JOB APPLICATION FORM

EXPRESS RAIL LINK

AF1
Private & Confidential

For HR Use Only

Interview No: _____________________
Test 1 : ______________
Test 2 : ______________
Interviewer 1 : _____________________________________
Interviewer 2 : _____________________________________
Interview Status : To Hire / Reject / KIV

Position Applied : Date :

Expected Salary : RM Current Salary : RM

Name Date of Birth : Age :

Place of Birth : Sex :
Office Address Permanent/Home Address

E-Mail Address: E-Mail Address:

Telephone : Telephone :
Marital Status Single Married Others (Please specify) :
FAMILY DETAILS
If married, Spouse Name Spouse Occupation Spouse Employer's Name &
Address/Telephone No

Childrens Name (If any) Sex Date of Birth Age

1.
2.
3.
4.

[Use another sheet (if necessary]

Please give details of members of your family (parents, brothers, and sisters)
Name Relationship Occupation Employer & Address
1.
2.
3.
4.
Use another sheet (if necessary)
How did you come to know of this vacancy ?
EPF No.
SOCSO No Newspaper Employment Agency
Income Tax No
I/C No / Colour Walk in ERL Employee
Passport No (if any)
Nationality Others (please specify)
Driving License No/
Class (if any)
Vehicle Registration No
Type of Vehicle Car / Motorcycle

Have you received summons for Traffic Violation or involved in ay accident in the past three years?
If yes, please describe : Yes No

Have you ever been convicted/declared bankruptcy/summons by the court? Yes No

Do you have any criminal record previously and/or are there any other legal Yes No
proceedings currently taken against you.
If yes, please describe :

Do have any relatives working in ERL? Yes No

If yes, who

ERL-HTM-0507310.A
 MEDICAL RECORD
Have you had any illness? Yes No
If yes, please describe and indicate year :

Have you been under a doctor's care within the past 5 years? Yes No
If Yes, give details :

Are you allergic to any drugs? Yes No

If Yes, give details :

Are you currently on medications? Yes No

If Yes, give details :

Is your vision good in both eyes? Yes No

If no, please explain below
Corrected by Glasses Contact Lenses Others :
(Pls specify)
Is your hearing good in both ears? Yes No
If no, give details :

Do you have any handicaps? Yes No

if yes, please describe

Under your current employment, for the past 12 months how many days of medical/emergency/unpaid leave you have taken?
Medical/Sick Leave Emergency Unpaid Leave Others :
(Pls specify)

EDUCATION
Type of School Name of School Qualifications Year Did You Graduate
(Secondary/College/University) Obtained Obtained

Are you studying for other courses? No

If yes, please describe

OTHER QUALIFICATIONS
Professional or other qualifications including membership of Professional and/or Scientific Societies
Name of Institutions Year of Admission Membership Status

OTHER TRAININGS

HOBBIES AND INTERESTS

Languages written/spoken and computer knowledge

LANGUAGE PROFICIENCY* Note :-

Written Spoken
Bahasa Malaysia *Level of Proficiency
English 1. Excellent 2. Good 3. Fair

Computer Knowledge Beginners Intermediate Advance Note :-

Microsoft Outlook
Microsoft Word 1. Tick against your computer
Microsoft Excel competency level
Microsof Powerpoint 2. Enclose your certificate of
Others (Pls specify) : competency

2 ERL-HTM-0507310.A
 EMPLOYMENT RECORD
LIST IN DETAIL STARTING WITH YOUR PRESENT EMPLOYMENT

Name, Address & Contact No. Nature of From To Job Title Job Description Basic Salary (RM) Other Reason for Leaving
of Company Business (Date/Mth/Yr) (Date/Mth/Yr) (Brief Summary) Start End Allowance

Use another sheet (if necessary)

Do you have any Annual Leave balance? Notice required to terminate present employment

3 ERL-HTM-0507310.A
 DESCRIPTION OF CAREER

Apart from the specialised qualifications and experience outlined earlier please give a brief description, your future plans

REFERENCES

A) Applicants who have previous working experience need to give 3 referees (who are not related to them) :-

1. From existing employer :- 2. Most recent past employer :-

Name : Name :

Tel. No : Tel. No :

Designation : Designation :

3. Character reference :-

Name :

Tel. No :

Designation :

B) For fresh graduates, please attach testimonial from your College/University

I authorise investigation of all statements contained in this application. I understand that a misrepresentation or omission of facts
called herein will be sufficient cause for cancellation of consideration for employment or dismissal from the Company's service if
I have been employed.

I also agree to subject myself to medical examination at any or all the Company doctors, should the company require me to do so.
Refusal on my part to do so, will subject me to termination of my service with the Company.

Signature Date

REFERENCE CHECK (For HR Use Only)

HR Official's Name: _______________________________________________

Referee's Name: __________________________________________________
Referee's Designation & Company's Name: _______________________________________________________
Date: _______________________
Findings: ______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

4 ERL-HTM-0507310.A