Job Application Form  
Location:
Position applied for:
 
1. Personal Details
Name as per IC (in CAPITAL LETTERS)  
 
Permanent Address:  
 
Tel. No: Hp No:
   
E-mail:
 
Gender: Date of Birth: Place of Birth:
     
IC NO:  
New IC
Old IC
   
Nationality Status: Ethnic Group:
Malaysian
Permanent Resident
Non Permanent Resident
Bumiputra Chinese
Indian Others
   
Religion: Marital Status:
Muslim Buddhist Hindu
Christian Other  
Single Married
Divorced Widowed
   
No of Children:  
Below 18 years Above 18 years
 
 
2. Please Tick One Box Only
If you are a female, please state if you are pregnant. If yes, when is your expected due date. Yes No
Have you worked at Carrefour before? If yes, please state year, last position and store. Yes No
Have you ever claimed compensation for any injury before? If yes, when and where. Yes No
Are you suffering from any illness, if yes please state. Yes No
Have you been declared a bankrupt? Yes No
Have you ever been charged and/or prosecuted for any criminal act before? If yes, what was the charge(s) and the outcome of the case. Yes No
     
3. Educational Record
Name of school, college, university (Starting with the highest level)
Year
(From - To)
Highest qualification achieved
Grade Attained
       
Language Proficiency Written:
  Spoken:
 
Other training / skills / qualification that you may wish to highlight
 
4. Employment History
Name & Address of Employer
(Starting with present employer and/or the most recent)
Position
Year
(From - To)
Last drawn
salary
Reason for leaving:
Reason for leaving:
Reason for leaving:
 
5. References (List 3 character references which the Company may contact)
Name & Address
Relationship
Years known
Contact No.
 
6. General
Would you work shift?
Yes No
Would you work weekends?
Yes No
Would you work on Public Holidays?
Yes No
     
If selected, when can you start work? What is your expected salary:  
RM  
7. Additional Information
 
8. Declaration by Applicant
  • I hereby declare that all the above particulars and answers given by me are true and correct to the best of my knowledge.
  • · I authorized verification of all statements and answers to questions herein contained if I am considered for employment.
  • I understand that any misrepresentation, whether deliberate or negligent, of a material nature in the company's opinion or omission of facts called for herein, will be sufficient cause for dismissal without compensation from the Company, if so discovered upon or during the course of my employment.