UPM/TNCPI/RMC/P02/LRA/BR16

PEJABAT TIMBALAN NAIB CANSELOR Please

(PENYELIDIKAN DAN INOVASI) affix a
passport-sized
photograph
PUSAT PENGURUSAN PENYELIDIKAN
(RESEARCH MANAGEMENT CENTRE)
Tel: 603-8947 1245/1249 Faks: 603-8947 1252
http://www.rmc.upm.edu.my

BORANG PERMOHONAN PEMBANTU PENYELIDIK

APPLICATION FORM FOR RESEARCH ASSISTANT

BAHAGIAN A – UNTUK DILENGKAPKAN OLEH PEMOHON

PART A - TO BE COMPLETED BY THE APPLICANT

Nama Penuh (Full Name):

Tarikh Lahir (Date of birth): Umur (Age): Status Perkahwinan

(Marital status): S / M
No. MyKad / No. Pasport Warganegara Bangsa (Race): Jantina
(Mykad No. / Passport No.): (Citizenship): (Gender):

Alamat Semasa Alamat Tetap E-mel dan URL

(Current Address): (Permanent Address): (E-mail Address and URL):

Tel: Tel: H/P:

Nama Program / Sekolah / Institusi

Tahun
Sijil (Programme / Pengajian (School / Education (Year):
Certificate): Institution):

PENDIDIKAN (Education):

No. Semakan : 02 1/3

No. Isu : 01
Tarikh Kuat kuasa : 19/11/2009
 UPM/TNCPI/RMC/P02/LRA/BR16

PENGALAMAN KERJA
(Work Experience):

ANUGERAH DAN
AKTIVITI LAIN
(Award and other activities):

KEMAHIRAN
KOMPUTER
(Computer Skills)

Kenderaan yang dimiliki (Type of vehicle owned)

Nombor Model Sukatan
Jenis kenderaan
(Type of vehicle) pendaftaran kenderaan (c.c).
(Reg. no.) (vehicle model)
PEMILIKAN
Kereta (car):
KENDERAAN
(Vehicle ownership): Motorsikal (motorcycle):
No. Lesen Memandu
Driving License no.:
Tarikh tamat:
Expiry date:

PERAKUAN PEMOHON / DECLARATION BY THE APPLICANT

Saya mengaku bahawa segala maklumat yang diberikan di atas adalah betul dan benar.
Berikut adalah dokumen yang dilampirkan*.
I hereby proclaim that all information given as stated above is accurate and true. The
attachment of documents are as below*:

 Resume  Salinan MyKad / copy of Mykad

 Salinan sijil kelayakan akademik  Borang Perjanjian Kerahsiaan / Non-
yang disahkan / Certified copy of Disclosure Agreement Form
academic qualification

Tarikh/Date:
Tandatangan Pemohon /Signature of Applicant

*Sila lampirkan lain-lain dokumen tambahan (jika ada). Please attach other supporting details (if any)

No. Semakan : 02 2/3

No. Isu : 01
Tarikh Kuat kuasa : 19/11/2009
 UPM/TNCPI/RMC/P02/LRA/BR16

BAHAGIAN B – UNTUK DILENGKAPKAN OLEH PENYELIA / KETUA PROJEK

PART B - TO BE COMPLETED BY THE SUPERVISOR / PROJECT LEADER

Permohonan ini:  Disokong  Tidak disokong

This application is: Recommended Not recommended
Ulasan / Justifikasi (remarks/justification):

..................................................................................................................................................
..................................................................................................................................................
Tajuk Projek / Project title:

Jenis Geran/Type of fund: Kod Projek / Project code:

Jum.
Peruntukan / No. Vot / Vote no.:
Amaunt:
Cadangan kadar gaji / upahan (harian/bulanan)
Proposed salary/wages (daily/monthly): RM
Taraf kontrak / Status of contract:  Sementara/Temporary  Sambilan / Part-time
Tarikh Mula/ Tarikh Tamat/
Date Started: Date Ended:

Tarikh/Date:
Tandatangan Penyelia / Ketua Projek
Signature of Supervisor /Project Leader

BAHAGIAN C – UNTUK DILENGKAPKAN OLEH KETUA PTJ

PART C – TO BE COMPLETED BY THE HEAD OF PTJ

Permohonan ini:  Diluluskan  Tidak diluluskan

This application is: Approved Not approved
Ulasan / remarks:
................................................................................................................................................
Tarikh/Date:
Tandatangan Dekan/Pengarah
Signature of Dean/Director

BAHAGIAN D - UNTUK PENGESAHAN BAHAGIAN GERAN PENYELIDIKAN RMC

PART D – TO BE VERIFIED BY THE RESEARCH GRANT DIVISION, RMC

Permohonan ini Ditimbang / Ditolak*

………………………………………………..

*potong yang tidak berkenaan

No. Semakan : 02 3/3
No. Isu : 01
Tarikh Kuat kuasa : 19/11/2009