FUJIKURA FIBER OPTICS VIETNAM LTD.

JOB APPLICATION FORM
FORM: 1-Pr-002-1-Fo-001 / Version: 02 / Page 1 / 2

Name/ Address

Full name: / Birthday:
Sex: / Marital status:
Permanent address:
Temporary address (if any):
Contact phone: / Email:
Who recommended you to us? (person or agency):

Desired Employment

Position: / Date you can start: / Desired salary:
Have you applied to this company before? Yes No
If yes, when and for which position?

Education

High school / Name & Location of school:
Year attended: / Grade completed:
University/ College
Graduate / Name & Location of school:
Year attended: / Date graduated:
Major: / Grade completed:
University/ College Post-graduate / Name & Location of school:
Year attended: / Date graduated:
Major: / Grade completed:
Employment History
Give in chronological order beginning with the most recent
Employer: / Job title held/ period held:
Address: / Duties:
Nature of business: / Salary:
No. of months/ years employed: / Reason for leaving:
Employer: / Job title held/ period held:
Address: / Duties:
Nature of business: / Salary:
No. of months/ years employed: / Reason for leaving:

Additional Area of Expertise

Areas of specialized study, research or additional experience:
English skill: / Listen: / Speak: / Read: / Write:
Other foreign languages: / Listen: / Speak: / Read: / Write:

Use of computer:
Summary of Special Skill and Qualifications
Summarize special skill and qualification acquired from employment or other experience
Professional Associations
List professional, trade, business and civic activities and offices held

References

Please give names and addresses of persons to whom you are not related.

Full Name: / Position:
Address: / Contact phone:

Physical Record

Do you have any physical disabilities that prevent you from performing the work for which you are applying? YES NO
If yes, provide details:
Have you ever been injured?
YES NO / Provide details:

Person to be notified in case of accident or emergency

Name: / Phone:
Address: / Relationship:

In the event of employment, I understand that the false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of this company.

Signature Date