EMPLOYMENT APPLICATION FORM

STRICTLY PRIVATE & CONFIDENTIAL

(Applications will be treated in strict confidential and no
information will be disclosed without prior permission)

INSTRUCTIONS
1. This Application Form must be completed by the applicant and returned to Nielsen Audience Measurement Sdn
Bhd, 19/F, Menara MBPJ, Jalan Tengah, 46200 Petaling Jaya, Selangor.
2. All columns should be filled. If a column is not applicable, please mark N/A.
3. Only copies of certificates and testimonials need to be attached to this form. The originals should be produced
during the interview.
4. If space on this form is insufficient, please attach an addendum.
5. * Delete as appropriate.

Recent
Photograph
Position for which you are applying
If you have previously applied through
us, please state the year & position

PERSONAL DETAILS
Full Name *Dr/Mr/Ms Date of Birth
Nationality
Address Country of Birth
Ethnic Origin (Race)
NRIC No.
Telephone Home: Office: Religion
Mobile: Sex
Driving License * Yes / No Class(es): Marital Status
Do you own a car? * Yes / No
For FEMALE ONLY: Are you pregnant at the time you apply for this job? * Yes / No

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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EDUCATIONAL DETAILS
Name in chronological order, school attended from the age 13 onwards. (Please attach a list of training courses attended, if applicable)

Year Highest Standard Passed

School / Institution
Joined Left Exam/Grade Year

PROFESSIONAL QUALIFICATIONS & MEMBERSHIPS (Please attach photocopies of documents)

Name of Professional Body State Membership Status Year Completed / Admitted

(Graduate/Associate/Fellow/Others)

LANGUAGES & DIALECT PROFICIENCY

Written Spoken
* Good / Fair * Good / Fair
* Good / Fair * Good / Fair
* Good / Fair * Good / Fair
* Good / Fair * Good / Fair
* Good / Fair * Good / Fair
* Good / Fair * Good / Fair

CHARACTER REFEREES
One of the Character Referees should be an immediate superior in a previous employment and not a friend, relative or member of your family.

Full Name Full Name

Employers Employers
Name Name
Occupation Occupation
Tel. No. Years Known Tel. No. Years Known
Relationship Relationship

DETAILS OF HUSBAND / WIFE

Name NRIC No.
Occupation Date of Birth
Name of Employer

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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DETAILS OF CHILDREN
Name Sex Date of Birth Occupation Name of Employer

DETAILS OF FATHER / MOTHER

Fathers Name Mothers Name
NRIC No. NRIC No.
Date of Birth Date of Birth
Occupation Occupation
Name of Employer Name of Employer

DETAILS OF BROTHER / SISTER

Name Sex Date of Birth Occupation Name of Employer

ADDITIONAL INFORMATION
Have you ever been convicted in a court of law? Yes No
If so, give details:

Are you involved in any administrative, civil or criminal case(s)? Yes No

Have you been declared a bankrupt? Yes No
If so, to whom, to what extent & for what reason:

Have you been dismissed or suspended from any position? Yes No

If so, state details:

Are you currently engaged in any other business other than your present employment? Yes No
If so, what type of Business?

Countries worked in Will you serve overseas? Yes No

Have you been, or are you suffering from any physical impairment or disease i.e. epilepsy, Yes No
lameness, stammering etc?

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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EMPLOYMENT RECORDS
If space on this form is insufficient, please attach an addendum

PRESENT EMPLOYMENT
Starting Date Employer/Company Name: Starting Salary
(Month/Year)
Starting Position/Date
Current Salary
Current Position
Nature of Business Staff Size of
Organization
Reason for Size of Your
wanting to leave Department
How did you get (Through advertisement, recommendation etc) No of Staff Supervised
employed in this
Company? Name & Designation of
Immediate Superior

Primary Duties & Responsibilities (summary)

CURRENT REMUNERATION (* Please delete where appropriate)

Monthly Salary RM Bonus (Quantum) months

Company Car (Model/cc) Car Allowance RM
Commission RM Share Option Scheme * Yes / No Value:
Entertainment Allowance RM Medical Insurance * Self / Self & Family
Housing Allowance RM Life Insurance * Yes / No Value:
Details of other Sources Other Benefits
of income
Remuneration Expected
Notice Period required to be given to employer

ORGANIZATION CHART OF PRESENT EMPLOYER

Please sketch a chart showing your present position within the organization (please show one level up & one level down)

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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EMPLOYMENT RECORDS
If space on this form is insufficient, please attach an addendum

DETAILS OF PAST EMPLOYMENT IN CHRONOLOGICAL ORDER

Date Employer/Company Name: Starting Salary
From To
(Mth/Yr) (Mth/Yr)
Last Drawn Salary

Starting Position Last Position Date Promoted

Person Reporting To Staff Size of

Organization
Nature of Business Size of Your
Department
Reason for Leaving Number of Staff
Supervised
Primary Duties & Responsibilities

DETAILS OF PAST EMPLOYMENT IN CHRONOLOGICAL ORDER

Date Employer/Company Name: Starting Salary
From To
(Mth/Yr) (Mth/Yr)
Last Drawn Salary

Starting Position Last Position Date Promoted

Person Reporting To Staff Size of

Organization
Nature of Business Size of Your
Department
Reason for Leaving Number of Staff
Supervised
Primary Duties & Responsibilities

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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EMPLOYMENT RECORDS
If space on this form is insufficient, please attach an addendum

DETAILS OF PAST EMPLOYMENT IN CHRONOLOGICAL ORDER

Date Employer/Company Name: Starting Salary
From To
(Mth/Yr) (Mth/Yr)
Last Drawn Salary

Starting Position Last Position Date Promoted

Person Reporting To Staff Size of

Organization
Nature of Business Size of Your
Department
Reason for Leaving Number of Staff
Supervised
Primary Duties & Responsibilities

DETAILS OF PAST EMPLOYMENT IN CHRONOLOGICAL ORDER

Date Employer/Company Name: Starting Salary
From To
(Mth/Yr) (Mth/Yr)
Last Drawn Salary

Starting Position Last Position Date Promoted

Person Reporting To Staff Size of

Organization
Nature of Business Size of Your
Department
Reason for Leaving Number of Staff
Supervised
Primary Duties & Responsibilities

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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PLEASE WRITE BRIEFLY YOUR STRENGTHS & WEAKNESSES
STRENGTHS:

WEAKNESSES:

ACHIEVEMENTS
Major achievements in the last Five(5) years

ACKNOWLEDGEMENT / CERTIFICATION

I hereby declared that to the best of my knowledge and belief, the information given in this application form is correct. I understand
that any misrepresentation or omission of information will be sufficient reasons for withdrawal of an offer, or subsequent dismissal
without notice, if employed.

Signature of Applicant : Date

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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 INTERVIEWERS EVALUATION

INTERVIEW SESSION: 1ST / 2ND / 3RD

Name Signature Date

INTERVIEW SESSION: 1ST / 2ND / 3RD

Name Signature Date

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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 FOR OFFICE USE ONLY
Interview 1st Interview 2nd Interview 3rd Interview
Date
Signature of Interviewer(s)

Recommended

Selected

KIV

Rejected

Job Position Department

Report to
Date of Commencement
Commencing Salary
Allowance

APPROVED FOR EMPLOYMENT

Name Signature Date

Department Head

HR Manager

Director / Assoc. Director

Managing Director

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Employment Application Form Nielsen Audience Measurement (Malaysia)
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