Consent Forms

BACKGROUND CHECK AUTHORIZATION FORM
(Personal Data Protection Act 2010 (“PDPA 2010”), Credit Reporting Agency Act 2010 (“CRA Act 2010”), Central Bank of Malaysia Act
2009 and the European Union General Data Protection Regulation)
MAISARAH ZUHAIRAH BINTI ZULKIFLI

By signing this Consent Form, I, _________________________________, 901209-15-5096
bearing the NRIC / Passport No.: ________________________
hereby have granted informed consent to the organization with whom I am employed or seeking employment, herein referred as ‘the
Company’, and to their appointed third party screening business partner, VENOVOX Group of Companies, herein referred as ‘the
Screening Company’, to conduct Pre and/or Post Employment background screening as part of the recruitment selection / HR policy
requirement in assessing my suitability for selection on the position applied or continuance of my employment in the Company.
I consent to the Screening Company shall acting as the Representative (located within Malaysia, Singapore and USA), engaged by the
Company to perform certain functions connected to my education, employment and security related issues to which the disclosure is
necessary for the Company to make an informed decision on my selection for the position applied or continuance of my employment.
The Company is hereby authorized to release to the Screening Company any and all information concerning my personal data, education
and employment and my application, and I agree to hold the Company blameless and free of any liability for releasing any such
information to the Screening Company.
The Screening Company is hereby authorized to release my personal data and seek verification on certain functions to agencies and lawful
entities and I agree to hold the Screening Company blameless and free of any liability for releasing any such information in the course of
gathering and conducting the due diligence.
I understand an investigative report may be generated on me and I authorize the relevant agencies and lawful entities to disclose to the
Screening Company and its agents all information about or concerning me, including but not limited to: my past or present employers;
learning institutions, including colleges and universities; law enforcement and all other government agencies; federal, state and local
courts; credit bureaus; all other private and public sector repositories of information; and any other person, organization or agency with
any information about or concerning me within their knowledge or record, and I agree to hold any or all of them blameless and free of any
liability for releasing any truthful information that is within their knowledge or records.
I also agree to hold the Company blameless and free of any liability for using any information received from such parties in making an
employment decision regarding me. I understand that the Company may rely on this authorization to order additional background reports,
including investigative consumer reports, during my employment without asking me further for my authorization as allowed by law.
I agree that a copy of this form is valid like the signed original. I certify that all of the personal information I provided is true and correct. I
understand that misrepresentation or omission will constitute sufficient ground for rejection or for subsequent dismissal if I am hired.
ACKNOWLEDGEMENT AND RELEASE

I acknowledge receipt of this form. I release your company and its employees and agents from all liability relating to your obtaining
and use of such information solely and only for the purpose of being evaluated for a recruitment position. I authorize all companies,
schools, organizations, registered credit reporting agency under the CRA Act 2010 and other persons to process my personal data as per
the PDPA 2010 and provide such information to you and your agents and release them from all liability for doing so.
6 MARCH 2024
Candidate’s Signature Date
MAISARAH ZUHAIRAH BINTI ZULKIFLI 901209-15-5096

Candidate’s Name (typed or printed) NRIC / PASSPORT NO:
Mandatory Information to be Filled:

PREVIOUS COMPANY REFEREE INFORMATION (please make sure you have informed your Referees below on your
job application)
Referee #1: Ex-Supervisor Referee #2: Ex-Supervisor Referee #3: Ex-Supervisor

NAME: NURUL ATIQAH BINTI ROSZOPOR NAME: MOHD ARIF BIN OTHMAN NAME:
DESIGNATION: ASSOCIATE I DESIGNATION: Assistant Vice President I DESIGNATION:

PENGURUSAN AIR SELANGOR
CO. NAME: PENGURUSAN
SDN BHD
AIR SELANGOR CO. NAME: SDN BHD CO. NAME:
TEL. NO: 017-391 0957 TEL. NO: 012-9318826 TEL. NO:
EMAIL: atiqah.roszopor@airselangor.com EMAIL: arif.othman@airselangor.com EMAIL:

PRIVACY NOTICE
The Personal Data Protection Act 2010 and the European Union General Data Protection
Regulation
VENOVOX Group of Companies is committed to protecting the confidentiality of the personal data you, the candidate has
consented hereabove. This notice outlines what personal data we will collect, how we intend to use and protect this
information, and your rights with respect to your personal data for purposes of GDPR. Although you are entirely in control
of your decision to give consent, and if you choose to withhold consent, there will be no repercussions, take note that
without some data, the above-mentioned Company may not be able to make a decision on your suitability for employment
or comply with the law and HR policy, therefore they may not be able to make an offer of employment or allow for
continuance of your employment.
NOTE: The GDPR may apply to personal data that you provide while physically located in the EU/EEA. It does not apply to
information provided while located outside of the EU/EEA (e.g., while in the United States). GDPR data protection
requirements do not apply to your personal data that is rendered anonymous such that you are not identifiable or can no
longer be identified.
What Data is Collected

The purposes for which and the manner in which any personal data are, or are to be, processed is defined in the Personal
Data Protection Act 2010 and the European Union General Data Protection Regulation. The type of data collected is
recruitment data.
Purpose of Processing
Data collected by the Data Processors will be processed for legal, administrative, management, compliance, audits and
other legitimate and lawful business purposes and such processing will be conducted within such purpose limitations and
in accordance with applicable law. The data compiled is to allow the Client to make a decision on your suitability for
employment or continuance of employment.
Transferring personal data

We will ensure that your information is safeguarded in accordance with suitable safeguards recognized by the Personal
Data Protection Act 2010 and the European Union General Data Protection Regulation (GDPR). When using the services of
the independent third-party for reporting, we will ensure that the third party shall have suitable technical and
organizational measures to protect the personal data as required by the applicable law.
Security
We are committed in ensuring the security of the personal data collected and we take reasonable technical or
organizational measures to help protect the information from unauthorized or unlawful processing and against accidental
loss, destruction or damage.
Retention
The report will be stored for the time period required by the applicable laws or as required by the legal requirements or till
the time you exercise your right to erasure or enable us to manage the relationship with you effectively, lawfully and
appropriately, whichever is the higher. Data/Record will be kept for duration of your employment. When your
employment is completed, it will be destroyed when the Client communicates to us.
Your Rights
We respect your right to access and control your information, and we will respond to the requests for information and,
where applicable, will correct, amend, or delete your personal data. In such cases, we will need you to respond with proof
before you can exercise the rights.

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BACKGROUND CHECK AUTHORIZATION FORM

MAISARAH ZUHAIRAH BINTI ZULKIFLI

ACKNOWLEDGEMENT AND RELEASE

Candidate’s Signature Date

MAISARAH ZUHAIRAH BINTI ZULKIFLI 901209-15-5096

Mandatory Information to be Filled:

Referee #1: Ex-Supervisor Referee #2: Ex-Supervisor Referee #3: Ex-Supervisor

DESIGNATION: ASSOCIATE I DESIGNATION: Assistant Vice President I DESIGNATION:

TEL. NO: 017-391 0957 TEL. NO: 012-9318826 TEL. NO:

EMAIL: atiqah.roszopor@airselangor.com EMAIL: arif.othman@airselangor.com EMAIL:

What Data is Collected

Transferring personal data

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