CONFIDENTIAL

Recent Passport Size Photograph of Applicant

Lot PT 2393 HS (D), 353-92, Jalan Kisap, 07000 Kuah Langkawi, Kedah

www.wildernessmalaysia.com info@wildernessmalaysia.com Tel: 04- 9668000 Fax: 04- 9665050

(To be pasted)

APPLICATION FOR EMPLOYMENT

For Office Use Only Instruction to completing this form
You may attach your standard biodata for additional information but not as a substitute for this form. This form must be completed in full, where not applicable, please indicate. No interview shall be conducted with incomplete form. Recommended by: Employment agency Answer vacancy ad Others, state name: ________________

POST APPLIED FOR: _______________________________

Note: Please state Not Applicable N/A where necessary. A) PERSONAL PARTICULARS
Full Name (As in Passport): Permanent Address: Current Address: Phone (Home) E- mail: Residence: Date of Birth: Passport No.: Self Owned Living with parents/relatives Place of Birth: Nationality: Rented Sex: Mobile phone: Alias:

Others, specify Single Married

Marital Status:

B) FAMILY BACKGROUND Parents

Fathers Name: Address: Office Phone No: Hand phone No: Home Phone No Mothers Name: Address Office Phone No: Hand phone No: Home Phone No.

C) LINGUISTIC CAPABILITIES
Language/Dialect English Bahasa Melayu Others, specify Good Spoken Fair Poor Good Written Fair Poor

D) ACADEMIC & PROFESSIONAL / TRAINING QUALIFICATIONS 1. Academic & Professional Qualifications

Name of School / University / Institution Course / Examination Completed Within From To Results Achieved

2. Certification (eg. Technical skills, teaching First Aid, Water Safety, etc.) Do you have the following qualifications (please attach evidence) CPR Certificate Wilderness First Responder/Aid (60+ hours) Bronze Medallion / Water life Saving Certificate River / Swift Water Rescue Certificate IV in Outdoor Recreation or Equivalent Other: Name of Institution Course Name Completed Within From To Results Achieved YES / NO Expiry Date (dd/mm/yy)

3. Personal Outdoor Experience (list your most interesting and adventurous experiences) Activity Location Organization/ Leader Date/ # Of Days

Bushwalking

Climbing/ Abseiling

Kayaking

Other

4. Technical Skills (Please at the respective column) Activities Rock Climbing

Briefing Activity Top roping Bottom Belay Managing a site Rigging a site Rescue & Evacuation Debriefing activity

No Experience

Limited Experience

Extensive Experience

Can Assist Teach

Can Teach

Abseiling
Briefing activity Top Belay Managing a site Rigging a site Rescue & Evacuation Debriefing activity

High Ropes Courses

Briefing Activity Safety Training Managing a Course Rigging a course Rescue & Evacuation Debriefing Activity

Water Skills
Kayaking flat water Kayaking white water Sea kayaking Managing a group Raft building River rescue

Camp craft
Map & Compass Cooking & Nutrition Minimal impact camping Equipment care Camp stove use & care Camp hygiene

Miscellaneous
Games & Initiatives Low ropes course Flora / Fauna knowledge Weather Equipment Repair

E. HUMAN RELATIONS EXPERIENCE i. Describe a time when you contribute to a team environment. Please identify the following; how did you present your ideas? What relationships were formed with other team members? How did you deal with difficult situations?

ii. Please cite a situation where you were the leader. How would you describe your style of leadership and what did you learn about yourself as a leader?

F) MAJOR STRENGTHS
Personal Attributes

G) EMPLOYMENT Present Employment

Name of Employer Address of Employer Office Telephone No. Period of Employment Position Held on Entry Salary on Entry Other Allowances Current Position Current Salary Other Allowances To Whom Responsible Reasons for Leaving Job Responsibilities on Entry From: To:

Current Job Responsibilities

Previous Employment (1)

Name of Employer Address of Employer Office Telephone No Period of Employment Last Position Held To Whom Responsible Salary Other Allowances Reasons for Leaving Job Responsibilities

From: Initial:

To: Last:

Previous Employment (2)

Name of Employer Address of Employer Office Telephone No Period of Employment Last Position Held To Whom Responsible Salary Other Allowances Reasons for Leaving Job Responsibilities From: To:

Initial:

Last

1) Can we refer to your previous employer? 2) Does your current employer know you are thinking of leaving? 3) Notice required to your present employer 4) Remuneration expected from this position (per month)
5)

RM

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

H) REFEREES (other than relatives) (1)

Name in Full Address

(2)

Phone No. Occupation Company Email Address Web Address Period Known Relationship

Office: Hand phone: Home:

Office: Hand Phone: Home:

Yes or No 1) Are you free from any legal or financial problems? 2) Do you possess any credit card? 3) Have you been convicted in any Court of Law? 4) Are you prepared to serve in any part of Malaysia or Overseas? 5) Are you / have you been suffering from any illnesses? 6) If yes, please state the illness

I) DECLARATION
I hereby declare that to the best of my knowledge and belief, the information given in this application form is true and accurate. I understand that if it is subsequently disclosed that I have willfully given incorrect information or withheld any information, my application will be disqualified or if I have been appointed, the employer may terminate my engagement without notice.

Date:____________________

Signature:____________________