APPLICATION FOR EMPLOYMENT FORM

HRDF/SM/28/App

POSITION APPLIED FOR

Faculty or department where vacancy exists:
How Where did you find out about this vacancy? (Please list media or website if applicable):
Photo

1. PERSONAL DETAILS

Full Name as in Passport or

Date of Birth
MyKad (for Malaysian)
Gender (Male/Female) Place of Birth
Nationality MyKad No (for Malaysian)
Passport No Marital Status
Correspondence Address Home Address

Mobile No Home/Work Tel No

Email Address

2. CURRENT EMPLOYMENT

Name of current employer Job title

Current salary Start date
Next increment due date Benefits
Address Notice period

3. EDUCATION AND PROFESSIONAL QUALIFICATIONS

Starting with the highest, please list academic and professional qualifications, together with grades (where applicable)
Years Attained
Name of Institution Place/Country Qualifications Obtained
From To

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Professional Body Membership

Please provide details of any professional body membership which you hold.
Institution/Professional Body Membership Level Start date

Career History

Please provide details of your full career history starting with the most recent. Please include any periods of voluntary
work, career breaks and unemployment. If you have worked for the University before, we may ask the relevant
department on your employment records.
Start End
Employer Job Title & Responsibilities Reason(s) for leaving
Date Date
4. SKILLS, CONTINUING PROFESSIONAL DEVELOPMENT AND TRAINING

Please list any additional training or competencies that you would like us to consider in support of your application.

5. SUPPORTING CV / STATEMENT

Applicant is requested to:

a) submit a CV which provides information on the following: (i) duties in present post; (ii) previous posts held with
dates of employment for each; (iii) (if appropriate to the person specification): research interest, awards and
publications (books and major publications should be listed first with details of all authors, titles, journals and dates);
(iv) (if appropriate to the person specification): conference presentations; (v) any other additional relevant
experience. CVs will not be accepted without a completed application form.

b) address the Selection Criteria, and give an account of your skills and experience in relation to the set criteria in
your CV. The selection criteria should not exceed 300 words.

6. REFEREES

Please provide details of three (3) person excluding relatives or friends who will be able to provide employment reference.
The referees must include current or most recent employer. Please provide details of your lecturer/course tutor/volunteer
work supervisor if you have no current or recent employer. The University treats all references confidentially.

Referee 1:
Name:
Office/Mobile No.:
Position Title:
Organization:
Email Address:
Relationship to you:
Referee 2:
Name:
Office/Mobile No.:
Position Title:
Organization:
Email Address:
Relationship to you:
Referee 3:
Name:
Office/Mobile No.:
Position Title:
Organization:
Email Address:
Relationship to you:

Please indicate whether a reference may be obtained prior to interview: Yes/No

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7. CRIMINAL RECORDS

Have you had any criminal convictions? Yes/No

If yes, please send the details of the conviction stating your name and the position that you applied for, in a sealed
envelope to:
Human Resources Manager
Curtin University Malaysia
CDT 250, 98009 Miri
Sarawak, Malaysia

8. OTHER PERSONAL INFORMATION

Do you have any relatives or friends working in Curtin University or its related campus? Yes/No
If yes, please state name, relationship and in which department or faculty.
Have you previously applied to or worked with Curtin University or its related campus? Yes/No
If yes, please state when and position applied or worked in
What is your expected salary?
If selected, when will you be able to commence work?

9. HEALTH DECLARATION

As a result of the information that you gave, you may be referred to the company’s panel doctors so that further
enquiries can be pursued.

I am in good health. I am not aware of having any medical condition that might give rise to a health problem in the
future which may affect my work.

Signed: Date: ________________________________________

If you are unable to sign the above statement, please provide further details about the state of your health:

10. DECLARATION AND AUTHORISATION

I declare that the information provided above is true and complete in all aspects. I understand and agree that any
false
statement could result in termination of my application or employment.

I hereby give my irrevocable consent to Curtin University to perform periodical random checks from time to time to
verify the particulars given above.

I consent to the collection, use, processing, disclosure, retention by Curtin University of my personal data (and any
sensitive
personal data as defined by the Personal Data Protection Act 2010, where applicable) under the terms of Curtin
University’s
Privacy Policy and the Personal Data Protection Act 2010 in Malaysia.

Signed: Date: A
For Human Resources Use

A. SHORTLISTING (to be completed by the recruiting department)

Was the applicant shortlisted? - Yes / No

If no, please provide reasons, with particular reference to the Person Specification.

B. INTERVIEW (to be completed by the recruiting department)

Was the candidate been offered the post? – Yes / No

If no, please provide reasons, with particular reference to the Person Specification.

C. APPOINTMENT

Job Title
Starting salary
Probationary period
Name of probationary supervisor
Start date
End date
Length of contract
Name of previous post holder (including relief
for incumbent on maternity leave, study leave or
other absence

D. HR CHECKLIST

Job description attached

References attached

Academic Certificates

Valid Passport Certificates

Work Permit