Please attach a CONFIDENTIAL

recent photograph
of yourself here Job Application Form
Notes:-
1) Complete all required fields and mark “N/A” where appropriate;
2) Incomplete and unsigned form shall be rejected; and
3) False statement may cause rejection of the application or if
employed disciplinary action shall be taken including dismissal.

POSITION APPLIED FOR:

PART A:PERSONAL DETAILS
Name:
(Underline surname) NURIDAYA BINTI AB JALIL NRIC / Passport No.: 910802125562
Home Address: Current Address (if different from home/for expatriate):
BANDAR BARU SALAK TINGGI
Home Number: Mobile Number: 0149109291
Email Address – Personal/Official (Compulsory): Office Number:
Nuridayajalil91@gmail.com
Date of Birth Age: Marital Status: Gender: No. of Children: Nationality:
(DD/MM/YY):
32THN MARRIED P 2 MALAYSIA
02/08/91
PART B: SPOUSE & FAMILY MEMBERS’ DETAILS
If married, Spouse Details:-
Name Occupation Employer
ABDUL HALIM SECURITIY
Children’s Details:-
Name Age Sex Birth Date Birth Cert No. / NRIC
LYSHA QUSTINA 8 P 15/06/2015 150615121356

Parent’s Details:-
Name Occupation Employer
SITI SURAH SURI RUMAH

Sibling’s Details (for 18 and above only):-

Name Occupation Employer
ABDUL KARIM USEDCAR

PART C: EDUCATIONAL PARTICULARS

Institution Highest Qualifications & Date of Completion (Month/Year)
SMK KABOGAN 2 SEMPORNA SPM (2004-2008)

PART D: EMPLOYMENT DETAILS (CURRENT & PREVIOUS)

Employer’s Name Position Date Joined / Left Reasons for leaving
CBTL SUPERVISOR 04/04/22-03/02/23 Get a new job
SHELL STAFF 2021-2022 personal problems
Notice period required Text
Current Salary (RM) (Basic) + (Allowance) Expected Salary (RM)
RM3000 RM2000
PART E: EMERGENCY CONTACTS / IMMEDIATE FAMILY MEMBER (STATE 2)
1. Name: ABDUL HALIM Relationship: HUSBAND
Address: Contact No.:
BBST 0174181391
2. Name:
SITI SURAH Relationship: IBU
Address:
SEMPORNA SABAH Contact No.: +60 11 3609 0727
PART F: ADDITIONAL INFO AND DECLARATION
I, hereby declare(If yes, please state the details) Yes No

1. Were you previously employed by GTR/AirAsia Group?

2. Are you serving any bond/contract with your current or any other organization?
If yes, please indicate bond period: From / / to / / .
3. Do you have any relatives working in GTR/AirAsia Group?

4. Have you been declared a bankrupt?

5. Do you have any major disease / illness or any serious medical condition / previous
accident and workplace injury history / and previous back injury?
6. Have you been charged and/or found guilty for any act of criminal?

7. Are you currently an owner/shareholder of an enterprise or private limited company?

8. Are you currently pregnant? (For female candidates)

9. Have you made any legal claims against GTR/ AirAsia Group?
PART G: REFERENCE (NAME 2 PEOPLE, NOT FAMILY MEMBERS)
1. Name: MUHAMAT SAFRI Relationship: COUSIN
Company’s Name: Contact No.: 012 329 2602
2. Name: Relationship:
FAIZAL OSIN COUSIN
Company’s Name: Contact No.:
+60 11 3619 1966
STATEMENT DECLARATION
I hereby declare that:
• I have provided a copy of my CV, certificates, and IC (or first page of Passport for Foreign applicants) in order for my application to be
considered;
• The particulars in this application form and document attached hereto are true in every respect; and
• I have not wilfully suppressed any material fact.
By signing this application, I agree to authorise the use of any information in this application to verify my statements, and I authorise all past
employers, past educators and references to release any/all information concerning my previous employment and educational records.

Applicant’s Signature: Date: 20/05/2023

For Office Use Only

Designation Allowance/s (If any) Amount

Job Grade
Station
Basic Salary
Date of Appointment
Remarks:

Verified by: Approved by:

Head of Department People Department

Name: Name:
Date: Date:
 Information Release Form / Consent Form

As part of the hiring procedure and as a condition of my offer of employment, I have agreed to allow a background check and verification of information I have
provided in connection with my application with the hiring company. Therefore, unless I notify the hiring company to the contrary in writing, I authorize the hiring
company and its agent – BGS Checks Sdn Bhd (BGS CHECKS) and/or its agents thereof to carry out all necessary enquiries to verify the information I have
entered on this form which may include employment references, civil and criminality records, local language media information, directorship information,
directorship disqualification information, property ownership information, credit records where applicable, driver’s license offense records, driver’s license
verification, education and credential verification, passport and / or identity documents and other background information on me as requested by the hiring
company (the “Collected Information”). I hereby authorize the hiring company through (BGS CHECKS) and/or its agents, as well as (BGS CHECKS) explicitly,
to contact various government agencies, any and all corporations, former employers, educational institutions, consumer credit information agencies, law
enforcement agencies and courts and other contributors (the “Contributors”) as a relevant party acting on my behalf for the purposes of obtaining the Collected
Information.

In consideration of my conditional offer of employment with the hiring company, I hereby consent to the collection, use and disclosure of this information and
release and forever discharge the hiring company and BGS CHECKS, their successors, affiliates and assigns and their past and present officers, directors,
employees, lawyers and agents from any claim whatsoever in any way relating to (a) the information released by the persons to whom this authorization and
direction is provided, and (b) the use of the information in connection with the background check and verification of information by the hiring company and/or
BGS CHECKS. The hiring company acknowledge that BGS CHECKS (and its agents) in collecting, holding, processing and using the Information, the Collected
Information and such other related information and documents that may contain my personal data solely on behalf of the hiring company and does not hold,
process or use those information for any of its own purposes.

I understand that this information is being collected for the purposes of conducting pre-employment background screening and I declare that the information
provided by me in connection with the hiring process and background check is complete, true and correct, to the best of my knowledge.

Signature:

Full Name in Block Capitals:

Maiden Name or AKA:

Name in Other Language: ____________________________________________________________________

(Chinese, Thai, Japanese, Korean)

Address:

ID Number: (NRIC Number)

(Please include all relevant ID including HKID, PRC ID and Social Security Number)

Date of Birth:

Date: