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Pusat Pengajian/Kolej(Centre of School/College)

Bidang Pengkhususan (Area of specialization)

Gred Jawatan(Grade of position)

Nama Jawatan Yang Dipohon (HURUF BESR!(Position applied for) (CAPITAL LTT!S)

PERH"#N$

(i! %amatkan permohonan kepada PENDF"R& BHG#N PENGURUSN SU'BER 'NUS#&UN#ERS#"# U"R ')YS#& *+*,* UU' S#N"-. .EDH DRU) 'N /ersama0samadengan sa%inan #1a2ah dan si1i%0si1i% 3ang disahkan dan hendak%ah sampai

pada atau se/e%um tarikh 3ang ditetapkan di da%am ik%an4(Send "our application to# !GIST!A!$ %&'A !S&!C 'AAG'T &IT$&I*!SITI &TA!A 'ALA+SIA$ ,-,., &&' SITK$ KA% A!&L A'A together0ith certified true copies of "our degrees and certificates1 Applicationsshould reach the &nit/&ni2ersit" 3efore or on the date specified in thead2ertise4ent!4

(ii! Pegawai .era1aan 3ang sedang /erkhidmat mesti%ah mem/uat permohonan

me%a%ui .etua Ja/atan5'a1ikan mengikut Perintah m Ba/ dan pastikan)aporan Su%it dan .en3ataan Perkhidmatan 3ang kemaskini disertakan/ersama4(Applicants 0ho are currentl" 0or5ing at an" Go2ern4ent ffice/Statutor"6od"/Local Authorit" should su34it their applications through theirrespecti2e %eads of epart4ent together 0ith the latest appraisal reportand Ser2ice record!4

(iii! "u%iskan di /ahagian atas sampu% surat nama 1awatan 3ang dipohon4(Please 0rite do0n the na4e of the post applied for on top left7handcorner of the en2elope!4

(i6! Pihak Uni6ersiti tidak akan mem/ia3ai sega%a per/e%an1aan 3ang /erhu/ungdengan permohonan dan temuduga4("he &ni2ersit" 0ill not incur the cost/3ear the e8penses of "ourapplication or inter2ie0!4

(6! Permohonan 3ang tidak diisi dengan %engkap dan tanpa sa%inanSi1i%5Dip%oma5#1a2ah5dokumen 3ang disahkan tidak akan di%a3an4(Inco4plete application for4s and applications 0ithout copies of "ourdegrees/certificates/rele2ant docu4ents 0ill not 3e entertained)1

Passport Si2e

No4 Pasport

(Passport o1!

No4 "e%$

(Phone o1)

E0me%$

(7'ail!

%amat Surat 'en3urat ('ailing Address!$

Poskod $

(Postcode!

.ewarganegaraan

(Citizenship)

No4 "e%$(Phone o1!

E0me%$

%amat "etap (Per4anent Address)$

Poskod $

(Postcode!

"ara7 Perkahwinan

('arital Status)

"empat )ahir 0 Bandar5Negeri

(Place of 3irth 9 Cit"/State)

"arikh )ahir

(ate of 3irth)

gama

(!eligion)

Ras

(!ace)

Jantina

(Gender)

No4 .ad Pengena%an (I/C o4!$Nama (a4e!$

4 BU"#R0BU"#R PER#BD# (P!SAL I:!'ATI)

Bi%4 nak5"anggungan(o1 of Children/

Dependants!

Peker1aan 8 'a1ikan #/u Bapa5Pen1aga

(ccupation ; a4e of 4plo"er)

Nama #/u Bapa5Pen1aga

(a4e of Parent/Guardian)

Bi%4 nak5"anggungan(o1 of

Children/ependants)

Peker1aan 8 'a1ikan Suami5#steri(ccupation ; a4e of 4plo"er)

Nama Suami5#steri(a4e of Spouse)

B4 BU"#R0BU"#R .E)URG (:A'IL+ I:!'ATI)

(74ail!

