Application for Apprentice Training Program in Automotive Mechatronics Personal Information. Education

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1 Mercedes-Benz Malaysia Sdn Bhd ( H) Wisma Mercedes-Benz (Training Academy) 16A Jalan BK 1/13 Taman Perindustrian Bandar Kinrara Puchong Selangor Darul Ehsan, Malaysia mbm_apprentice@daimler.com Affix photo Please type in the specified field and print. Submit your application with a detailed resume, copies of education certificates, testimonials and a recent passport sized photograph (n.r.) to the address stated above: Name : Application for Apprentice Training Program in Automotive Mechatronics Personal Information Address : City : State : Postal Code : Address : Telephone : Mobile Phone : NRIC. : Date of Birth : Race : Age : Religion : Nationality : Education Name of institution & location Level Of Education Results Secondary schools SPM English Grade : Maths Please specify for 2 other subjects with credit : ( Please indicate the school name ) Vocational/Technical SPMV College/University DIPLOMA CGPA: HR Department, MBM (2014) 1/4

2 Language Proficiency Language Spoken Written English Bahasa Melayu Chinese Tamil ( Please indicate the level of proficiency : Poor, Good or Excellent ) Curricular Activities Types of Activities Position and Responsibilities Held Hobbies & Interest Additional Information Have you ever been convicted of a misdemeanor or a felony? Do you have any friends/relatives working with MBM and/or our affiliated companies? Have you ever applied for this program/a job with MBM before? Do you suffer from any serious ailments, physical handicap or allergy? Do you possess a valid driving license? If yes, state class Have you ever applied for any Degree or Diploma courses in University/College? Intake year How do you know about our Apprentice Training Program? Please indicate the newspaper : or other media circulation : ( example : The Star Newspaper, Sin Chew Daily, Mingguan Malaysia, Borneopost, Website, School & etc ) HR Department, MBM (2014) 2/4

3 Compliance Information 1. Have you given any bribes or received any bribes before? If yes, describe incidence: 2. Have you violated any of the following? 2.1 Company/Organisation s policies/guidelines/regulations If yes, please provide details: 2.2 Legal Regulation or local laws If yes, please provide details: 3. Have you been involved in any unethical practices? If yes, please provide details: A) Questionnaire Relationship Declaration Do you or your family (wife, husband, children, mother, father, brothers, sisters etc.) have any relationship with state authorities or government officials? If yes, describe the character of your relationship (please specify name, relationship, position, name of government agencies/state authorities) B) Individuals related to the state authorities or government officials are: People related to the state authorities of government officials could be as follows: Individuals who have relationships with the state authorities or organizations (companies) controlled by the state (and/or to the employees of such organizations). The following are some examples of the state authorities or organizations controlled by the state: Sports Organizations Police, Fire Emergency, Medical Organizations Municipal State Government (State Transport Services etc.) International Social Organizations (National Unions, International Banks etc.) Diplomatic organizations etc. The above list is illustrative and by no means exhaustive. Individuals who have relationships with some other government related structures, which are not included to the above list, could also fall under the given definition. Please note that individuals related to the state authorities or government officials could also be employees of such structures, e.g: HR Department, MBM (2014) 3/4

4 Employee, contractor or government s representative of any state organization, agency or intermediary (half-state, state companies). State official, representative of the country or legislative authorities. Individual being at the service of the government including military, civil service as well as policymakers. Civil servants of the Executive, Legislative and Judicial Power, administrative state organizations and high officials (judges). Employee or contractor of the International Social Organization. Political Party Member, an employee of a Political Party or any Candidate to the Government Post. Members of the family and relatives who work in the authorities mentioned above. Personal Referees 1. I hereby declare that I have never been convicted of any criminal or social offence in court of law. 2. I understand that my training is subject to passing the medical examination by the Company s physician. 3. I understand that if at any time after engagement it is found that a false declaration has been made in this form or in my pre-training medical examination, the company shall have the right to terminate my training forthwith, without any further claims by me. 4. In accepting training with the company, I agree to abide by all the Standing Rules and Regulations of the Company governing the conditions of work and the conduct of its employees. 5. I hereby declare that the information submitted in this form is in every respect true and complete. 6. I authorise the Employer to submit the said information to any person, firm, corporation, body, bureau, department, police officials and Police Record Bureau for the purpose of any investigation which the Employer may desire to make with reference thereto. I also indemnify the Employer from all liabilities, demands, claims, suits, proceedings, costs and expenses of any nature in connection with the foregoing. Date of Application Signature of Applicant For Internal Use Accepted Rejected HR Department, MBM (2014) 4/4

5 Signature/ Name Date PERSONAL DATA PROTECTION ACT 2010 NOTICE PERSONAL DATA PROTECTION ACT 2010 Collection, Recording, Storage and Retention of Personal Information Mercedes-Benz Malaysia Sdn Bhd ( we or us or our ) is currently taking an exercise to comply with the Personal Data Protection Act The Personal Data Protection Act 2010 ( the Act ) is an Act that is passed by the Malaysian government to regulate the processing of personal data in a commercial transaction. To comply with the Act, we are required to manage the personal data that we collect from you. The purposes for which your personal data may be used are, but not limited to:- interview and selection process to conduct reference and background checks; to verify information provided in the application form; and to assist us in facilitating the total recruitment process of Automotive Mechatronic. ("the Purposes") Your personal data will be collected from the application form. It is obligatory that you provide us with your personal data. If you fail to supply us with such personal data, we may not be able to process and/or disclose your personal data for any of the above Purposes. Please be informed that if required for any of the foregoing Purposes, your personal data may be transferred and/or disclosed to any person(s) in or outside Malaysia including but not limited to the Daimler Group of companies, our authorized dealers, respective agents, authorised and appointed outsourcing agents for purpose of fulfilling our obligations to you in respect of the Purposes and all such other purposes that are related to the Purposes and also maintaining and storing records. To this end, we are committed in ensuring the confidentiality, protection, security and accuracy of your personal information made available to us. In this regard, it is your obligation to ensure that all personal information submitted and retained are accurate, not misleading, updated and complete in all aspects. For the avoidance of doubt, we and/or the Daimler Group and/or its employees or authorised officers or agents will not be responsible for any personal information submitted by you that is inaccurate, misleading, incomplete and not updated. HR Department, MBM (2014) 5/4

6 Any personal information retained by us shall be destroyed and/or deleted in accordance with our retention policy applicable for us in the event such information is no longer required for the said Purposes. Consent By submitting this notice you hereby authorise and consent to us processing (including disclosing) your personal data for the Purposes and/or for any other purposes related to the Purposes. Please read the following, sign and date this form in the column provided to indicate your consent. If you do not consent or subsequently withdraw your consent to the processing and disclosure of your personal data (other than for direct marketing), we will not be able to fulfil our obligations to you in respect of the Purposes and/or for any other purposes related to the Purposes. You may at any time after the submission of your personal data to us, request us to update your personal data and/or limit your data processing by directing it to our human resource department or at Applicant s signature Applicant s name Date HR Department, MBM (2014) 6/4