Job Application Form

Position Applied

How do you get to know about this position?

 AIA Corporate Website (AIA Careers)  Headhunter. Please specify:

Personal Particulars

Preferred
Title / Salutation
Name
Full name as per
NRIC / Passport
New NRIC No. /
Passport Number Old NRIC No.
(E.g.: 880215-14-8787) (Kindly affix passport size
photograph here)
Date of Birth
Birth Country
(DD/MM/YYYY)

Gender Nationality

Religion Race

Ethnicity Email Address

Contact Number (1): (2):

Valid Driving License

Current & Past Employment (in the period of 7 years)

Employment Period
(MMM-YYYY) Basic
Company Job Title Reason of leaving
Salary
From To

1
 Current Remuneration Package

Present Basic Salary

Fixed Allowances Other Benefits

Expected Salary Notice Period

Referee 1 (MUST NOT be your relatives or friends, preferably supervisor or manager)

Name Job Title

Company

Number of
Relationship
Years Known

Contact Number Email Address

Referee 2 (MUST NOT be your relatives or friends, preferably supervisor or manager)

Name Job Title

Company

Number of
Relationship
Years Known

Contact Number Email Address

Disclosure & Declaration

Whenever an asterisk (*) appears, please delete / cancel whichever is not applicable.

1. I *(DO / DO NOT) have any past criminal conviction under any written law relating to companies, financial services, capital markets,
prevention of money laundering or terrorism financing, and for offences involving dishonesty or fraud under any written law whether in or
outside Malaysia. Please provide the details if you have any criminal conviction under this Paragraph 1.
2. I *(DO / DO NOT) have any pending criminal investigations, inquiries, or criminal charges or any other criminal or legal proceedings
against me relating to laws and offences referred to in Paragraph 1. Please provide the details if you are subject to such investigation,
inquiries, proceedings, or charges under this Paragraph 2.
3. I *(DO / DO NOT) have any past internal employment disciplinary action taken against me nor are there any pending disciplinary
proceedings initiated against me. Please provide the details if you are subject to such disciplinary action or proceedings.
4. I *(HAVE / HAVE NOT) been employed as a dealer or broker.

I hereby certify that the particulars and statements provided by me are true. I understand that any misrepresentation or omission of facts shall
be considered sufficient cause for denying employment or termination of my employment. My employment may be based on receipt of
satisfactory information from current and former employers, schools, and other references.

I authorize AIA and/or its related companies, agent, affiliated partners and subcontractors to investigate, without liability, any information
supplied by me including occupational, police and government records in consideration of my application for employment. I also authorize AIA
to release any information required for the purpose of agency / financial planning recruitment.

Name

NRIC / Passport No.

Signature of Applicant Date

2
 AIA CONFIDENTIAL

Letter of Authorization

To whom it may concern:

I hereby authorize AIA Bhd. and/or its related companies and its agent, Verity Intelligence Sdn. Bhd. and/or its affiliated
partners and subcontractors, to verify information provided in my Employment Screening Form and other employment
application forms and make an inquiry into my previous employment records which covers all current and former
employers in the period of seven (7) years up to the date of the application for employment and, where relevant, the
Financial Markets Association of Malaysia (FMAM) and to conduct such enquiries as may be necessary, at the
discretion of and on behalf of AIA Bhd.; and/or its related companies.

I authorize all persons, including my current and former employers in the period of seven (7) years up to the date of the
application of employment to disclose to AIA Bhd. and/or its related companies, its agent, Verity Intelligence Sdn. Bhd.
and/or its affiliated partners and subcontractors all relevant information required for my employment screening,
including my employment history, the facts and details of any internal disciplinary proceedings I have been subjected
to, irrespective of whether such disciplinary proceedings have been concluded, or initiated after I left the employment;
and

I also authorize the FMAM to disclose the facts and details of any case of financial market misconduct I have been
subjected to, including disciplinary proceedings under the Asian Institute of Chartered Bankers (AICB)-FMAM Joint
Disciplinary Scheme, irrespective of whether such proceedings have been concluded as at the date of the written
inquiry with FMAM; and

I release all persons, including my current/former employers and, where relevant, the FMAM, from any contractual
obligations which limit, in any way, their ability to disclose the information required under this employment screening.

I understand that the scope of this report/employment screening may include, but is not limited to:

• Names and duration of my previous/current employment in the period of seven (7) years up to the date of the
application
• Work experiences and compensation
• Any internal employment disciplinary proceeding/records
• Any criminal history/ records (from local, state, federal, international, and other law enforcement agencies’
records) and any civil cases
• Educational/ Financial Markets Association of Malaysia (FMAM) and/or any other license verification
• Business interest and directorship
• Financial checks which may include bankruptcy, Credit Reporting Agencies and Bank Negara Malaysia
Central Credit Reference Information System (CCRIS) record
• Any sanction lists

I certify that all information provided on my resume, my Employment Screening Form and in all other employment
application forms/documents are correct and to the best of my knowledge. Any false statements provided in the said
documents will be considered as a just cause for the termination of employment at any time. This authorization and
consent shall be valid in original, fax or photocopy, and I authorised that a fax, or photocopy form of this letter can be
used and accepted with the same authority as the original signed by me.
*The term “related company” shall mean AIA Public Takaful Bhd., AIA Pension & Asset Management Sdn. Bhd., AIA Health Services
Sdn. Bhd., and AIA General Berhad.

Signature :

Date :

Full Name :

Date of Birth :

Identity Card No./ Passport No. :

Home Address :