STAFF APPLICATION FORM

Job Application
Apply for position*
(tick more than one if applicable)		 : 
Available to start work*
Type of application* : 
Expected salary / Hourly rate* RM   to RM 
   (Monthly salary for Day Care Assistant; or Hourly rate for Tuition Teacher)
Reason for part time
(if choose Part Time)
Expected last day of work
(if any)
Personal Particulars
Name (as per I/C)*
I/C no.*
Gender*
Marital status*
Nationality*
Race*
Religion
Place of birth
Contact METHODs
Mobile phone no.*
Email*
Street address*
City*
Postcode*
State*
Education Records
List maximum of THREE (3) highest education qualifications. Please provide one (1) copy of Certificate and Transcript.
Name of School / Institute Location of School / Institute Period of Study Highest Qualification
Attained
From To
Employment Records
List maximum of THREE (3) latest employments.
Name of Employer Working Period Job Position Held Last Drawn
Salary		 Reason for Leaving
From To
RM
RM
RM
Language Proficiency
Languages / Dialects Spoken Written
Chinese / Mandarin
English
Bahasa Malaysia
Activities
Sports / Hobbies
Scholarship / Prize awarded
Professional / Organization membership
Remarks
Medical Records
Height cm
Weight kg
Physical disabilities or handicaps
Major illness or accidents
(if any)
Immediate Family Members
Name Relationship Year of Birth Name of Employer Job Position
Emergency Contact
Name Relationship Contact no. Current Location (City)
Referral
List two persons, other than friends and relatives, who have been acquainted with your education or work (preferably former Teacher or Supervisor) and would give you a reference.
Name of Referral Contact no. Job Position & Employer Years Known
How did you know about this job opportunity?                                               
           
Declaration

I certify that all information I have provided in order to apply for and secure work with 101 Classroom is true, complete and correct.

I expressly authorize 101 Classroom and its employees or representatives to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have against 101 Classroom and its employees or representatives for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.

  *