Academia-Industry-Community Relation Division (AIC)

Department of Industry Partnership and Community Relation Affix

Universiti Malaysia Pahang
photo
26300 Gambang, Pahang | Malaysia

Please type Mercedes-Benz Malaysia scholarship on the envelope. Submit

your application with a detailed resume, copies of education certificates,
testimonials and a recent passport sized photograph (n.r.) to the address
stated above:

Personal Information

Name :

Address :

City : State :

Postal Code : Email Address :

Telephone : Mobile Phone :

NRIC No. : Date of Birth :

Race : Age :

Religion : Nationality :

Education
Name of institution & Level Of Results
location Education

Secondary schools SPM English

Maths
Please specify for 2 other
Grade : subjects with credit :

( Please indicate the school

name )

Vocational/Technical SPMV

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 College/University DIPLOMA CGPA:

Language Proficiency
Language Spoken Written

English
Bahasa Melayu
Chinese
Tamil
( Please indicate the level of proficiency : Poor, Good or Excellent )

Curricular Activities
Types of Activities Position and Responsibilities Held

Hobbies & Interest

Additional Information
Have you ever been convicted of a misdemeanor or a felony?
Yes No
If yes, please provide details
________________________________________________________

Do you have any friends/relatives working with MBM and/or our affiliated
companies? Yes No
If yes, please provide details
________________________________________________________

Have you ever applied for this program/a job with MBM before?
Yes No
If yes, please provide details
________________________________________________________

Do you suffer from any serious ailments, physical handicap or allergy?

Yes No
If yes, please provide details
________________________________________________________

Do you possess a valid driving license?

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Yes No
If yes, state class ________________________________________________________________

Have you ever applied for any Degree or Diploma courses in University/College?
Yes No
If yes, please provide details
________________________________________________________
Intake year__________

How do you know about our Apprentice Training Program?

Please indicate the newspaper :
______________________________________________________
or other media circulation :
______________________________________________________
( example : The Star Newspaper, Sin Chew Daily, Mingguan Malaysia, Borneopost,
Website, School & etc )

Compliance Information
1. Have you given any bribes or received any bribes before? Yes No
If yes, describe incidence:
_____________________________________________

2. Have you violated any of the following? Yes No

2.1 Company/Organisation’s policies/guidelines/regulations
If yes, please provide details: Yes No
______________________________________
2.2 Legal Regulation or local laws
If yes, please provide details: Yes No
_______________________________________

3. Have you been involved in any unethical practices?

If yes, please provide details:
__________________________________________

Relationship Declaration
A) Questionnaire

Do you or your family (wife, husband, children, mother, father, Yes No

brothers, sisters etc.) have any relationship with state authorities
or government officials?

If yes, describe the character of your relationship (please specify

name, relationship, position, name of government agencies/state
authorities)
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

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B) Individuals related to the state authorities or government officials
are:
People related to the state authorities of government officials could be as
follows:

Individuals who have relationships with the state authorities or organizations

(companies) controlled by the state (and/or to the employees of such
organizations).

The following are some examples of the state authorities or organizations

controlled by the state:

 Sports Organizations
 Police, Fire Emergency, Medical Organizations
 Municipal State Government (State Transport Services etc.)
 International Social Organizations (National Unions, International Banks
etc.)
 Diplomatic organizations etc.

The above list is illustrative and by no means exhaustive.

Individuals who have relationships with some other government related

structures, which are not included to the above list, could also fall under the
given definition.

Please note that individuals related to the state authorities or government

officials could also be employees of such structures, e.g:

 Employee, contractor or government’s representative of any state

organization, agency or intermediary (half-state, state companies).
 State official, representative of the country or legislative authorities.
 Individual being at the service of the government including military,
civil service as well as policymakers.
 Civil servants of the Executive, Legislative and Judicial Power,
administrative state organizations and high officials (judges).
 Employee or contractor of the International Social Organization.
 Political Party Member, an employee of a Political Party or any
Candidate to the Government Post.
 Members of the family and relatives who work in the authorities
mentioned above.

