APPLICATION FOR INTERNSHIP						Personal Photo :
BACHELOR IN *	:
IMPORTANT NOTE
Please fill in every column clearly. All supporting documents and certificates for this application are to be attached together with this form. Write (N/A) if not applicable.
Source *	:	Staff Recommendation (Specify name) : Others (Kindly state) : LLC Berhad Website
Duration of Internship *	:
Expected Reporting Date *	:
Industrila Training Letter issued by University (max 3MB) *
( A ) PERSONAL PARTICULARS
Full Name as per I/C *	:
Email *	:
Current Address *	:
Permanent Address *	:
Marital Status *	:	Single Married Divorced	Sex * M F				Age *
Contact No. *	:	HP   Office       House
I.C No./ Passport No. *	:
Date of Birth *	:	DAY 12345678910111213141516171819202122232425262728293031 MONTH JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember YEAR 197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014
Place of Birth *	:
Nationality				Religion *
Blood Group	:	- A B AB O		Race *
Height *	:	CM		Weight		KG
Linguistic Ability*	:	Languages   Spoken Reading Written Bahasa Malaysia   Good Average Below Average Good Average Below Average Good Average Below Average English   Good Average Below Average Good Average Below Average Good Average Below Average Mandarin   Good Average Below Average Good Average Below Average Good Average Below Average   Good Average Below Average Good Average Below Average Good Average Below Average
( B ) DEPENDANTS
Spouse's Name	:
I/C No.	:
Occupation	:
Age	:
Company	:
Spouse Tax Ref No.	:
No. of Children	:
Children's Age	:	1.   2.   3.   4.   5.

( C ) FAMILY DETAILS
Other Immediate Family Details
Father's Name	:			Occupation	:
Mother's Name	:			Occupation	:
No. of Sibling(s) including yourself	:			Your status in the family (elders/youngest/3rd)	:
( D ) EDUCATION *
Year   School / College / University   Attainment / Qualification( PHD, Master, Degree, Diploma, Certificate, etc.) From   To                                   Scholarship Received (if any) Organisation/Institution
( E ) ACTIVITIES
Description   Sports, Games   Club, Societies, Associations, etc.   Position Held Secondary School /College/ University                                       At Present             Hobbies / Interests
( F ) PREVIOUS EMPLOYMENT HISTORY INCLUDING PART TIME
Year         Name of Employer   Position Held   From   To   Salary   Reason For Leaving

( G ) COMPUTER SKILLS (Please indicate with a tick ( √ )
Computer Software Please rate the following statements 1. Microsoft Word Very Good Good Average Below Average 2. Microsoft Excel Very Good Good Average Below Average 3. Microsoft Project Very Good Good Average Below Average 4. Primavera Very Good Good Average Below Average 5. AutoCAD Very Good Good Average Below Average 6. Other ( Please specify ) Very Good Good Average Below Average
( H ) FIDELITY INFORMATION (Please answer the following by ticking ( √ )
1. Have you ever been convicted of a criminal offfence or been in prison? Yes No 2. Have you ever been declared a bankrupt? Yes No 3. Have you ever been hospitalised or diagnosed or treated for any illness or are undergone any medical treatment? Yes No 4. Do you have any personal interests in any business undertaking? Yes No 5. Have you ever been employed with LLC Infra Sdn Bhd? Yes No 6. Do you have any friend / relative working in LLC Infra Sdn Bhd? Yes No 7. For female applicant, are you now pregnant? Yes No 8. Have you been fully Vaccinated with 2 jabs of Covid-19 Vaccine? If yes, Kindly submit your fully Vaccination Certificate as proof Yes No If your answer is YES to any of the above question, please furnish particulars below:
( I ) REFEREES ( Do not list relatives or in-laws )
Name   Relationship   Years Known   Occupation   Name, Address & Contact No. of Employer
( J ) DECLARATION
I declare that the foregoing particulars regarding myself are true in every respect and that I am not a drug addict and I agree that if, at any time after I start my internship, it is found that a false declaration has been made on this form, the Company reserves the right to terminate my employment without any liability whatsoever.