KPMC/AD/F/002, Revision 2

Sila kembalikan borang yang telah diisikan ini ke (Kindly submit your completed form to): KLIA Tranining & Research Centre Sdn. Bhd., Kompleks KLIA Holdings, Jalan KLIA 1/70, 64000 KLIA, SELANGOR DARUL EHSAN. No. Tel.: 03-87831006 No. Faks: 03-87831040.

E-mail: enquiry@kliatraining.com.my atau ktrc.klia@gmail.com

Mod Kursus (Mode of course) Sepenuh masa (Full time) Separuh masa (Part time)

Nama Penuh (Full Name)

No. Kad Pengenalan (Identity Card No.) Umur (Age) Jantina (Gender) Lelaki (Male) Perempuan(Female)

Alamat Surat Menyurat (Mailing Address)

Nama syarikat dan alamat (Company Name and address)

E-mel (E-mail)

No. Telefon Pejabat (Office Telephone No.) No. Telefon Bimbit (Handphone No.)

No. Telefon Rumah (House Telephone No.) No. Faksimili (Facsimile No.)

Kelayakan Tertinggi (Highest Qualification) LCE/SRP/PMR SPM/SPVM/SPM(V) Diploma Ijazah Sarjana Muda Lain-lain, sila nyatakan (Others, please specify)

(Bachelor’s Degree) _________________________________________

Yuran kursus (Course Fee) Yuran lain (Other fee)

Mod Pembayaran (Mode of Payment)

Tunai (Cash) Kiriman Wang (Money Order) Draf bank (Bank Draft) Deposit tunai (cash deposit) (Maybank: 5121 4702 1251)

Pesanan Kerajaan (LO) Cek (Cheque) No. Cek (Cheque no.)

Sila hantarkan invois/’payment advice’ ke syarikat saya (Please send the invoice/payment advice to my company) Perhatian kepada: (Attention to)

Saya mengaku bahawa sepanjang pengetahuan saya, maklumat yang saya berikan adalah tepat dan benar. Saya juga faham bahawa sekiranya terdapat sebarang bentuk pemalsuan maklumat, pihak KLIA Training berhak menolak permohonan ini, menarik kembali tawaran saya pada bila-bila masa.

(I hereby declare that the information contained herein is complete and accurate to the best of knowledge. I fully understand that withholding or giving false information, KLIA Training has the right to reject my application at any times) Tandatangan pemohon & cop rasmi (Applicant’s Signature and Official stamp)

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* Tandakan √ pada kursus yang dipohon Tick √ for applied course

Penyelia Keselamatan Tapak Bina (Site Safety Supervisor)

Penyelia Tapak (Site Supervisor)

Pegawai Keselamatan & Kesihatan (Safety & Health Officer)

Lain-lain kursus, cth: Kursus CEP (HIRARC): ______________________________ Other Course e.g. CEP course (HIRARC) , (please specify)

BORANG PERMOHONAN KURSUS (COURSE APPLICATION FORM)

BAHAGIAN 1 (SECTION 1) : KURSUS DIPOHON (COURSE APPLIED)

BAHAGIAN 2 (SECTION 2) : MAKLUMAT PERIBADI (PERSONAL BIODATA)

BAHAGIAN 3 (SECTION 3) : LATAR AKADEMIK & PEMBAYARAN (ACADEMIC BACKGROUND & PAYMENT)

Tarikh (Date): ____________________

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R M .

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BAHAGIAN 4 (SECTION 4) :PENGAKUAN (DECLARATION)

R M .

Tarikh Kursus yang dipohon Date of course