Unit 19.
1, Level 19, Menara AIA Sentral,
No. 30 Jalan Sultan Ismail,
50250 Kuala Lumpur.
T (+603) 2203 0808
F (+603) 2203 0909
www.persolkelly.com.my
DEX NO:
Application Form
Name:
Passport/IC No: Nationality:
Address: Photo
Tel (Off): H/P:
Email:
Socso No: EPF No: Income Tax No:
Applicable for Job application requires driving of vehicle
Class Do you own a car: Yes No
Emergency Contact Person: Emergency Number: Relationship:
Employment Sought
What type of work are you looking for? Contract Permanent Temporary Part Time
Education & Professional Qualification
From-To (Dates) Name of School, College State Level attained Major Course or Subject
Membership of Professional & Other Associations :
IT Skills:
Other Skills:
Job Application
Position Applied For:
Other Position interested In:
When are you available for work: Notice Period:
Employment History
Date of Employment: _______________________________ Last Employment Date: ___________________________
Name of Employer: ___________________________________________________________________________________
Address of Employer: _________________________________________________________________________________
___________________________________________________________________________________________________
State nature of Employer’s Business: _____________________________________________________________________
Position Held: ________________________________________________________________________________________
Total number of employees in Company: __________________________________________________________________
Provide detailed description of duties / responsibilities: __________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
How did you hear about the above company/opportunity? (through Advertisement, Recommendations, etc)
___________________________________________________________________________________________________
Reason for Leaving: __________________________________________________________________________________
Date of Employment: _______________________________ Last Employment Date: ___________________________
Name of Employer: ___________________________________________________________________________________
Address of Employer: _________________________________________________________________________________
___________________________________________________________________________________________________
State nature of Employer’s Business: _____________________________________________________________________
Position Held: ________________________________________________________________________________________
Total number of employees in Company: __________________________________________________________________
Provide detailed description of duties / responsibilities: __________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
How did you hear about the above company/opportunity? (through Advertisement, Recommendations, etc)
___________________________________________________________________________________________________
Reason for Leaving: __________________________________________________________________________________
Internal use only
Resume Control
Date Client Position Interview/s Remarks
Assessment
Indicate your impressions gained from interviewing the applicant by making an (X) on the scale for each heading
1. Apprearance
Very untidy Somewhat careless Satisfactory personal Neat and tidy better Unusually well groomed
about personal appearance than average appearance and very neat
appearance
2. Friendliness
Appears very Approachable; Warm; friendly; Very sociable and Extremely friendly very
Distant and aloof fairly friendly sociable outgoing warm and outgoing
3. Poise
At ease; jumpy Somewhat tense; Reasonably at ease Sure of himself / Extremely well
and very nervous easily irrtated herself composed
4. Personality
Unsatisfactory Doubtful Average and Very good; above Outstanding;
satisfactory average excellent all round
5. Conversational Ability
Talks very little; expresses Tries to express Average fluency Talks well and does Excellent expression
himself / herself poorly clearly and expression not waste words extremely fluent; forceful
6. Alertness
Very slow to Rather slow; Graps ideas with Quick to understand Exceptionally alert;
grasp ideas requires more than average speed perceives well understands new ideas
average explanation instantly
7. Knowledge of Work Field
Poor; no appropriate Limited knowledge; Average knowledge; Well informed; knowledge Excellent knowledge
knowledge at all covering some areas not covering all covers most areas with faultless coverage
areas fully
8. Qualifications
Not relevant to job Some relevance Satisfactory; as good Very suitable for job Ideal for job;
to job as might be expected perfect match
9. Skill
None appropriate Some skills in Reasonable amount; Well Skilled in job area Excellent skills;
job area average for job ideal for job
10. Experience
No relation between Some experience Average; background Very good and Excellent and
background and job in relevance area covers job area relevant experience ideal background
11. Drive and Initiative
Poorly defined goals; Makes little effort Average affort; High desire to achieve; Sets high goals;
acts without purpose to achieve goals some initiative Strives hard always takes initiative
Consultant’s Comments
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Interviewed by: ________________________________________________ Date: _______________________________
Achievement & Projects Undertaken
Hobbies
Hobbies, Games and other interests:
Languages
Spoken: English Bahasa Malaysia Mandarin Other
Written: English Bahasa Malaysia Mandarin Other
Organisation Chart of Company of your current position
(Previous or Current Employer) State name of company, indicate where you fit within the organisation.
Employment References From Past & Present Employment
I consent / do not consent PERSOLKELLY and/or its affiliates to contact my Employment references at any time.
Name: ___________________________________________ Name: ____________________________________________
Position: __________________________________________ Position: _________________________________________
Company Name: ___________________________________ Company Name: ____________________________________
Company Address: _________________________________ Company Address: __________________________________
_________________________________________________ _________________________________________________
Tel (Office): __________________ (H/P): ________________ Tel (Office): __________________ (H/P): ________________
Have you applied with this office before? Yes No State Date: _____________________________
PERSONAL DATA PROTECTION ACT
I understand and voluntarily consent to the collection and processing of my personal data as outlined in the full privacy statement available
online and during registration with PERSOLKELLY Workforce Solutions Malaysia Sdn Bhd, Persolkelly Consulting and Agensi Pekerjaan
PERSOLKELLY Malaysia Sdn Bhd hereafter referred to this form as “Persolkelly”, and to the summary outlined below.
I authorize Persolkelly or appointed party to showcase my profile, based on my personal data as submitted, to the client(s) of PERSOLKELLY,
I further consent to PERSOLKELLY transferring my relevant data to PERSOLKELLY offices and clients out of Malaysia for purposes of
evaluating my suitability for employment and also to conduct reference checks.
I understand that, under the 2010 Personal Data Protection Act, if, at any time, I wish to access my personal data held by PERSOLKELLY,
withdraw my consent to it being processed, or correct any error found within this data, that I may do so in writing directly to PERSOLKELLY.
I acknowledge that the full Privacy Policy is available at www.persolkelly.com.my or at my request.
I declare that the particulars in this application are true to the best of my knowledge and I have not willfully suppressed any material fact. I also
understand that if it is found that I have deliberately made a false declaration on the form after engagement by PERSOLKELLY to work for its
Client(s), I may be dismissed from my employment with immediate effect without further compensation.
ACKNOWLEDGEMENT
I, NRIC/Passport No: acknowledge that i have
read and fully understand the above Personal Data Protection Act Policy.
Signature: Date :
