Kementerian Sumber Manusia, Malaysia

PROGRAM VTO/VTE/VTM SECARA FAST TRACK DAN SINGLE-TIER

KATEGORI PERMOHONAN : INDIVIDU BERKELOMPOK Nyatakan Nama Agensi ____________
1 MAKLUMAT !ALON " IN#ORMATION O# !ANDIDATE
Nama : _________________________________________________ No. KP/ Tentera/ Pasort: _____________________________
Name NRIC/Army/Passport no.
!m"r: ________________ A#amat s"rat men$"rat : _______________________________________________________________
Age Postal Address
_______________________________________________________________
%ant&na: Le#a'& Perem"an Pos'o( ____________ )an(ar ______________________ Ne*er& ___________________
Gender Male Female Postcode City State
No. Te#. R"ma+ / House Tel. No :______________________ No. Te#. )&m,&t/ Handpone No. ___________________________
Ema&# : ___________________________________________
$ MAKLUMAT MA%IKAN " IN#ORMATION O# EMPLO&ER
Nama Ma-&'an: ____________________________________________________ No. Pen(a.taran S$ar&'at: _____________________
Name o! "mployer Company Registration No.
A#amat : ____________________________________________________________________________________________________
Postal Address
Pos'o( ____________ )an(ar _____________________________________ Ne*er& ________________________
Postcode City State
No. Te# Pe-a,at / O..&/e Te#. No.
' MAKLUMAT PEKER%AAN " IN#ORMATION O# O!!UPATION
PEKER%AAN (EMA(A " !URRENT O!!UPATION
%a0atan: ____________________________________ Temo+ )er'+&(mat: ___________________________
Position #engt o! Ser$ice
1"ra&an Ker-a ata" Tan**"n*-a0a,/ %escription o! %uties or Responsi&ilities )&(an* Kema+&ran/ S'ill Sector
PEKER%AAN TERDAHULU " PREVIOU( O!!UPATION
%a0atan: ____________________________________ Nama Ma-&'an : ______________________________________________
Position "mployer
Temo+ )er'+&(mat: ________________________________
#engt o! Ser$ice
1"ra&an Ker-a ata" Tan**"n*-a0a,/ %escription o! %uties or Responsi&ilities )&(an* Kema+&ran/ S'ill Sector
Nota : S&#a se(&a'an senara& $an* ,eras&n*an -&'a se'&ran$a r"an*an $an* (&se(&a'an t&(a' men/"'"&.
Note ( Please prepare separate list i! space gi$en are not enoug.
Pen*esa+an Ma-&'an :
"mployer)s Con!irmation ______________________________
Tan(atan*an 2 Co Rasm& Ma-&'an
Employer's Signature & Official Rubberstamp
Nama 2 %a0atan : ______________________________
Name * Position
Tar&'+ : __________________
%PK"PPT"1))1*VTOEM + #ast T,a-k. P1
-
%ate
/ MAKLUMAT PROGRAM &ANG DIPOHON / PROGRAMME APPLIED
Ko( Pro*ram 3an* D&o+on 4 : I-567-6 / I-567-8 / I-567-9 Ta+a: VTO VTE VTM
Programme Code Applied #e$el
Nama Pro*ram 3an* D&o+on 4 : PEG. LATI1AN VOKASIONAL / EKS. LATI1AN VOKASIONAL / PENG!R!S LATI1AN VOKASIONAL
Programme Name Applied
+Potong mana yang tida' &er'enaan
0 MAKLUMAT BA&ARAN " PAYMENT
)a$aran ,o#e+ (&,"at sama(a men**"na'an K&r&man :an*; )an' Dra. Ata" Pesanan Kera-aan <LO= atas nama >Ket"a
Pen*ara+ Pem,an*"nan Kema+&ran> $an* mem&#&'& temo+ sa+#a'" se'"ran*-'"ran*n$a t&*a <6= ,"#an (ar& tar&'+
ermo+onan (&ter&ma.
