The Right Place. The Right People. Have you been or ar mental iliness? Do you smoke? Have you ever been dismissed or discharged from the service of any | —ves— | No {company Have you ever been convicted in a Court of Law in any country? tee bs Have you ever been declared bankrupt? | —¥es— | No Are you in debt / bonded? —¥ee- | No Present Basic Salary per Month: Bonus: Fixed: Variable: ‘Commission/ Profit Sharing: Expected Salary per Month: ‘Transport allowance: Notice Period (For applicants currently employed): Earliest Date of Commencement, if appointed: 'PARTIM = DECLARATION —__ a z - | hereby deciare that the information given by me in this form is correct and true to the best of my knowiedge VR to-Oct-201b Applicant's Signature Date Private & Confidential