Jackie Services

Recruited by / Introduced by :
Handphone No :

PERSONAL DETAILS
Name in Full (BLOCK LETTERS) :
I/C No :	Sex :Male Female
Telephone No :	H/phone No :
Email Address :	Race :
Correspondence Address :
Permanent Address :
Date of Birth :Place of Birth :Marital Status :Nationality :

Have you ever been associated with the following business? (Please list down all if you have more than 1.)
Job Recruitment, Car, Property, Travelling (Time share & company trip quotation), project undertaking, recycled products trading, raw material sourcing. Also, please provide Company name & position:


*HIGHEST QUALIFICATION
YearLevel(fields)Name of School/College/University




*EMPLOYMENT HISTORY (START WITH THE MOST RECENT)
From - To (Mth/Yr)Name of EmployerPositionSalaryLeaving Reason




*PREFERENCES
Do you wish to receive any Daily or Weekly EMAIL ALERT on our new merchant, customer, promotions or update? (Also you may specify certain nature that you are interested in only. Example, Car, Property etc...)


DECLARATION
Have you ever been convicted of any criminal offence / declared bankrupt?
Yes No
If so, please give full details:


I declare that the information given above is true and correct. I understand that any false or withheld information may lead to immediate termination of any agreement or contract I may have with the Company.
I have read, understood and agree to these rules and conditions

Agent Application Form