No. R"-"'an )a$aran
%"m#a+ )a$aran RM 655.55
1 PERAKUAN" DECLARATION
Sa$a men*a'"; sa$a te#a+ mem,a/a (an mema+am& se*a#a erat"ran (an s$arat ermo+onan Pan("an Pe#a'sanaan Pro*ram I-567-6
<VTO=/ I-567-8 <VTE=/ I-567-9 <VTM= Se/ara Fast Tra/' Dan S&n*#e-T&er Me#a#"& Kae(a+ Pen*&'t&ra.an Pen/aa&an Ter(a+"#" <PPT=
,ertar&'+ )1 Okt23e, $)1$. Sa$a -"*a te#a+ men$ema' (an men*em"'a'an se*a#a 'eer#"an ermo+onan seert& ,er&'"t:
I ere&y declare tat I a$e read and understand all te terms and conditions regarding my application as stated in Panduan Pela'sanaan
Program I,-./,. 01T23/ I,-./,4 01T"3/ I,-./,5 01TM3 Secara Fast Trac' %an Single,Tier Melalui 6aeda Pengi'tira!an Pencapaian
Terdaulu 0PPT3 dated 01 October 2012 and a$e !ul!ill all te !ollo7ing(
7. S"rat era'"an temo+ en*a#aman 2 en*esa+an ma-&'an
"mployer)s / Company)s re!erence letter
?. Sa#&nan 'a( en*ena#an4
Copy o! NRIC / passport+
6. Dera. )an'/ K&r&man :an*/ Pesanan Tematan - RM 655
&e : Ma$,an' / 57?689
8an' %ra!t / Money 2rder / #ocal 2rder , RM .--
8. Sa#&nan SKM ta+a tert&n**& $an* te#a+ (&ero#e+& <-&'a a(a=4
Copy o! igest S6M pre$iously attained+
Sa#&nan D&#oma/ I-a@a+4
Copy o! %iploma/ %egree+
9. Mem"n$a& temo+ en*a#aman seert& ,er&'"t:
%uration o! e9periance as !ollo7s(
NO((
(ya,at Tam3a4an
VTO
&. D&#oma (en*an en*a#aman men*a-ar ro*ram #at&+an 'ema+&ran se'"ran*-
'"ran*n$a 56a *$. ta46nA ata"
&&. SKM ? (en*an en*a#aman men*a-ar ro*ram #at&+an 'ema+&ran se'"ran*-'"ran*n$a
tiga *'. ta46nA ata"
&B. Ter#&,at (a#am a't&B&t& en*a-aran (an em,e#a-aran ro*ram #at&+an 'ema+&ran
(en*an en*a#aman se'"ran*-'"ran*n$a t6764 *8. ta46n.
VTE
&. I-a@a+ Sar-ana M"(a ata" D&#oma Lan-"tan (en*an en*a#aman men*a-ar (an
men$e#&a ro*ram #at&+an 'ema+&ran se'"ran*-'"ran*n$a tiga *'. ta46nA ata"
&&. D&#oma (en*an en*a#aman men*a-ar (an men$e#&a ro*ram #at&+an 'ema+&ran
se'"ran*-'"ran*n$a em9at */. ta46nA ata"
&B. SKM 6 ata" VTO (en*an en*a#aman men*a-ar (an men$e#&a ro*ram #at&+an
'ema+&ran se'"ran*-'"ran*n$a em9at */. ta46nA ata"
B. Ter#&,at (a#am a't&B&t& en*a-aran (an em,e#a-aran ro*ram #at&+an 'ema+&ran
(en*an en*a#aman se'"ran*-'"ran*n$a se96:64 *1). ta46n (an men-a0at -a0atan
se'"ran*-'"ran*n$a er&n*'at en$e#&aan.
VTM
&&. I-a@a+ Sar-ana M"(a ata" D&#oma Lan-"tan (en*an en*a#aman men*"r"s a't&B&t&
en*a-aran (an em,e#a-aran ro*ram #at&+an 'ema+&ran se'"ran*-'"ran*n$a em9at
*/. ta46n; ata"
&&&. D&#oma (en*an en*a#aman men*"r"s a't&B&t& en*a-aran (an em,e#a-aran ro*ram
#at&+an 'ema+&ran se'"ran*-'"ran*n$a :ima *0. ta46nA ata"
B. VTE (en*an en*a#aman men*"r"s a't&B&t& en*a-aran (an em,e#a-aran ro*ram
#at&+an 'ema+&ran se'"ran*-'"ran*n$a 56a *$. ta46nA ata"
B&. SKM 6 ata" VTO (en*an en*a#aman men*"r"s a't&B&t& en*a-aran (an em,e#a-aran
ro*ram #at&+an 'ema+&ran se'"ran*-'"ran*n$a :ima *0. ta46nA ata"
B&&. Ter#&,at (a#am en*"r"san a't&B&t& en*a-aran (an em,e#a-aran ro*ram #at&+an
'ema+&ran (en*an en*a#aman se'"ran*-'"ran*n$a 56a 3e:as *1$. ta46n (an
men-a0at -a0atan se'"ran*-'"ran*n$a er&n*'at en*"r"san.
4 Nota: Set&a sa#&nan (o'"men +en(a'#a+ (&sa+'an o#e+ ma-&'an ata" e*a0a& 'era-aan '"m"#an A.
C. Me#en*'a'an Senara& Sema' )oran* Pen&#a&an Ken(&r& <%PK/PPT/7557 PK=.
Sa$a .a+am; se'&ran$a sa$a t&(a' memen"+& mana-mana 'eer#"an $an* (&n$ata'an (& atas; ma'a ermo+onan &n& a'an (&to#a'
(an ,a$aran t&(a' a'an (&'em,a#&'an
I understand tat i! any o! te a&o$e mentioned is not satis!ied: my application 7ould &e re;ected and !ee is not re!unda&le.
________________________________
Tan(atan*an Pemo+on
Applicant )s Signature
Nama/ Name: DD.DDDDDDDDDDDDDDD Tar&'+/ %ate( <<<<<<<<<<<.