Personal Referees
1. I hereby declare that I have never been convicted of any criminal or social
offence in court of law.
2. I understand that my training is subject to passing the medical examination by
the Company’s physician.
3. I understand that if at any time after engagement it is found that a false

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 declaration has been made in this form or in my pre-training medical
examination, the company shall have the right to terminate my training
forthwith, without any further claims by me.
4. In accepting training with the company, I agree to abide by all the Standing
Rules and Regulations of the Company governing the conditions of work and the
conduct of its employees.
5. I hereby declare that the information submitted in this form is in every respect
true and complete.
6. I authorise the Employer to submit the said information to any person, firm,
corporation, body, bureau, department, police officials and Police Record
Bureau for the purpose of any investigation which the Employer may desire to
make with reference thereto. I also indemnify the Employer from all liabilities,
demands, claims, suits, proceedings, costs and expenses of any nature in
connection with the foregoing.

________________ ___________________
Date of Application Signature of
Applicant

For Internal Use

Accepted Rejected

Remarks

____________________________
___________________
Signature/ Name
Date

PERSONAL DATA PROTECTION ACT 2010 NOTICE

PERSONAL DATA PROTECTION ACT 2010

Collection, Recording, Storage and Retention of Personal

Information

Mercedes-Benz Malaysia Sdn Bhd (“we” or “us” or “our”) is

currently taking an exercise to comply with the Personal Data
Protection Act 2010. The Personal Data Protection Act 2010 (“the Act”)
is an Act that is passed by the Malaysian government to regulate the
processing of personal data in a commercial transaction. To comply
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with the Act, we are required to manage the personal data that we
collect from you.

The purposes for which your personal data may be used are, but not
limited to:-

 interview and selection process

 to conduct reference and background checks;
 to verify information provided in the application form; and
 to assist us in facilitating the total recruitment process of
Automotive Mechatronic.

("the Purposes")

Your personal data will be collected from the application form.

It is obligatory that you provide us with your personal data.

If you fail to supply us with such personal data, we may not be able to
process and/or disclose your personal data for any of the above
Purposes.

Please be informed that if required for any of the foregoing Purposes,

your personal data may be transferred and/or disclosed to any
person(s) in or outside Malaysia including but not limited to the
Daimler Group of companies, our authorized dealers, respective
agents, authorised and appointed outsourcing agents for purpose of
fulfilling our obligations to you in respect of the Purposes and all such
other purposes that are related to the Purposes and also maintaining
and storing records.

To this end, we are committed in ensuring the confidentiality,

protection, security and accuracy of your personal information made
available to us. In this regard, it is your obligation to ensure that all
personal information submitted and retained are accurate, not
misleading, updated and complete in all aspects. For the avoidance of
doubt, we and/or the Daimler Group and/or its employees or authorised
officers or agents will not be responsible for any personal information
submitted by you that is inaccurate, misleading, incomplete and not
updated.

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Any personal information retained by us shall be destroyed and/or
deleted in accordance with our retention policy applicable for us in the
event such information is no longer required for the said Purposes.

Consent

By submitting this notice you hereby authorise and consent to us

processing (including disclosing) your personal data for the Purposes
and/or for any other purposes related to the Purposes. Please read the
following, sign and date this form in the column provided to indicate
your consent.

If you do not consent or subsequently withdraw your consent to the

processing and disclosure of your personal data (other than for direct
marketing), we will not be able to fulfil our obligations to you in respect
of the Purposes and/or for any other purposes related to the Purposes.

You may at any time after the submission of your personal data to us,
request us to update your personal data and/or limit your data
processing by directing it to our human resource department or at
pdpa_mbc@daimler.com.

__________________________________________
Applicant’s signature

__________________________________________
Applicant’s name

__________________________________________
Date

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