Photograph

.DE'#.J9"NUN"U.PER'-H-NN

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Gred(Grade)

.e%u%usan dan "ahun(Certificates and +ear)

"ahun 'asuk dan "amat(+ear of ad4ission ;

co4pletion)

Nama Seko%ah dan %amat(a4e of school ; Address)

:4 .E)U)USN SE.-)H RENDH DN 'ENENGH (sertakan sa%inan si1i% 3ang disahkan!P!I'A!+ ; SCA!+ &CATI (Please enclose certified true copies of certificates)

Bidang Pengkhususan(Areas of

Specialization)

P'.(CGPA)

Dip%oma5#1a2ah5PhD(Ph/'aster/egree/

iplo4a)

"ahun(+ear)

Nama #nstitusi(a4e of Institution)

D4 .EPU"USN PENGJ#N "#NGG# (sertakan sa%inan #1a2ah5Dip%oma5Si1i% 3ang disahkan!

%IG%! &CATI (Please enclose certified true copies of degrees/diplo4a/certificates)

No4 Siri Penda7taran(!egistration o1)

"arikh 'en1adi h%i(ate of 'e43ership)

Nama )em/aga5Badan Pro7esiona%(a4e of Professional 6od"/rganisation/6oard)

E4 PENDF"RN PR-FES#-N) (P!:SSIAL A::ILIATI)

"u%isan (

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Hingga(To)

Dari(:ro4)

Se/a/0se/a/ Berhenti

(!easons for Lea2ing)

"empoh Perkhidmatan

(Period of 4plo"4ent)

Ga1i5Pendapatan

(Salar")

'a1ikan dan

%amat(a4e of 4plo"er

; Address)

Nama Jawatan5Peker1aan

(a4e of Position/=o3)

#4 PENG)'N5PE.ERJN DHU)U (P!IC!

Di )uar Seko%ah5'akta/5Uni6ersiti(utside School/College/&ni2ersit")

Di Seko%ah5'akta/5Uni6ersiti(In School/College/&ni2ersit")

J4 .EG#"N .-.UR#.U)U' DN .H#D'" 'SYR." (>T!A C&!!IC&LA! ACTI*ITIS A SCIAL S!*IC)

.4 '.)U'" PENYE)#D#.N DN PENERB#"N (I:!'ATI !SA!C% A P&6LICATI)

"arikh (ate!Jurna% (=ournal)"a1uk (Title)Pengarang (Author)

Bidang (:ield)"a1uk (Title)

$ (Please pro2ide attach4ents if the space pro2ided is insufficient!!esearch

Pen3e%idikan $ (1ika ruang tidak men;ukupi si%a %ampirkan di da%am kertas 3ang /erasingan!

Please 0rite do0n details of Pu3lications# Author$ Title$ a4e of =ournal and ate ofPu3lication1 Pu3lications include articles$ 3oo5s and research papers that ha2e 3een

pu3lished in acade4ic journals/3oo5s4

Pu3lications#

Pengarang& "a1uk& Jurna% dan tarikh diter/itkan4 Pener/itan harus termasuk artike%& /uku0/uku dan kertas0kertas pen3e%idikan untuk diter/itkan da%am 1urna%01urna% akademik5/uku0/uku4

Pener/itan $

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:atatkan nama& a%amat dan peker1aan dua orang se%ain dari saudara0mara 3ang /o%eh mem/eri mak%umatmengenai diri anda4 Sekurang0kurangn3a seorang daripadan3a /o%eh me%aporkan tentang ke/o%ehan danpenga%aman ikhtisas5akademik tuan5puan4 Pegawai0pegawai Uni6ersiti ini tidak /o%eh dinamakan ke;ua%ipemohon ada%ah siswa2ah Uni6ersiti ini4(Please pro2ide the na4es$ addresses and occupation of t0o (?) references (e8cluding "our relati2es)

0ho can pro2ide infor4ation on "ou1 ne person should at least 3e a3le to testif" on "our acade4icand professional a3ilit" and e8perience1 &ni2ersit" officers cannot 3e no4inated unless "ou are agraduate of the &ni2ersit")1

,4 Nama $ (::IC &S)

Mfs1:Borang Jwtn Akademik