has absolute right to terminate my
employment forthwith. I agree to inform Human Resource Department (HR) if there is any change to the current information provided by me in this form.

Signature of applicant: 990929045159

NRIC number:
Name of applicant: 19/01/1999
CHONG SHENG JIE Date:

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 INTRODUCE YOUR FRIENDS TO US!!!
Name
EE ID
Contact
No.

N
o Friend Name Contact No Email
1
2
3
4
5
CONSENT FOR REFERRALS - PERSONAL DATA PROTECTION ACT 2010

The above matter refers.

I have provided Startek (formerly known as Aegis BPO Malaysia Sdn. Bhd.)with
names and contact details (“Personal Data”) of potential candidates, for employment
purposes with Startek.
I hereby represent, warrant and covenant that I am authorised to disclose all
Personal Data that I have provided to Startek and I have obtained all consents,
permits, authorizations and notice necessary from these potential candidates to
permit such disclosure and transfer to Startek and use thereof by Startek as required
by the Personal Data Protection Act (“PDPA”) 2010, for the purposes
abovementioned.
All the Personal Data acquired by Startek from me shall only be used for the
purposes of hiring new employees (Employee Referral Program).
I hereby fully indemnify Startek for any breach of the PDPA 2010 legislation on my
part which may render Startek liable for any costs, claims or expenses, howsoever
arising.

I hereby declare that the information given by me in this form is correct and true to
the best of my knowledge. I fully understand and accept that if at any time after
employment engagement with the Company, it is found that false declarations have
been made in this form, the Company has absolute right to terminate my
employment forthwith.

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