Volunteer Programme Application Form
Volunteer Programme Application Form
Preferred Area Of Volunteer:
Personal Particulars
Full Name: ______
Address: ______
______
New Identification Card: ______
Old Identification Card: ______
Phone (H/P): ______
(O): ______
Emails: ______
Date of Birth: ______Place of Birth: ______
Age: ______Nationality: ______
Male Race: ______Religion: ______
Female Height: ______Weight: ______
Single
Married
In case of emergency, notify (Name): ______
Relationship: ______
Address: ______
Contact Number: ______
Medical Restriction / Allergies: ______
Preferred Days to Volunteer
Monday Tuesday Wednesday Thursday Friday Saturday Sun
Duration of Voluntary Work
From: DD MM YY to DD MM YY
Educational Background
Level Name of Institution Year Attended Certificate/Diploma/Degree Obtained
______
______
______
______
______
- List of hobbies / sports you enjoy most
______
- Skills
Art & Craft Public Speaking Research Creative Writing Information Technology
InternetOthers______
Current Employment Background
List the most recent employment first
- Employer: ______
Address: ______
______
Date Joined: ______Date Left: ______
Supervisor: ______
Contact Number: ______
Job description: ______
Language Proficiency & Skills
Language SpokenWritten
Well FairPoorWell FairPoor
______
Well Fair PoorWell Fair Poor
______
Well Fair PoorWell Fair Poor
______
Other Information
- Do you suffer from any physical defects or have you recovered from any serious illness? YesNo
If yes, please explain: ______
- Have you ever been convicted in a court of law? YesNo
If yes, please explain: ______
- Have you ever been discharged from employment? Yes No
- If you are selected, when can you start?
______
Declaration
I hereby certify that all the foregoing information is, to the best of my knowledge, accurate and understand that willfully withholding information or making false statement in this application will be the basis for dismissal from the Company. I will not hold Penang Butterfly Farm responsible or liable for any accident, injury etc. whatever and however caused that may occur to me during my service with Penang Butterfly Farm.
Information entered on this application form is voluntarily given by me as a statement of fact and qualifications for the position assign for and / or hired for. I authorize the Butterfly House (Pg) Sdn. Bhd. to submit the said information to any person, firm corporation, body, bureau, department, police officers and police record bureau for the purpose of any investigation which the Butterfly House (Pg) Sdn. Bhd. may desire to make with reference thereto. I also do remise the Butterfly House (Pg) Sdn. Bhd. from all liabilities, demands, claims, suits, proceeding, cost and expenses of any nature in connection with foregoing.
Signature: ______
Name: ______
Date: ______