DECLARATION
FORM
PETRONAS TECHNICAL SERVICES SDN BHD
NOTES: (347848-X)
1. Complete all required fields. Mark ‘N/A’ where applicable.
2. Incomplete and unsigned form shall be rejected.
3. False statements may cause rejection of the application or if employed, termination of employment.
PERSONAL DETAILS
1. Full Name (as per NRIC/Passport) : ............................................................................................................................. ........................................................................................
2. NRIC/Passport Number : ................................................................................. 3. Nationality : ......................................................................................................................
4. Mobile Number : .............................................................................................. 5. Email Address : ...............................................................................................................
EDUCATION DETAILS
Results Date of Completion
Qualification Program Institution /WAM)
(C (CGPA) (Month/Year)
PhD
Master
Degree
Diploma
SPM/O-Level
1. Have you been awarded a PETRONAS education sponsorship before? ......................................................................................................... YES NO
If ‘YES’, year awarded: ...................................... Type of sponsorship: ............................................................................................................................. ..........................
2. Have you been awarded an education sponsorship from any organizations (e.g. PTPTN/JPA/MARA)? ............................................... YES NO
If ‘YES’, name of organization: ............................................................................................................................. ..............................................................................
3. Are you contractually bonded with the organization? .....................................................................................................................................................YES NO
EMPLOYMENT HISTORY
1. Name of current employer : ............................................................................................................................. .....................................................................................................
Employment type : Permanent Contract
2. Have you been offered an employment/employed by PETRONAS and/or its group of companies? YES NO
If ‘YES’, name of company : ............................................................................................................................. ........................................................................................
Type of employment : Permanent Contract
Duration: .....................................................................................................................
3. Current basic salary: ................................... Expected basic salary: ...................................
ADDITIONAL INFORMATION
1. Area of job interest : 1) ................................................... 2) ................................................... 3) ...................................................
2. Have you participated in any of PETRONAS entry level assessment as below (Fill details where applicable) :
Assessment Date
Assessment (DD/MM/YY)
(M onth / Y ear)
Phone interview / chit-chat
Name of company : ............................................................................................................................. ........
Online test
Technical assessment
Final interview
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3. Do you have any relative(s)*, either by blood, marriage or adoption who is/are currently employed by PETRONAS and/or
its group of companies? ............................................................................................................................. ...................................................................... YES NO
If ‘YES’, kindly list their particulars:
Name Relation to You Company Employed
Relative(s) include spouse(s), parents, parents-in-law, siblings, siblings-in-law, aunties, uncles, nieces, nephews, first cousins and fiancée / fiancé
4. Have you been identified to attend National Service Program (Program Latihan Khidmat Negara)? ............................................... YES NO
If ‘YES’, did you attend? : ............................................................................................................................. ......................................................................
5. Have you been declared a bankrupt? ........................................................................................................................................................................ YES NO
If ‘YES’, please state the year of bankruptcy declared upon you : .....................................................................................................................
6. Have you even been convicted by any division of criminal court? .................................................................................................................. YES NO
If ‘YES’, please state at which court : .................................................................. Case : ........................................................... Year of conviction: .....................
7. Has any disciplinary action been taken against you in your previous employment(s)/educational institution(s)? ......................... YES NO
If ‘YES please state year of action taken : ........................................................ Case : .................................................................................................................... Name
of company/institution : ............................................................................................................................. .............................................................................................
8. Are you currently an owner/shareholder of an enterprise or private limited company? ........................................................................... YES NO
If ‘YES’, please state the name of company/enterprise : ............................................................................................................................. ...........................................
Title held in company/enterprise : ........................................................ Nature of business : ............................................................................................................
9. Please provide us with two (2) referrals (Preferably your previous working superior(s) :
Name Position / Company Contact Number
DECLARATION
I hereby certify that all the statements made in this declaration are true and correct. I understand that I must demonstrate that I meet the
minimum requirements of the job, and further understand that any exaggerated or false statement(s) or omission of requested information may
be a cause for my application to be rejected; or, if I have been employed may be cause for my termination. By signing this application, I agree to
authorize the use of any information in this application to verify my statements, and I authorize all past employers, past educators and references
to release any/all information concerning my previous employment and educational records.
Signature : Date (DD/MM/YY ) : .................................................................
Name : ..........................................................................................
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