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PSMB/GEN/1/16 APPENDIX A

TRAINEES APPLICATION FORM

A. APPLICANT PERSONAL INFORMATION

Name
Religion
Malay Indian

Correspondence Chinese
Race
Address
Others(specify)

Marital
Date of Birth Status
Email
Place of Birth Address
Gender Tel. No (H)
I/C No Tel. No (H/P
Duration of being Last job Permanent Others
Unemployed after employment
Graduation status Temporary
Previous Employment
Salary RM
No. of Job Applying Government Private Company

No. of Interview Attended


B. ACCOUNT INFORMATION
Name of Bank

Account No
C. EDUCATION BACKGROUND
Highest Education
Name of University /
College
Field of Study
CGPA/Grade
Convocation Date
D. JOB PLACEMENT - COMPANY'S DETAILS
*Upon Training Completion
Name of Company
Address
Tel. No Email
Name of Supervisor Designation

Please tick ( ) if
E. COPIES OF DOCUMENTS TO BE ATTACHED BY APPLICANT documents are
available
i. Copy of I/C
ii. Copy of Diploma / DegreeTranscript
iii. Copy of Bank Account

F. APPLICANT DECLARATION

I declare that the facts stated in this application and the accompanying information are true and
correct and that I have not withheld / distorted any material facts.I understand that if I obtain the
grant by false or misleading statements, I may be prosecuted.

Applicant's signature:

Name:
IC No :
Date :

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