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SETEM
Tarikh:
Tuan/Puan,
PENERIMAAN BORANG PERMOHONAN JAWATAN DI UNIVERSTTI
TEKNOLOGI MALAYSIA
Adalah dimaklumkan balrawa borang permohonan tuan/puan telahpun diterima pada
Sekiranya tuan/puan tidak menerima jawapan 6 bulan dari tarikh tutup iklann maka
permohonan tua#puan adalah dianggap tidak berjaya.
Terima kasill
Yang benar,
Batragian Pengurusan Modal tnsanPejabat PendaftarUTM Intemational Campus Kuala Lumpur
ffiHIM BOII.ANG PERMOI{ONAN JAWATAN(JOB APPLTCATTON FORM)
PERINGATAN KEPADA PEI}IOHON (Pleasc read inslruttiont below cotefulty before fillingln the form);Pemohon dikehendaki mcngisi bcrang pcrmohonan ini dengan lenghap dan ju.;ur- Maklumat ini akan digunakan lnluk me
bagilawatan yang dipohot. Borang berastngln pedu digunakan bagi memohon jawatan lain. Pemohon yang scdang mcmegr
Badan Bcrkanun atau Kuasa-Kuasa Tcmpalln, permohonan hendaklah ditruat melalsi Ketua Jabatan bcrserta dengan salinan I
Peoyam Perkhidmatin Ttr&ini.(Applicant mutt ftll otrt all sccriow olrhit application completely and honestly,
A sEpirste applimtton rwl be completed {or each position for which
Gat'ernnent Olficz/Statatory BaQ'/Locol lulhoritv should submit oflrlrcolion
and semiees stdement.)lhrough respecttre Ilead of Department logether sith lutest apqraisat
This inlarmation will be uvd to determine .r'<you ore applying. lpplicants vho are
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0t - i l - lq$LAgam} {Religion\
ls iarvlhl5;rnal {lddressl
Donunc,gcrrdn Vi v I t o I 0Bdndar (( )0'l
Y o6 sakr4dd\Afamst E-mail (&mail Addressl Ncgqti (-\rarr)
\ndonLl lAI 'oskod {i/rp)
6 El4tNo. Te I Rumah {I/ome f hone No .l
(12 | 27Y. ri90li{c)T el fltmbirl llatdthile Na \
r$r- r BrE o2?g 0171tanlina (Gendett
EltLelatl 1Mat.'yl*l Prr"-ouan (Female)
Wurganalgara (.Cit];erchtpl
Indpn&stqftTaral Perkahwtna$ ( Mor ital Saat{i,
I Butang (Singte'1 {Bgl'rah*tn\l ' larrietfi n latn-letn {Othersl
Nama bapalpnjaga-/suarni/istcri ( li a m e of s Vo u s e i p o r e n t./guard ia nl
r\9Y *utt tlda[ah anda terikat untul berkhidmat dengan KeraJaan, ltadan-l]adafi Berkanun atau lain -lain pe,tubuhan'r (l)o 1'ou hute un-r' tt,iltfaL:t to )rork Jar
(;o|erhn?nt, Stttutnry ll,dv nr uther t,rgtrntzulrcnal
fl Yar fes) ffr'ioar 1,rurScliranya Ya, Nama Eadan/Pertubuhan tersetlut (f-l'll. |ilt:use nanw lht orxunalltonr.
Ti7;;I'7WI Lanan fvebUTM (l,tf'M lleb pagel l_] Petabat ?End'nl'rat (Registru's l]lftccl @f Sraf Unrversitt(l!nversity Enployeel fJ Akhbat (Nevspaper)
ff lain-lain (Others] .
'TAITAP PSNDIDIKAN & KEIT{ATIIRAN (EDUCATION A SKII,LS''Sila nyagkan tahap pcndidikan bermula dengan tcrkinr dan sgrtakan salinan ijazah, diploma dan strt-sUildtsahklfi lPlease lisl all sdaeation begianng wilh m.]sl recent and enclose a *rltfied true copy ofdegret
berkartan lermasrk salinan transkrip yang telah
diplam, lranscript ond any relevanl terti/icsk.)
Nrm2 Uri"tr$itilKel€j/Sckohh( N n m e of, A n i va rs i ty/Ca ll e g elS c h o o 0
Tahun{l'car)
li.NrhlDiplomtlsii l{ D e g ree/Dl p I o ma/C e rl ili c at c)
Kelas Keprjian CCPA(CGfA\
Bideng Frngkhususan(Dryret & N$orl
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Uvrrwrs,tax GoJrhf"ta&a noo5 (acrtpq Tel..nrlc 9,54 Ltor-hrcnl &Srtnpt
Sauni fsndrirrr t*nitd aa, k$olchrtt }ilog bctl<aittr &ogm je*rtan ini tcrmastt< tcrndrirn/pcngadruan komputcr d et bdres . (Litt Echnical orgecblaed skilaaedentiah retewnt to thit joh, irchding &.l,i.arhdge olony cuttputer and language skil!.)
KOCIATAIY LUAR SSIIASA Dl SSKOLAHTN|VERSIT| (fxml caRNcuLAn ACTTqITIES rN SCHOOL/rJNrVEnSrrgtSila sourri&an kcgitlrnfuar yalryoxr,oa/lhcdalnrgili*lrlni. (Please tist rhe ertrd arria/lar previansly/cunently involved.l
SE tARAfi PERKfl IITMATA N (EII PLO YA E NT HISTO R O tSdaai&a pcogrlamt P*sjan bcraulr dcrgtr !.tE tcrkial . Bahagiar iai pcrtu diparuhi walauprn pcmoho.l nrngcmukatan rcl3uatc bcrsill|a pano[q&.S*lap t*4bo id dd.& .dafqAi dd8a k',gr?{. pcnof@t tilCc *r digrm. $ib grm*:r lcl3 rabrha jite tlrug ridze mco€ilkupi. (List a$ dadns vith thc twstefie }&bt L&. Voa ry andt a resnc, ka 1nt mst conphtc tte et rpb'osil ectior. Faihre to a rver dll itz,ft in lle loltoving ccrion aay elimirrau ,puJroarfur{*reorilkraliotl, Pbay a&4iladdiiibtalatUittnru iltle spw yai&dndenugh.
PENGAKUAN PEttloHON U PP LICA NrS b ECIrtnATIOtgslya nerg*o batr*e fidclsne yatg dabcti dd* bctti. Salir aicmaliani bJrawa rc*irmya adi di entara m*lumat aan dokrmcn so*ongan io dilnpai 91su,pctmofiilil ttyr d{flt ffid la, pct*hltofla ttya *tr ditanrdan sata mcrtr Univc$iri Tctnologi Malalria juga mcmprnyai hak mcnyan ak kday*.na&adsnih pqd&rlt Lqj. tcrddult , rctod jcn y:dt fui ldn-Lin |tarbclrtrrg yatg bcrtcnaan.{I eTtily lts, t ta dbde tbQ tr/ttts dc c6rect. I urrd.lstsnd tlat onyfdlsc it{tt sti& (@ dntstk a) b rtis applicariu, N its supporting docame^tr. vill b sufic*ntgraudtlornrt&lbhb.m€ q temt,ationvkhet rdle. IJwtterur&rsuidttpt tlt llniveniti febotqi Malqsia has the iight to leviev ad in*est4ate tnyadrcttion, Wetots crrgloyen\ afurrml rcc*ds and dler fuckstourrd data.
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