BM version



Dutch Lady Milk Industries Berhad
13, Jalan Semangat, 46200 Petaling Jaya, Selangor, Malaysia.
Tel :03 - 7956 7477,
Fax : 03 - 7956 7477 (HR) / 03 - 7958 4055 (Gen),
E-mail :
General Information
  • All information in this form will be kept strictly private and confidential.
  • The information provided will be held and processed for the purpose of the selection process of Dutch Lady Milk Industries Berhad, and in the event you are offerred a position, this form becomes part of our records

  • Note: All fields marked with an asterisk * must be completed

    * Position Applied Product Manager/Assistant Product Manager
    * Base Town Petaling Jaya

    1)Personal Information
    * Full Name
    * Correspondence Address

    * Nationality
    * Telephone Mobile -
      Office -
      House -
    * Birth Date [Calendar]
    * NRIC (New)
    * Gender  
    * Marital Status 

    * Do you posses a valid driving license?      Yes     No 

    * Spoken Language    
    * Written Language    

    2) Family Information (if married)
    Spouse Name
    Number of children
    Age of each child
    Use "/" to separate children ages E.g. 10/11/12

    * 3) Education
    List of Education :

    * 4) Employment History. Start with your present (or last) employer

    Fresh Graduate

    Working Experience :

    * 5) References / Declaration
    List two references below. Relatives should not be included
    Name Post / Company / Telephone
    Telephone -
    Telephone -

    Do you suffer from any chronic illness, i.e. cancer, diabetes, high blood pressure, etc?
    Yes        No  
    If YES, please state nature & period

    * Have you ever been convicted of a criminal offence?
    Yes        No  
    If YES, please state nature & period

    Expected Salary
    Available Date [Calendar]

    If you already have your resume with your photo included,
    please attach it here.

    I declare that the information provided in the form is true and complete in all aspects. I authorize investigations of all statements contained in this application. I understand that any misinterpretation or omission of information may be considered sufficent for withdrawal of an offer or subsequent dismissal from my employment at any time without any previous notice. I hereby release the Company from any liability as a result of any contacts, inquiries, or records in order to ascertain my qualfications and fitness for employment.
    * I Agree     Yes    No

    This is an online application form. No signature is required.