BORANG PENGESAHAN PENERIMAAN JAWATAN MAJIKAN

EMPLOYER VERIFICATION FOR RETURN TO WORK FORM

PROGRAM PENEMPATAN PEKERJAAN SEMULA
RE-EMPLOYMENT PLACEMENT PROGRAMME

BUTIRAN MAJIKAN / EMPLOYER DETAILS

No. Pendaftaran Perniagaan

Business Registration No.

Nombor Kod Majikan (jika ada)

Employer Code No. (if any)

Kategori Majikan Ibu Pejabat Cawangan

Employer Categories Headquarter Branch

Nama Majikan
Employer Name

Alamat Majikan dan No. Telefon

Employer Address and Contact No.

BUTIRAN PEKERJA / EMPLOYEE DETAILS

Nama Penuh
Full Name
No. Kad Pengenalan
Identification Card No.
Jawatan
Position
Gaji Bulanan
RM
Monthly Salary
Tarikh Lapor Diri
Report Duty Date

PERAKUAN MAJIKAN / EMPLOYER DECLARATION

Saya mengesahkan bahawa semua butiran yang diberikan adalah sah dan benar
I, declare that all the information given are true and valid.

Tandatangan & Nama Majikan / Jawatan Cap Rasmi Majikan Tarikh

Wakil Position Official Stamp of Employer Date
Signature & Employer Name /
Representative

UNTUK KEGUNAAN PERKESO / FOR SOCSO USE

Tandatangan & Cap Anggota Cap Terima

Signature & Staff Stamp Received Stamp

Sebarang pertanyaan mengenai borang ini, sila hubungi Pusat Khidmat Pelanggan PERKESO di nombor 1300 22 8000.
Any enquiries pertaining to this application, please contact SOCSO Customer Service Centre at 1300 22 8000