PGM/HR/F/062/Rev.

6/15Apr22

PRIVATE & CONFIDENTIAL

PG GROUP OF COMPANIES
JOB APPLICATION FORM

COMPANY:

1) Please attach photocopies of all your educational certificates & present the original certificates during interview
2) Please attach a copy of your IC or passport showing all relevant details
3) Please attach a copy of your latest curriculum vitae/Portfolio

Position Applied for : Branch Applied for :

Job Source : Newspaper  Jobstreet  Referral  (Name of Referral )

Date of Application :

Available start date :

Personal Particulars
Name as in NRIC / Passport :
(Please underline Surname / Family Name)
Preferred Name to be Known in Office:
(No Nickname or Initials)
Nationality : Country of Birth :
NRIC No: Race :
Age : Religion :
Gender : Male / Female Marital Status :
Height (CM): Weight (KG):
Contact Details
Home Address :
Mailing Address (if different from Home Address) :

Residence Telephone No: Mobile No:

E-mail:
Family’s Information
Relations Name Age Present/Previous Occupation and Employer Name
Father:
Mother:
Brother:

Sister:

If Married:
Spouse:
Children:

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Spouse Contact No:
Languages Proficiency (Average, Good , Excellent): English Malay Mandarin Others ( Pls Specify: )
Proficiency in Speaking:
Proficiency in Writing:
Hobbies / Interests:
Education / Professional Qualification (from secondary school onwards)

Highest Qualification Attained Specialisation Year of School / College / University

(eg. Accountancy) Award Name Country

Present Membership of Professional Bodies and Organisations

Name of Professional Bodies/Organisation Type of Membership Period of Membership

Career History (starts with present employment)

Employment Date
Position (mm/yy)
Name of Employer Reason for Leaving
From To

Statutory Information:
EPF No: MBB Account No (if any):
Income Tax No: PBB Account No (if any):
Emergency Contact Person (at least two):
Name: Relationship: Mobile No: Address:

Name: Relationship: Mobile No: Address:

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Other Personal Information
1) Have you ever been convicted an offence by a court of law in any country? Yes / No
If yes, please give details:

2) Have you ever been declared BANKRUPTCY or charged under BANKRUPTCY ACT? Yes / No
If yes, please give details:

3) Have you ever been dismissed from a job? Yes / No

If yes, please give details:

4) Are you willing to allow us to verify your previous employment including current employment? Yes / No

5) Are you willing to transfer from one company/branch to another group of company/branch or between subsidiaries? Yes / No

6) Have you or are you suffering from any ailment, physical impairment/disease, mental disorder or chronic illness? Yes / No
If yes, please specify:

7) Do you have driving license? If yes, please give details: Yes / No

8) Are you pregnant/suspected pregnant (for female applicant only)? If yes, please state the month: Yes / No

9) Are you a Public Gold’s or Competitors’ Dealer? Yes / No

If yes, please state the company’s name and status:

10) Do your immediate family member(s) a Public Gold’s or Competitors’ Dealer? Yes / No

If yes, please give details:

11) Do you have any Seller Store at PG Mall Sdn. Bhd ? Yes / No
If yes, please state the Store name and status:

12) Do your immediate family member(s) had any Seller Store at PG Mall Sdn. Bhd.? Yes / No

If yes, please give details:

References
Employment References from Present and Past Employment (for Past 5 Years)
1. Name of Referee (Ms/Mrs/Mr/Madam/Dr) Position:

Company: Office Telephone No:

Address: Email:

2. Name of Referee (Ms/Mrs/Mr/Madam/Dr) Position:

Company: Office Telephone No:

Address: Email:

Personal Reference (non-relative)

1. Name of Referee (Ms/Mrs/Mr/Madam/Dr) Occupation:

Address Office Telephone No:

Mobile No:

Privacy Statement
The personal data collected in this application form will be used to assess your suitability to assume job duties of the position for which you
have applied and to determine preliminary remuneration, bonus payment and benefits package to be discussed with you subject to selection
for the position. Personal data on the application form are regarded as mandatory for selection purposes. Failure to provide these data may
influence the processing and outcome of your application. In the event of an unsuccessful application, we will retain your personal data for
future recruitment purposes. When there are vacancies in our associate firms during that period we may transfer your application to them for
consideration of employment. Personal data will be kept for only as long as it is reasonably necessary for the purposes as described above.
Should you in future wish to have access to and to request for correction of your personal data in relation to your application, please contact
Human Resources Department by emailing to hr@publicgold.com.my.

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Other Declaration
I confirm that I have not been so charged or convicted in a court of low and if employed, undertake to inform the Company immediately with
full details should I so be served with a notice of bankruptcy, made or discharged as a bankrupt, or convicted in a court of law with similar or
lesser sentence.

I hereby declare that the information given by me in this application form, my resume, certificate of academic and any other document that I
provide during interview in connection with my application for employment and my personal interviews is correct, complete and true to the
best of my knowledge and belief, and that I have not wilfully suppressed any facts.

I fully understand and accept that if any time after employment, it is found that a false declaration has been made in this form or that I have
not complied with the terms and conditions of my employment, the Company has the absolute right to terminate my employment forthwith
without assigning any reasons.

I confirm that I am providing permission for PG Group and its representatives to contact any of the references I have listed above to verify the
information I have given in this application.

Signature :

Name : Date :

Interviewer’s Comments
Hired ( ) KIV ( ) Rejected ( ) Company :

Signature & Date :

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Part I. Salary History shall be completed by the candidate.

For Human Resource Use Only:

Part I. Salary History (starts with present employment)

Position Monthly Salary (RM)

Name of Employer
Start End/Current

Period of Notice to Present Employer: Expected Salary:

Part II. HR’s Comments
Hired ( ) KIV ( ) Rejected ( ) Company :

Signature & Date :

Part III. HR Approval:

Position Offered :

Date of
Commencement :

Salary Offered :

Signature & Date :

Part IV. Director Approval:

Signature & Date :