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QSD-2.

1-3

AKADEMI LAUT MALAYSIA


(A Subsidiary of MISC Berhad) Passport
Size
WINDOW DELIVERY 2051 Photograph
MASJID TANAH POST OFFICE
78300 MASJID TANAH, MELAKA
Tel: 06 - 388 2200 Fax: 06 - 387 6700
APPLICATION FOR EMPLOYMENT
PLEASE READ THE INSTRUCTIONS CAREFULLY:
1. Please fill up all the relevent columns in this form in block letters using your own hand writing.
2. Please attach the photocopy of I/C, academic certificates/transcript (SPM & above), other relevant documents and latest payslip.

POSITION APPLIED :

A. PERSONAL PARTICULARS

1. NAME IN FULL : MR/MRS/MISS…………………………………………………………………………………………………………………

2. MARITAL STATUS : SINGLE/MARRIED/WIDOWED/DIVORCED

3. SEX : MALE/FEMALE

4. POSTAL ADDRESS : …………………..……………………………………………………………………………………………………………..

…………………..……………………………………………………………………………………………………………..

…………………..……………………………………………………………………………………………………………..

5. TELEPHONE NO (H) : …………………….. OFFICE : …………………….. HANDPHONE : …………………………

6. EMAIL ADDREESS : …………………………………………………………………………………………………………………………………………………

7. DATE OF BIRTH : …………………….. PLACE : ……………………………………………………..

8. NRIC NUMBER : …………………….. COLOUR : …………………………………………………..

9. RACE : ……………………..
……………………….. 11. RELIGION : ……………………………………………………

10. NATIONALITY : …………………….. 12. CITIZENSHIP : …………………………………………………..

B. FAMILY BACKGROUND

RELATIONSHIP NAME OCCUPATION


FATHER
MOTHER (MAIDEN NAME)

NO NAME OF BROTHER (s)/ SISTER (s) SEX AGE EDUCATION LEVEL/ OCCUPATION

QSD-2.1-3 Application Form Issue:3 Rev.:1 28 November 2016


RELATIONSHIP NAME OCCUPATION
SPOUSE

NO NAME OF CHILDREN SEX AGE EDUCATION LEVEL/ OCCUPATION

C. EDUCATION/QUALIFICATION

1. PRIMARY AND SECONDARY :


YEAR
NAME OF SCHOOL/INSTITUTION/ EXAM
EXAM
LOCATION ADMITTED LEFT RESULT

UPSR
PT3
SPM / SPMV
STPM

2. TERTIARY/PROFESSIONAL/TECHNICAL :
YEAR
CERTIFICATES, DIPLOMA, DEGREE, NAME OF SCHOOL/INSTITUTION/
CGPA
MASTER, PhD LOCATION ADMITTED LEFT

3. COURSE BEING PURSUED AT PRESENT :


CERTIFICATES, DIPLOMA, DEGREE, YEAR
NAME OF SCHOOL/INSTITUTION/
MASTER, PhD CGPA
LOCATION ADMITTED LEFT

4. TYPING/SHORTHAND/TRENGKAS/DRIVING SKILLS
YEAR
TYPING/SHORTHAND/TRENGKAS/ NAME OF SCHOOL/INSTITUTION/
DRIVING SKILLS LOCATION ADMITTED LEFT

5. MEMBERSHIP OF PROFESSIONAL BODIES :


MEMBERSHIP STATUS NAME OF INSTITUTION/
YEAR OBTAINED
(ASSOCIATE/HONORARY/CERTIFICATE) LOCATION

QSD-2.1-3 Application Form Issue:3 Rev.:1 28 November 2016


D. WORK EXPERIENCE

1. PRESENT EMPLOYMENT :
Name of Employer (Present) Job responsibility
Address of Employer
Position Title
Period of employment From: To:
To whom responsible
Salary Initial: Last:
Other Allowances
Reason for leaving

2. PREVIOUS EMPLOYMENT :
Name of Employer Job responsibilities
Address of Employer
Position Title
Period of employment From: To:
To whom responsible
Salary Initial: Last:
Other Allowances
Reason for leaving

3. PREVIOUS EMPLOYMENT :
Name of Employer Job responsibilities
Address of Employer
Position Title
Period of employment From: To:
To whom responsible
Salary Initial: Last:
Other Allowances
Reason for leaving

E. REFEREES

1. Please give details of relative(s) if any, working in ALAM/ MISC Berhad and/or its subsidiaries.

NAME RELATIONSHIP POSITION DIVISION/DEPARTMENT

2. Other than relatives.


NAME ADDRESS OCCUPATION PERIOD KNOW TO YOU

3. Are you prepared to serve in any part of Malaysia or overseas? YES/NO

4. Do you have any physical defects/medical illness/chronic disease/mental illness? YES / NO (If YES, please give details)

……………………………………………………………………………………………………………………………………………………………………………….

QSD-2.1-3 Application Form Issue:3 Rev.:1 28 November 2016


5. Are you color blind/deaf? YES / NO (If YES, please give details)

……………………………………………………………………………………………………………………………………………………………………………….

6. Do you depend on any medication? YES / NO (If YES, please give details)

……………………………………………………………………………………………………………………………………………………………………………….

7. Are you declared bancrupt? YES / NO

8. Have you ever been convicted of any criminal offence? YES / NO (If YES, please give details)

……………………………………………………………………………………….…………………………………………………………………………………………

9. Have ever been employed by ALAM/ MISC Berhad/ PETRONAS or its Group of Companies? YES / NO (If YES, please give details)

……………………………………………………………………………….………………………………………………………………………………………………………………………

10. State any position of responsibility held in School/College/University, Club, etc. ………………..……….....………………………………….……………

11. Games played while in School/College/University (State also the highest level of participation): ……………………………………………………………..

……………………………………………………………………………………….…………………………………………………………………………………………

12. Give details of any 'bond' or obligation to serve the government or any other body (including period of contract): …………………………………………

……………………………………………………………………………………….…………………………………………………………………………………………

13. Does your employer know you are thinking of leaving? YES/NO

14. When would you be able to enter our employment if offered? …………………………………………………………….………………………………...……

15. Salary expected if offered: RM…………………..per month.

16. Highlight any achievements attained in your previous and/or present employment. ……………………………………………………………………..…..

……………………………………………………………………………………….…………………………………………………………………………………………

17. Please state here any additional information which you consider to be of assistance to us in assessing your suitability for the position :

……………………………………………………………………………………….…………………………………………………………………………………………

18. State your present interest and hobbies. ……………………………………………………………………..……………………………………………………..

……………………………………………………………………………………….…………………………………………………………………………………………

Note:- Please submit a photocopy of all relevant certificates and please also bring the original certificates during the interview session.

F. IN THE CASE OF EMERGENCY

NAME : ………………………………… NAME : ………………………………………..


ADDRESS : ………………………………… ADDRESS : ………………………………………..
………………………………… ………………………………………..
………………………………… ………………………………………..
TELEPHONE NUMBER : ………………………………… TELEPHONE NUMBER : ………………………………………..
RELATIONSHIP : ………………………………… RELATIONSHIP : ………………………………………..

G. DECLARATION

I hereby certify that the particulars furnished by me are true and accurate in every detail. If employed, in the event of a discovery of any
misrepresentation of acts, wilful or otherwise I will be subjected to summary dismissal.

Date: …………………….. Signature: ………………………………..

QSD-2.1-3 Application Form Issue:3 Rev.:1 28 November 2016

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