EMPLOYMENT APPLICATION FORM
(All information given in this form will be held in strictest confidence)
PHOTOGRAPH
PLEASE TYPE OR WRITE IN BLOCK LETTERS
SURNAME: MALE CITIZENSHIP: RACE/DIALECT:
GIVEN NAMES: FEMALE
HOME ADDRESS: DATE OF BIRTH AGE LAST BIRTHDAY
PLACE OF BIRTH RELIGION
CONTACT DETAILS: MARITAL STATUS KTP NIK:
HP:
Email:
MEMBERSHIP OF PROFESSIONAL
AND OTHER SOCIETIES LANGUAGES
SPEAK WRITE
G F P G F P
O A O O A O
LANGUAGE/DIALECT O I O O I O
D R R D R R
EDUCATIONAL DETAILS (Please attach copies of academic results and certificates)
PRIMARY & SECONDARY YEAR QUALIFICATION MERIT/AWARDS
SCHOOL From To
TERTIARY (University/College)
OTHER COURSES COMPLETED
CURRENTLY STUDYING
SPECIAL COURSES ATTENDED
CERT
FROM TO NAME AND DETAILS OF COURSE SEEN
MEDICAL DETAILS
PLEASE STATE WITH DATES, ANY SERIOUS ILLNESS, ALLERGIES, OPERATIONS OR DISABILITIES
DO YOU SMOKE? □ YES □ NO
2
FAMILY DETAILS
NAME ADDRESS OCCUPATION
In case of emergency, who should we notify?
POST FOR WHICH YOU ARE APPLYING
EXPECTED SALARY EARLIEST DATE AVAILABLE
CURRENT WORKING EXPERIENCE (Present Position)
NAME OF EMPLOYER ADDRESS
NO. OF EMPLOYEES NATURE OF BUSINESS
DATE STARTED
STAFF SUPERVISED
(NOS.)
STARTING BASIC BENEFITS: CURRENT BASIC BENEFITS:
SALARY PER MONTH SALARY PER
Annual Leave: ___ days MONTH Annual Leave: ___ days
AWS: ___ mths AWS : ___ mths
Variable Bonus: ___ mths Variable Bonus: ___ mths
Allowance: $_____ Allowance: $_____
Other Benefits: Other Benefits:
Medical allowance : $____ pa Medical allowance : $____ pa
TITLE WHEN HIRED: REPORTED TO: (TITLE) CURRENT TITLE: REPORTED TO: (TITLE)
RESPONSIBILITIES: SPECIAL ACHIEVEMENTS:
REASON FOR LEAVING:
3
If you have held your present appointment for less than one year, please describe your previous appointment in as much
detail as is requested for your present position.
PREVIOUS EMPLOYMENT HISTORY (List in reverse chronological order)
FROM TO STARTING PRESENT OR
NAME & ADDRESS OF EMPLOYER SALARY LEAVING
SALARY
POSITION HELD
EMPLOYER’S BUSINESS REPORTING TO (TITLE)
DUTIES AND RESPONSIBILITIES
REASON FOR LEAVING
FROM TO STARTING PRESENT OR
NAME & ADDRESS OF EMPLOYER SALARY LEAVING
SALARY
POSITION HELD
EMPLOYER’S BUSINESS REPORTING TO (TITLE)
DUTIES AND RESPONSIBILITIES
REASON FOR LEAVING
4
FROM TO STARTING PRESENT OR
NAME & ADDRESS OF EMPLOYER SALARY LEAVING
SALARY
POSITION HELD
EMPLOYER’S BUSINESS REPORTING TO (TITLE)
DUTIES AND RESPONSIBILITIES
REASON FOR LEAVING
PLEASE ATTACH DETAILED RESUME FOR OTHER WORK EXPERIENCES
5
DEGREE OF EXPERIENCE (Please Tick)
CONSIDERABLE SOME NONE
COMPUTERS
- Word Processing
- Spreadsheets
- Database
- Accounting Package (names)
AUDITING (by type of entity)
- Public companies
- Private companies
- Partnerships
- Sole traders
AUDITING (by type of industry)
- Manufacturing
- Service
- Broking/Trading
- Other Industries (specify)
TAXATION
- Corporate
- Personal
ACCOUNTING
- Manual
- Computerised
INSOLVENCY
- Liquidations
- Others (specify)
COMPANY SECRETARIAL
6
CHARACTER REFEREES
Please provide particulars of two persons who are not related to you. They should be responsible persons who know you
well with regard to your character and work performance. Both referees should be gainfully employed.
(1) Full Name Title (2) Full Name Title
Address Tel No. Address Tel No.
Email Address Email Address
Occupation Years Known Occupation Years Known
May we contact your past and present employers? Yes/No
HAVE YOU EVER BEEN CONVICTED IN A COURT OF LAW?
IF YES, GIVE DETAILS
HOBBIES, GAMES AND OTHER INTERESTS
ADDITIONAL INFORMATION
GIVE ANY ADDITIONAL INFORMATION WHICH YOU CONSIDER MAY BE OF INTEREST TO A PROSPECTIVE
EMPLOYER
I GIVE MY CONSENT TO GO ACC PTE LTD TO OBTAIN AND VERIFY INFORMATION FROM OR WITH ANY
SOURCE INCLUDING THE SALARY VOUCHER FROM PREVIOUS COMPANY, AS YOU DEEM APPROPRIATE
FOR THE ASSESSMENT OF MY APPLICATION FOR EMPLOYMENT.
I DECLARE THAT THE PARTICULARS GIVEN IN THIS FORM ARE COMPLETE AND CORRECT. I
ACKNOWLEDGE THAT IF AT ANY TIME AFTER ENGAGEMENT IT IS FOUND THAT A FALSE DECLARATION
HAS BEEN MADE IN THIS FORM, THE COMPANY HAS THE ABSOLUTE RIGHT TO TERMINATE MY
EMPLOYMENT FORTHWITH.
DATE SIGNATURE OF APPLICANT
