MEGAH SAMUDERA SDN BHD

Co.No : 584277-U No 59-1 (1st Floor), Jalan Ramin 2, Bandar Botanic, Klang Selangor. MALAYSIA Tel : (+603) 3318 6425 Fax : (+603) 6142 2262

APPLICATION FORM FOR SUBSEA COMMERCIAL DIVING COURSE

PERSONAL INFORMATION
DATE:______________

Name in Full

: _________________________________

Paste Passport Size Photo Here

(Please write your name in full as in your IC or passport) NRIC / Passport No. : __________________________________ Date of Birth Nationality Address : __________________________________ : __________________________________ : __________________________________

_____________________________________________________ Contact Number Email Address Race Age Marital Status Place of Birth Height (In cm) : (Home No)_____________ (Mobile No)___________________ :____________________________________________________ : ________________________Religion:____________________ :________________________Gender:_____________________ :________________________Driving License : _____________ :_______________________ Date of Birth:_________________ :_______________ : Weight (In kg) :____________

Languages / Dialects Spoken & Written

.. Hobby & Interest :

What diving certificate you have or how many hours youve dived?

______________________________________________________________________

MEGAH SAMUDERA SDN BHD

Co.No : 584277-U No 59-1 (1st Floor), Jalan Ramin 2, Bandar Botanic, Klang Selangor. MALAYSIA Tel : (+603) 3318 6425 Fax : (+603) 6142 2262

EDUCATION Name and Location

High School College or University Specialized Training, Trade School

Year

Degree

Majoring

Special Training Course

Traning Attended Provider Year

Membership of organizations (Professional, social, sporting etc.)

Organization Year

Please list your areas of highest proficiency, special skills or other items that may contribute to your abilities in performing the above mentioned position.

PREVIOUS EXPERIENCE
Please list beginning from most recent Dates Employed Company Name
Location Role/Title

Job notes and tasks performed:

Dates Employed

Company Name

Location

Role/Title

Job notes and tasks performed:

MEGAH SAMUDERA SDN BHD

Co.No : 584277-U No 59-1 (1st Floor), Jalan Ramin 2, Bandar Botanic, Klang Selangor. MALAYSIA Tel : (+603) 3318 6425 Fax : (+603) 6142 2262

Please answer the following questions : ( YES / NO ) : Have you or are you suffering from any physical handicap, serious illness or disease? .. Have you been convicted in any COURT of LAW for any criminal offence (other than Traffic Offence)? .. Are you in debt or a un-discharge bankrupt? ..

If any of the answer to the above is YES , please give details :

EMERGENCY CONTACT Name Telephone Number Relationship to Employee

I hereby certify that the foregoing information as provided by me is accurate and true. I further understand that any willful act on my part in withholding information or making a false statement is the Application is in itself sufficient ground for dismissal from the Company.

.. Signature of Applicant Name: Date:

NOTE: Please attach copies of your relevant certificates and testimonials when submitting this form. Disclaimer : Megah Samudera Sdn Bhd does not enter into correspondence with regard to the reasons for non selection

MEGAH SAMUDERA SDN BHD

Co.No : 584277-U No 59-1 (1st Floor), Jalan Ramin 2, Bandar Botanic, Klang Selangor. MALAYSIA Tel : (+603) 3318 6425 Fax : (+603) 6142 2262

FOR OFFICE USE:

First Interview: Recruitment Status (Please Circle)
ACCEPTED REJECTED

:
KIV

Remarks:

Interviewed By: .. . Signature & Date Second Interview: Recruitment Status (Please Circle)
ACCEPTED REJECTED

:
KIV

Remarks:

Interviewed By: ..

. Signature & Date Commencement Date : .