PROGRAMME APPLICATION FORM
(BORANG PERMOHONAN PROGRAM)
Iron and Steel Industry Training Programme
CONFIDENTIAL

MALAYSIA STEEL INSTITUTEPERSONAL DETAILS/ MAKLUMAT PERIBADI
Applicant Name:
Nama Permohon:
Identification Card:
No. Kad Pengenalan:Home Address:
Alamat Rumah:

PHOTO
GAMBAR

Bank Name:
Branch Location:
Account Number:Nama Bank:
Lokasi Cawangan:
Nombor Akaun:
Home Telephone:
Mobile Phone:
Email:
Telefon Rumah:
Telefon Bimbit:
Emel:
Date of Birth:
Place of Birth:Age:Tarikh Lahir:Tempat Lahir:
Umur
Religion:
Race:
Nationality:Agama:
Keturunan:
Warganegara:
Marital Status:
SingleMarriedDivorced
Others_______ Gender:
Taraf Perkahwinan: Bujang
Berkahwin
BerceraiLain-Lain_____ Jantina:
Spouse Name:
Occupation:
No. Of Children:
Nama Pasangan:
Pekerjaan:
Bilangan Anak:
EMERGENCY CONTACT PERSON/ ORANG YANG DIHUBUNGI KETIKA KECEMASAN
Name:
Relationship:
Telephone No:
Nama:
Hubungan:
No. Telefon:
HEALTH RECORD/ REKOD KESIHATANAre you pregnant:
Yes
No
Ever Hospitalized:
Adakah anda hamil:
YaTidak
Pernah dimasukkan ke Hospital:
Yes
NoDo you have any health problem?:
Yes
No
YaTidak
Adakah anda mengalami masalah kesihatan?:
Ya
Tidak
Duration of Treatment:___________
Illness (Operation/Accident):
Yes
No
Tempoh Dirawat:________________
Penyakit (Pembedahan/ Kemalangan):
Ya
Tidak
Covid-19 Vaccination Date (Tarikh Vaksin Covid-19): Yes / No (Ya /Tidak)
1st dose date (Tarikh dos pertama):
2nd dose date (Tarikh dos kedua):
EDUCATION DETAILS/ MAKLUMAT AKEDEMIK
Shchool/Institute/University Cert/Diploma/Degree(Sekolah/Institut/Universiti)(Sijil/Diploma/Ijazah)

Field(Bidang)

Duration(Tempoh)

Result(Keputusan)

Please indicate competency in languange [B = basic, I = intermediate, F = fluent](Sila nyatakan kecekapan dalam bahasa [ A = asas, S = sederhana, F = fasih]
Language/ Dialects(Bahasa/ Dialek)

Spoken(Percakapan)

Read(Pembacaan)

Written(Penulisan)CURRENT & PREVIOUS EMPLOYMENT/ PEKERJAAN SEKARANG & DAHULU
Company(Syarikat)

Position(Jawatan)

Reason for leaving(Sebab Berhenti)

From(Dari)
MM/YYTo(Ke)
MM/YY

Basic Salary/Allowances(Gaji/ Elaun)

REFERENCES/ RUJUKAN
List two references below. Relatives should not be included
Senaraikan dua rujukan di bawah. Saudara-mara tidak boleh dimasukkan
Name/ Nama

Company/ Syarikat

Telephone/ Telefon

Designation/
JawatanRelationship/
Hubungan

DECLARATION/ PERAKUAN
I declare that all above information is true and complete and I am liable to disciplinary action conducted against mefor falsifying or not declaring any of the above information required. I understand that my employment is sudjected
to my passing the medical examination conducted by Malaysia Steel Institute (MSI). False or inaccurate information
given will render any subsequent employment contact null and void.
Saya mengaku bahawa semua maklumat di atas adalah benar dan lengkap dan saya bertanggungjawap terhadap
tindakan tatatertib yang dijalankan terhadap saya kerana memalsukan atau tidak mengisytiharkan mana-manamaklumat diatas yang diperlukan. Saya fahan bahawa pekerjaan saya tertakluk kepada lulus ujian perubatan yangdijalankan oleh Malaysia Steel Institute (MSI). Maklumat palsu atau tidak tepat akan menyebabkan sebarang
kontrak pekerjaan berikutnya tidak sah.

_______________________________________
Singnature of Applicant/ Tandatangan Pemohon_________________________
Date/ Tarikh

FOR OFFICE USE/ UNTUK KEGUNAAN PEJABAT
Position/ Jawatan
Date Join/ Tarikh mula program
Allowance/ Elaun__________________________________________________________________________________________________________________________________________________________________