PERSONAL DETAILS

Title: Mr./Mrs./Miss/Ms./Other (please specify)

Name as stated in IC.:

Marital Status:

NRIC No.:

Passport No.:

Date of Birth:

Age:

Place of birth:

Nationality:

Race:

Religion:

Income Tax no.:

EPF No.:

SOCSO No.:

Home Address:

Correspondence address (only if different from home address):

Home telephone No.:

Mobile No:

Email Address

Fax No:

Please confirm if you hold a driving licence? Yes/No.

Yes No

FAMILY DETAILS

Name of Spouse:

Employer (name of organization):

Occupation:

Company’s address:

Name of Child:

Gender

Age

Name of Child:

Gender

Age

Name of Child:

Gender

Age

Name of Child:

Gender

Age

Name of Child:

Gender

Age

HEALTH DECLARATION

Kindly state if you are in good health.

Yes No

Do you have diabetes/high blood pressure/heart problems?

Have you had any surgery in the past, if so, please give details.

Please mention if you have any disability/handicap. In the event you are being offered employment, would the Firm be required to provide any adjustments to enable you to perform your duty?

EDUCATION

Name of School/Instituition

Level:

Dates From:

Dates To:

Subjects/Grades:

Name of School/Instituition

Level:

Dates From:

Dates To:

Subjects/Grades:

Please provide details of your tertiary education. Please provide a breakdown of all your grades. Please provide details of your professional qualification, e.g. BVC/LPC or CLP.

University/College:

Date From:

Date To:

Qualification & Date Awarded

Grade/Class

University/College:

Date From:

Date To:

Qualification & Date Awarded

Grade/Class

University/College:

Date From:

Date To:

Qualification & Date Awarded

Grade/Class

Please state the date of your admission to the Malaysian Bar:

Do you have a practicing certificate?

Yes No

Please state your Bar Council membership no.:

LANGUAGES (Please indicate basic/fair or good).

English:*

Understand

Speak

Read

Write

Bahasa Malaysia:*

Understand

Speak

Read

Write

Other languages (please specify)

CAREER HISTORY

Have you been employed by the Firm before?

Yes No

Please state your former position(s) in the Firm, and the dates of your employment.

PREVIOUS AND CURRENT EMPLOYMENT, LIST IN ORDER OF THE MOST RECENT FIRST.

Date From:

Date To:

Designation/Last earned salary:

Name and Address of Employer:

Reasons for leaving:

Date From:

Date To:

Designation/Last earned salary:

Name and Address of Employer:

Reasons for leaving:

Date From:

Date To:

Designation/Last earned salary:

Name and Address of Employer:

Reasons for leaving:

Have you been terminated or retrenched from your previous employment (please give details)?

Do you have a past criminal record? If so, please give details.

Kindly state if you have ever been declared bankrupt. If so, please give details.

Notice Period. If appointed, when would you be able to start work?

Please state how you came to know of this position.

REFERENCES

Please provide the names and contact numbers of two referees (one of whom should be your previous employer, and the other, preferably should be an academic referee). Do not give the names of family members/relatives as your referees.

Name:

Designation/ Name of Company:

Contact No. (house phone/ mobile number):

E-mail Address:

Relationship:

Name:

Designation/ Name of Company:

Contact No. (house phone/ mobile number):

E-mail Address:

Relationship:

INTERESTS AND SOCIAL

Please relate your interests and social activities.

PREFERRED AREA(S) OF PRACTICE

Please outline the areas of law in which you would like to practice in and give reasons for your choice(s).

FURTHER INFORMATION

If appointed, please state how you may contribute to our team.

Declaration and Consent: I hereby confirm that all the information given in this form is accurate and correct. I understand that any deliberate attempt to falsify information or failure to disclose relevant information where necessary may disqualify my application or if discovered after appointment may lead to summary dismissal. I also authorize Shearn Delamore & Co. to conduct comprehensive reviews and checks of me or my background with the relevant parties and/or authorities (as the case may be).

I also understand and agree that Shearn Delamore & Co. may collect, obtain, store and process my personal data for the purposes of processing and considering my employment application. By signing and/or submitting this application form, I hereby consent Shearn Delamore & Co. to store and process my Personal Data, whether within or outside Malaysia and/or disclose my Personal Data to the relevant governmental authorities or third parties where required by law or for legal purposes. For the avoidance of doubt, Personal Data includes all data defined within the Personal Data Protection Act 2010 including all data you had disclosed to the company in this form or your employment application letter.

I understand that for the purpose of ascertaining whether I am medically fit for employment and/or to carry out my duties (in the event that I am employed by the firm), Shearn Delamore & Co., may require me to undergo the necessary medical check-up with their panel doctor/hospital and for such purpose(s), I hereby consent and agree that the relevant doctor/medical practitioner/hospital may disclose my medical check-up report and/or medical information to Shearn Delamore & Co., upon request.

Signature: (Please type your name below to sign.)

Date:

Name:

NRIC No.:

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APPLICATION FORM / LAWYERS

PERSONAL DETAILS

FAMILY DETAILS

HEALTH DECLARATION

EDUCATION

CAREER HISTORY

REFERENCES

Information Summary