Petronas Declaration Form

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) :

Phone interview / chit-chat

Name of company : .....................................................................................................................................

Online test

Technical assessment

Final interview

Assessment Date(Month / Year)

EMPLOYMENT HISTORY

NOTES: 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.

1. Full Name (as per NRIC/Passport) : .....................................................................................................................................................................................................................

2. NRIC/Passport Number : .................................................................................

4. Mobile Number : ..............................................................................................

1. Name of current employer : ..................................................................................................................................................................................................................................

Employment type : Permanent q���Contract q

2. Have you been offered an employment/employed by PETRONAS and/or its group of companies?......................................................... YES q���NO q

� � If ‘YES’, name of company : ....................................................................................................................................................................................................................................

Type of employment : Permanent q���Contract q�������Duration : ...............................................................................................................................................

3. Current basic salary : ................................... Expected basic salary : ...................................

3. Nationality : ......................................................................................................................

5. Email Address : ...............................................................................................................

PERSONAL DETAILS

EDUCATION DETAILS

DECLARATIONFORM

Qualification Program Institution Results Date of Completion

(CGPA/WAM) (Month/Year)

PhD

Master

Degree

Diploma

SPM/O-Level

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1. Have you been awarded a PETRONAS education sponsorship before? .............................................................................................................. . YES q���NO q

If ‘YES’, year awarded : ...................................... Type of sponsorship : .......................................................................................................................................................

2. Have you been awarded an education sponsorship from any organizations (e.g. PTPTN/JPA/MARA)? .................................................. YES q���NO q

If ‘YES’, name of organization : ............................................................................................................................................................................................................................

Are you contractually bonded with the organization? ............................................................................................................................................... YES q���NO q

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 q���NO q

If ‘YES’, kindly list their particulars:

Signature : ................................................................................... Date (DD/MM/YY) : .................................................................

Name : ..........................................................................................

Relative(s) include spouse(s), parents, parents-in-law, siblings, siblings-in-law, aunties, uncles, nieces, nephews, first cousins and fiancée / fiancé

Name Relation to You Company Employed

Name Position / Company Contact Number

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.

DECLARATION

4. Have you been declared a bankrupt? ........................................................................................................................................................................ YES q���NO q

If ‘YES’, please state the year of bankruptcy declared upon you : .......................................................................................................................................................

5. Have you even been convicted by any division of criminal court? .................................................................................................................. YES q���NO q

If ‘YES’, please state at which court : .................................................................. Case : ........................................................... Year of conviction : .....................

6. Has any disciplinary action been taken against you in your previous employment(s)/educational institution(s)? ............................. YES q���NO q

If ‘YES please state year of action taken : ........................................................ Case : ............................................................................................................................

Name of company/institution : .......................................................................................................................................................................................................................

7. Are you currently an owner/shareholder of an enterprise or private limited company? ........................................................................... YES q���NO q

If ‘YES’, please state the name of company/enterprise : ........................................................................................................................................................................

Title held in company/enterprise : ........................................................ Nature of business : ............................................................................................................

8. Please provide us with two (2) referrals (Preferably your previous working superior(s) :

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