APPLICATION FORM

Position apply: ___________

PERSONAL DATA
Name : __________________________________________
Place & Date of Birth : __________________________________________
Sex : Male Female
Religion : __________________________________________
Permanent Address : __________________________________________
__________________________________________
Telephone / Hand phone : __________________________________________
Other Address (if any) : __________________________________________
__________________________________________
Telephone : __________________________________________
ID No : __________________________________________
Marital Status : Single Married, since__________
With ____________ children
Others, _________________
Physical / Health condition : Height ________cm, Weight ________Kg

EDUCATION

Formal Education
From To Name of School Majoring in City / Town Degree of
(year) (year) Diploma

Courses / Trainings completed

No Courses / Training Duration Place
1
2
3
4
5
6
7
8
9
10
WORKING EXPERIENCE

State Permanent Employment Only (starting with your present job)

Name of Company
Address
Telephone No
Service Period From : To :
Last Position
Direct Supervisor’s Position &
Name
Initial Salary :
Reason of Termination
Main Duties

Name of Company
Address
Telephone No
Service Period From : To :
Last Position
Direct Supervisor’s Position &
Name
Initial Salary : Last Salary :
Reason of Termination
Main Duties

EMPLOYMENT REFERENCE & SALARY EXPECTED

Do you object to reference being made to your present or previous employers? Yes/No
If yes, give reason (s) : __________________________________________________
Notice period required by current employer: __________________________________
Earliest date available to commence work: ___________________________________
Salary expected:________________________________________________________

REFERENCE (give 3 references who are not your relatives)

Name : ____________________________________________
Address : ____________________________________________
Telephone : ____________________________________________
Occupation : ____________________________________________
Relationship to applicant : ____________________________________________
No. of year (s) known : ____________________________________________
Name of company : ____________________________________________

Name : ____________________________________________
Address : ____________________________________________
Telephone : ____________________________________________
Occupation : ____________________________________________
Relationship to applicant : ____________________________________________
No. of year (s) known : ____________________________________________
 Name of company :
____________________________________________

Name : ____________________________________________
Address : ____________________________________________
Telephone : ____________________________________________
Occupation : ____________________________________________
Relationship to applicant : ____________________________________________
No. of year (s) known : ____________________________________________
Name of company : ____________________________________________

COMPUTER SKILL & LANGUAGE PROFICIENCY

Excellent Good Fair Not good

Computer
- Word
- Excel
- Powerpoint
- Outlook
- Internet
- Other…………………
Language
- English
- German
- French
- Mandarin
- Other ……………

CONFLICT OF INTEREST
Do you have any relative (s) or close friend (s) who are working in ACNielsen or
working / have business in marketing research and / or related industry? Yes / No
If yes, please give details:

Name of person Name of Company Position held Relationship

CAREER OBJECTIVES
What are your career objectives? (you may like to discuss the type of organization and
the sort of work you are looking for and levels you hope to attain)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________

MAIN RESPONSIBILITIES
What are your main responsibilities in your present job?
__________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

ORGANIZATION STRUCTURE

Please draw your current organization structure and circle your position

SOCIAL ACTIVITIES
Hobbies:
_____________________________________________________________________
_____________________________________________________________________
Organization (Social, Politic, Professional, etc):
_____________________________________________________________________
_____________________________________________________________________

DECLARATION
I declare that the information given by me in this application for employment is true to
be the best of my knowledge and that I have not withheld any relevant particulars. I
have disclosed all the information required to be given in this application. This
declaration shall, if I am employed by the company, be part of my contract service.

I accept that if any of the information given by me in this application for employment is
in any way false or incorrect, the company shall have the right to dismiss me without
notice and without assigning any reason.

(Signature of applicant)
_____________________
Name:
Place & Date: