QDOS Flexcircuits Sdn Bhd (416829-W)

No 99 Lebuhraya Kampung Jawa

Taman Perindustrian Bayan Lepas
11900 Penang Malaysia
Tel No. : (604)-6420000

Fax No. : (604)-6428222

http://www.qdos.com.my

E-mail : info@qdos.com.my

APPLICATION FORM ( MA)

(A) PERSONAL
Name
Address
Tel No. (House)

(H/P)

Passport No.

Issuing country

Passport Issuing Date

Passport Expiry Date

Date Of Birth

Place Of Birth

Age

Sex

Race

Religion

Nationality
Marital status

(B) FAMILY DETAILS

(Please list down from grand parents, father/mother, siblings & childrens details)
Name

Relationship

Age

Page 1

Occupation & Company

HR/ELTan/13

(C) EDUCATION
Name Of School

Year Attended

Cert/Diploma/Dergree Obtained

Salary

Reasons For Leaving

dos.com.my
(D) EMPLOYMENT HISTORY
Company

Duration

(E) EMERGENCY CONTACT

Name

Relationship

Tel No. (House)

(H/P)

(F) OTHERS
1) Are you related to anyone working in this company or its subsidiaries?

Yes

No

Yes

No

3) Are you willing to work on shift?

Yes

No

4) Have you ever been convicted?

Yes

No

5) Do you suffer from any physical impairment?

Yes

No

6) Have you had any serious illness?

Yes

No

7) Hospitalisation, psychiatric treatment, mental or nervous breakdown?

Yes

No

8) For FEMALE employee only, are you currently pregnant?

Yes

No

If yes, please state name & relationship :

2) Have you ever been dismissed or suspended from any position?
If yes, please state details :

DECLARATION
This particulars which I have stated are true and correct to the best of my knowledge and behalf. I
understand that my employment is subjected to my passing the examination conducted by the
company's panel if required. False or inaccurate information given will render any subsequent
employment contract null and void.

Signature Of Applicant :

Date :

Page 2

HR/ELTan/13