Expected Salary for This Position (Minimum): USD$______

VISIONFUND (CAMBODIA) LTD
Employment Application Form
#20, Street 71, Sangkat Tonle Basac, Khan Chamkar Mon, Phnom Penh, Cambodia
Mailing Address: Central Post Office, P.O Box 479, Phnom Penh.
E-mail Address:
Tel: (855) 23-6555 066/089-333-767
Position Applied for:………………………………………………..…………………..… Base in:………..………………………...…

Expected salary for this position (minimum): USD$______

1- PERSONAL DATA:
Name(in Khmer) ………………………………..…………………...………Name (in English):: ………………………………..………………Sex: ……… Date of Birth: …………………………………………Nationality: ……….….………National ID Card Number:...... Issue by:......
Place of Birth: ……………………….……………………...………………………………………………………………………………………………………………………
Permanent Address: ……………………………………………………………..………………………………………..………………… ………………………………… …………………………………………………………………………………………………………………………………………………………………………..…………………
Contact Address: ……………………………………………………………………………………………………..………………..……………………....………………… ………………………………………………………………………………………………………………………………………………………………………….……….…………
Telephone Number:………………………………………………………………… E-mail: .………………………………………………………………...…………….
In case of emergency, please notify:
Name:………………………………………..………..… Relationship: ………………………………………….……..………..…Tel: …………………………………..
Family:
Marital status: Single ¨ Married ¨ Widow / Widower ¨
Father Name: ……………………………………………….…… Occupation: …………………..…………………………………………………………………….
Mother Name: ………………………...……………………….… Occupation: …………………..…………………………………………………………………….
Spouse’s Name: ………………………………………………… Occupation: …………………..…………………………………………………………………….
Number of Children: ……….
2- EDUCATION: (Please list the latest first)
Degree Obtained / Specialized Skill / Name of School/University Location (city country) / Attended / Have you graduated?
(Y=yes, N=No)
From / To
¨ Y or ¨ N
¨ Y or ¨ N
¨ Y or ¨ N
¨ Y or ¨ N
¨ Y or ¨ N
3- OTHER TRAINING: (List any training related to the position)
Name of Institution/ Center, Location (city & country) / Training Course / Duration / Date Completed
(mm/yyyy)
4- LANGUAGE SKILLS: ( Poor - Fair - Averages - Good - Excellent)
Language / Speaking / Writing / Listening / Reading
5- SPECIAL INTERESTS:
Hobbies or Activities
…………………………………………………………………………………………………..…………………………………………………………………………………………………………………………………………………………….……………………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…………
6- EMPLOYMENT:
List past three (3) employers or voluntary assignments beginning with the most recent. Provide as much detail as possible.
Name of Organization/Company 1 / Employment Date
Month/ Year / Base Salary
(U.S. Dollars) / Other Compensation
(Overtime, Commission, etc.)
From: ………………...………. / Start:………….….... / Month. / …………………………….………
To: ………………...……..……. / Ending:………..….. / Month. / …………………………….………
Company’s Main Business: ...……………………………………………………..………………………………………….………………………………………………
Office Address: ……………………..……………………………………………………………………………………………………...………………………………………
Office Contact Number: ……..…………………………………………………………………………………………………………………………………………………
Position(s) (Title) Held: …………………………………...………………………………………….…………………………………………………………………………
Describe your duties: ………………………………………………………………………………………………………………………………………………………....… ………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….……………………………………………………………….……………………………………………………………………………………………………………………………………………………………………………………………………………..…………
Direct Supervisor’s Name: …………………………………………… Supervisor’s Title: ……………….……………………… Tel: …………………………
Reason for Leaving: …...……………………………………..…………………….…………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………….…………………….………………
Name of Organization/Company 2 / Employment Date
Month/ Year / Base Salary
(U.S. Dollars) / Other Compensation
(Overtime, Commission, etc.)
From: ………………...………. / Start:………….….... / Month. / …………………………….………
To: ………………...……..……. / Ending:………..….. / Month. / …………………………….………
Company’s Main Business: ...……………………………………………………..………………………………………….………………………………………………
Office Address: ……………………..……………………………………………………………………………………………………...………………………………………
Office Contact Number: ……..…………………………………………………………………………………………………………………………………………………
Position(s) (Title) Held: …………………………………...………………………………………….…………………………………………………………………………
Describe your duties: ………………………………………………………………………………………………………………………………………………………....… ………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….……………………………………………………………….……………………………………………………………………………………………………………………………………………………………………………………………………………..…………
Direct Supervisor’s Name: …………………………………………… Supervisor’s Title: ……………….……………………… Tel: …………………………
Reason for Leaving: …...……………………………………..…………………….…………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………….…………………….………………
Name of Organization/Company 3 / Employment Date
Month/ Year / Base Salary
(U.S. Dollars) / Other Compensation
(Overtime, Commission, etc.)
From: ………………...………. / Start:………….….... / Month. / …………………………….………
To: ………………...……..……. / Ending:………..….. / Month. / …………………………….………
Company’s Main Business: ...……………………………………………………..………………………………………….………………………………………………
Office Address: ……………………..……………………………………………………………………………………………………...………………………………………
Office Contact Number: ……..…………………………………………………………………………………………………………………………………………………
Position(s) (Title) Held: …………………………………...………………………………………….…………………………………………………………………………
Describe your duties: ………………………………………………………………………………………………………………………………………………………....… ………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….……………………………………………………………….……………………………………………………………………………………………………………………………………………………………………………………………………………..…………
Direct Supervisor’s Name: …………………………………………… Supervisor’s Title: ……………….……………………… Tel: …………………………
Reason for Leaving: …...……………………………………..…………………….…………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………….…………………….………………
7- ADDITIONAL QUESTIONS:
a).   Please provide 3 top sources of job announcement that you usually visit?
£- Newspapers, £- Websites, £-VisionFund’s announcement board, £-University’s announcement board
£- Friends, £- others, specify……………………………………………………………………………………………………………………….....
b).   Do you have any close friends or relatives employed by VisionFund Cambodia? Yes o No o
If Yes, give Name, Position, Department/Branch, and your relationship with him:
………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………
c).   What is the poverty situation in Cambodia?
………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………
d).   How is your current social involvement in Cambodia?
………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………
e).   What do you know about microfinance?
………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………
f).   What do you know about VisionFund Cambodia?
………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………
g).   VisionFund Cambodia is a Christian microfinance institution. How do you feel working in a Christian environment?
………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………
h).   Describe and explain child’s right.
………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………….…………………………………………….………
8- REFERENCE:
List those familiar with your capabilities in addition to the supervisors previously noted under employment (do not list relatives).

Name: ……………………………

………………………………………

/

Job Title/ Company:

/ /

Mobile Phone

/

Address

/ /

Relationship

/

Name: ……………………………

………………………………………

/

Job Title/ Company:

/ /

Mobile Phone

/

Address

/ /

Relationship

/

Name: ……………………………

………………………………………

/

Job Title/ Company:

/ /

Mobile Phone

/

Address

/ /

Relationship

/
I authorize the referees listed above to provide VisionFund Cambodia any and all information concerning my previous employment and any pertinent information that they may have.
To the best of my knowledge, the answers to all of the questions contained herein are true and correct, and I have not knowingly withheld any information which might in any way affect this application. I understand that any misstatements or omissions of material facts in this application may be cause for dismissal.
Applicant’s Signature: ………………………………………………………. Date: ………………..……………………..……

VisionFund Cambodia Revision date: August 17, 2012