PUBLIC MEDICARE GROUP SDN BHD (898870-V)

Management Office
No.6, 1st Floor, Jalan Merdeka,96100 Sarikei, Sarawak
No.Tel: 084-659966 /7966 /3966 No.Fax: 084-644996
Email: pmgmainhrdept@gmail.comWebsite: www.pmg2u.com

APPLICATION FORM
RECENT
PASSPORT
Position Applied: PHOTO

PERSONAL DATA

Full Name (Underline Surname) Gender NRIC/Passport No. Place of Birth

Nur Izzati binti Darasik
Male/Female 900804-12-5188

Marital Status Identity Card Color

Single
Blue
Mr/Mdm/Ms
Address Contact No. Date of Birth Religion
011-16022802
4.8.1990 Muslim

Tugu Peringatan Petagas,Jln.Ganang 88200,

Kota Kinabalu,Sabah. Office Tel No. Race Citizenship Age

Bajau Malaysia 34

Driving License Yes/No Income Tax File No. EPF No. SOCSO No. Last Grade

Class Category ……………….

PERSON TO CONTACT IN CASE OF EMERGENCY

Name Relationship Contact No. Office Tel. No.

Hazirah binti Darasik Older Sister 019-8434898

Address
Tadika Al-Hadanah,No108 Lorong Ikan Pepuyu,Jalan Mat Salleh,88100 Sembulan,

Kota Kinabalu,Sabah.

FAMILY PARTICULARS

Name Relationship Age Occupation Contact Number

Darasik bin Ismail Father 64 Retired 0195166989

Asiah binti Yenteng Mother 62 Housewife 0133255088

Hazirah binti Darasik Older sister 35 Teacher 0198434898

Abdul Rauf bin Darasik Brother 26 Support Analyst 01160866872

Alifah Yusrina binti Darasik Sister 27 Logistic Department 0128672443

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EMPLOYMENT HISTORY (Start with your present employer)

From To Name of Company Position Last Drawn Please list down benefits Reason Leaving the
Salary entitled company

Wanna find a stable

Apr 2023 Mac 2024 Pretty Cat Garden Pet Groomer RM754 Salary.

Apr 2022 Jul 2022 Al-Aisy Asst. Bakers RM750 Close

Taiwan Buddhist Tzu chi Volunteer

Sep 2019 Dec 2019 Foundation Malaysia Teacher RM900 Close

Kkc Everise Trading

Aug 2017 Jul 2018 Sdn.Bhd Clerk RM920 Close

Length of Notice Required Expected Salary

RM1500

Skills Possessed : Technical / IT Knowledge (Software) :

EDUCATIONAL BACKGROUND

From To School/Institution Certificates/Diplomas/Degrees Awarded

Please state you CGPA / Grades
2014 2016 Kolej Pertanian Malaysia Sijil Kemahiran

2003 2007 Smk St Francis Convent (M) Spm

1997 2002 Sk Tanjung Aru 1 Upsr

LANGUAGE PROFICIENCY

Language Written (Please tick ‘√’) Spoken (Please tick ‘√’)

Excellent Good Average Excellent Good Average

✔ ✔

Bahasa Melayu
✔
✔

English

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HEALTH AND INTERESTS

Have you been or are you suffering from any mental illness, physical disability, disease or serious illness? If yes, give details.
Yes / No

Female Applicant is compulsory to answer this question.

Are you expecting? Yes/No

If yes, please state week number:

State Professional Membership

REFERENCES (Do not include relatives)

Name Occupation / Company
Nursiah binti Hapah Bakers

Relation Contact No. Years Known

Friend 0128216299 2008

Name Occupation / Company

Mohd Nazri bin Sudirman Police

Relation Contact No. Years Known

Friend 01165179686 1999

SUPPLEMENTARY INFORMATION

Please give details if you indicate “yes” for any of the following questions:

Do you have any relatives or friends who are employed by the company or any member of the Public Medicare Group Sdn Bhd ? Yes / No
No

Have you ever been dismissed or suspended from employment by any company? Yes / No

Have you ever been convicted in a court of law in any country? Yes / No

Preferred working location : Near Home

Willing to travel : YES / NO Specific Location : …………………………

No specific locations

DECLARATION

I declare that the information given by me in this application for employment is accurate and that I have withheld no information which would
in any way affect my employment by the Company. I accept that if any information given by me in this application is in any way false or
incorrect, the Company shall have the right to terminate my employment without notice and without giving any reason.

Applicant’s Signature: Date: 12 April 2024

FOR OFFICIAL USE

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