APPLICATION FOR EMPLOYMENT

Position Applied
Expected Salary 1800

Part I : Personal Particulars

Name as in NRIC NUR AMALINA BINTI ROSMAN Sex Female
NRIC 040823010258 (New) (Old)
Age 19 Race MALAYSIA Nationality ISLAM
Correspondence
11-11,11,FLAT TAMAN PANDAN RIA BLOK A, JALAN PANDAN RIA 1,TAMAN PANDAN RIA 68000
Address
AMPANG , SELANGOR
11-11,11,FLAT TAMAN PANDAN RIA BLOK A, JALAN PANDAN RIA 1,TAMAN PANDAN RIA 68000
Permanent
AMPANG , SELANGOR
Address
Contact No 0137873781 (HP) - (Hse)
Email amalinarsnm@gmail.com

Marital Status Driving License D

Single / Married / Divorced / Widow
MOHAMAD FIRDAUS BIN
If married, Spouse’s Name Contact No 0137922264
ABDULLAH
Spouse’s Occupation STAFF SERVICE Company Name TONY ROMAS

Part II : Family Background (If married)

Name of Children Sex Age Name of School / Occupation / Company Name

Father’s / Guardian’s Name Sex Age Occupation Medical History

ROSMAN BIN KAMISAN MALE 49 SELF-EMPLOYED

Contact No (HP) 0107745249

Mother Name Sex Age Occupation Medical History

SITI SOLEHAH BINTI ABDULLAH FEMALE 41 SELF-EMPLOYED

Form – Job Application (HR) updated as on March 2020

1
 Contact No (HP) 01112756691

Name of Brother(s) & Sister(s) Sex Age Occupation / Company Name

MUHAMMAD AMIRUL BIN ROSMAN MALE 17
NUR AMALISA BINTI ROSMAN FEMALE 15
NUR ARISAH ZAAHIRAH BINTI ROSMAN FEMALE 7
MUHAMMAD AMIRUL RASYAD BIN ROSMAN MALE 5

Part III : Education / Professional Qualifications (Please attach copies of testimonials / certificates / transcripts)
From To Grade
Name of School / College and/or University
(Year) (Year) (Include CGPA where applicable)
MAKTAB RENDAH SAINS MARA (MRSM) BATU PAHAT 2019 2023
SMK DATO O’NN 2021 2023
SK SERI SEKAWAN DESA 2023 2023
PRASEKOLAH SK SERI SEKAWAN DESA 2023 2023

Other Education Information (eg Post Graduate / Professional Qualification / Related Courses)

Part IV : Other Skills

Computer Skills (Please indicate software applications you are familiar)

Languages & Dialects (Please √ any) Beginner Intermediate Advanced

Bahasa ✓
Spoken English ✓
Other:
Bahasa ✓
Written English ✓
Other:

Form – Job Application (HR) updated as on March 2020 2

Part V: Employment History

Name of Past Employer 1: TGI FRIDAYS WANGSAWALK

From To
Last Position held Last Drawn Salary (Including allowances)
(Date) (Date)
30/09/2022 17/02/2023 STAFF SERVICE 1700
Reason for leaving:
INDUSTRY CHANGES (INTERN)

May we contact this employer for verification purpose? YES / NO

If NO (State reason):
If YES Contact Person Name: AZWA Contact No: 01116702291

Name of Past Employer 2: MYNEWS.COM

From To
Last Position held Last Drawn Salary (Including allowances)
(Date) (Date)
20/03/2023 29/04/2023 STAFF SERVICE 1500
Reason for leaving:

STOP INTERN
May we contact this employer for verification purpose? YES / NO

If NO (State reason): LOST CONTACT

If YES Contact Person Name: SIR NAZRI Contact No:

Name of Past Employer 3: TROPICAL QUANTUMS SDN BHD

From To
Last Position held Last Drawn Salary (Including allowances)
(Date) (Date)
27/07/2023 03/12/2023 STAFFSERVICE 1500
Reason for leaving: END OF CONTRACT

GET BETTER OFFERS AND NEW EXPERIENCE

May we contact this employer for verification purpose? YES / NO

If NO (State reason):
If YES Contact Person Name: ZIN WINE Contact No:01163695720

Form – Job Application (HR) updated as on March 2020 3

Part VI : Other Information
i. Have you ever been charged or convicted for a criminal offence?
If YES, please explain: YES / NO

ii. Is there any past and/or pending legal and/or Industrial Court proceedings against you?
If YES, please explain: YES / NO

iii. Is there any past and/or pending bankruptcy proceeding filed and/or judgement entered against you?
If YES, please explain: YES / NO

iv. Have you ever been terminated and/or retrenched for your services or from your employment?
If YES, please explain: YES / NO

v. Have you suffered from any major illness, nervous breakdown or accidents which require hospitalization
during the past one (1) year? YES / NO
If YES, please explain:

vi. Do you have any friends / relatives dealing or working in BRICK HOUSE SDN BHD?
YES / NO
If “YES”, please state name and relationship.

Part VI : Other Information

vii. Please state period of notice which you would have to give to your current employer? 2 WEEKS EARLY
viii. If you were offered employment with us, please indicate date of commencement. 26 DECEMBER 2023

Part VII : References

(References stated herein must be known for at least a year, be gainfully employed, and must not be your relatives. Previous
employer/s is preferred).
Current occupation & Name of
Name of Reference Relationship Years Known Contact Number
Company working/worked with

SITI HAJAR UITM SHAH ALAM COUSIN 19 0194953171

AMRARE(SELLING JAPAN
HISHAMUDIN IMPORTED CARS AND UNCLE 19 0176082819
MOTORCYCLES)

HASIN AUTOMOTIVE SERVICE COUSIN 19 0135730499

Declaration

I hereby declare that the particulars and answers given in this application form is true and to the best of my
knowledge. I understand that the Company reserves the right TO TERMINATE MY SERVICE / EMPLOYMENT
WITHOUT NOTICE OR COMPENSATION at any time should the Company discover that any of the said particulars
and answers are false, untrue or incorrect at the time of completion of this form.

I hereby undertake to notify the Company immediately should the particulars supplied above be changed in any way
in future.

I also hereby warrant that I have obtained all necessary consent from the third party where I have provided their
personal information as part of my application.

Signature of Applicant ____________________________ Date

Form – Job Application (HR) updated as on March 2020 4