Applocation Form

Position to Apply Commencement Date
Company Rich & T Co.,Ltd Chartered Insurance Solutions SIMedia Co.,Ltd.
Personal Information
Name-Lanst (Thai)    * Nickname (Thai)
Name-Lanst (Enshish)    Nickname (Enshish)
Date of Birth (1900-12-01)  * Birth place
Chinese zodiac year of birth Religion
Race Nationality
Height Weight
ID Number  * Date Issued
Expiry Date Social Security available No Yes
Current Address
House owners Your own house Parents Relative Rental Others (Please specify)
Permanent Address
Telephone number(present) Mobile Phone Number
E-Mail
Current Office Address
Phone Number
Martial Status Single Married Widow Divorce
No. of Children person (s)     In school person (s)     Not in school person (s)
Name-Lastname Spouse Occupation
Company's name Phone number
Military service Discharged No Are there military commitments?    Exempted Due to
Family Information
Name-Lastname of father Occupation
Address
Name-Lastname of mother Occupation
Address
No. of Siblings person(s) Begins the number of
Name-Lastname Relationship Age Occupation Company/School
Educational background
Educational Level Name of Institute Date attended Date graduated Faculty/Major Grade Average
High School
College
Bachelor's Degree
Higher Than Bachelor's Degree
Trainnings Experience
Course Institute Organized Period Diplomat
Received scholarship or other attended activities during studyins period
Langvage skill
English      
Chinese      
Others      
Talent
Computer type (Thai) wards/minutes Computer type (English) wards/minutes
Computer programmning
Other talents
Hobby and Interest
Sport Hobby
Vehicle
Own vehicle Yes No
Car Yes No Driver license no.
Motorcycle Yes No Driver License no.
Work experience  (Current-Prior)
1.Company
1.Company's name Position
Address
Starting date Leaving date / Present
Responsibility
Start Salary Latest Salary
Reason of leaving
2.Company's name Position
Address
Starting date Leaving date / Present
Responsibility
Start Salary Latest Salary
Reason of leaving
3.Company's name Position
Address
Starting date Leaving date / Present
Responsibility
Start Salary Latest Salary
Reason of leaving
4.Company's name Position
Address
Starting date Leaving date / Present
Responsibility
Start Salary Latest Salary
Reason of leaving
Additional information
1.Have you ever applied with us before? Yes No
2.Can you work shifts? Yes No
3.Can you find at any suarantor? Yes No
4.Are you pleased to commute away province or overseas to perform and train? Yes No
5.Do you know any employee of the company? Yes No
Name-Lastname   Position   Department
6.Have you ever been arrested to any civil case/criminal case? Yes No
7.Have you ever been owed to any institute/person? Yes No
8.Have you ever been seriously sick in the last 3 year ? Yes No
9.Are you pregnant ? Yes No
10.Have you ever been dismissed due to unsatisfying work or misbehavior ? Yes No
11.Do you have insurance or reinsurance broker license ? Yes No
Please state
12.Do you have relatives who work on or hold share on any insurance companies ? Yes No
Please state
References (Please state relative(s) who can certify your behavior)
Name-Lastname Occpation/Position/Relationship Address and phone number
Available person(s) for emergency case
Name-Lastname Occpation/Position/Relationship Address and phone number
Addition statement to inform
I certify that all given information on this application form is true. If any information is untrve is there's any non-informed information that leads to misunderstanding,I cansent to the cmpany dismissing withat any annancement.