KOLEJ PROFESIONAL MARA BANDAR MELAKA KPMBM ALUMNI MEMBERSHIP FORM

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PERSONAL INFORMATION FULL NAME: __________________________________________________ IC NO: RELIGION*: RACE*: MARITIAL STATUS*: BIRTH PLACE: HOMETOWN: HANDPHONE NO: HOME TELEPHONE NO: E-MAIL ADDRESS: FACEBOOK: _________________________________ ISLAM / OTHERS (____________________) MALAY / BUMIPUTERA (__________________) SINGLE / MARRIED / DIVORCEE _____________________________________ _____________________________________ _____________________________________ _____________________________________ ______________________________________ ______________________________________ ADDRESS INTORMATION HOME ADDRESS: ____________________________________________________________ ______ POSTCODE: STATE: ______________________ ______________________

POSTAL INFORMATION (JUST LEFT BLANK IF YOUR ADDRESS IS THE SAME AS ABOVE) HOME ADDRESS: POSTCODE: STATE: ______________________ ______________________

CURRENT EMPLOYMENT (PLEASE LEFT BLANK IF YOU ARE SELF EMPLOYED) GOVERNMENT / PRIVATE

CAREER CATEGORY* :

ORGANIZATION NAME :

JOB POSITION : *TICK THE APPROPRIATE RATE

SALARY RATE (RM) :

BELOW RM1000 RM1000RM2000 RM2001RM3000 RM3001RM4000 RM4001RM5000 ABOVE RM5000

ORGANIZATION ADDRESS :

OFFICE TELEPHONE NO :

FAX NO : YEAR SERVICE START :

CURRENT BUSINESS (FOR SELF-EMPLOYEE ONLY)

ORGANIZATION NAME :

JOB POSITION : ORGANIZATION ADDRESS :

NATURE OF BUSINESS :

COMPANY TELEPHONE NO : COMPANY FAX NO :

No

Higher learning Institution Name

Cours e

Higher Institution Category*

Month

Year In

Year End

Convocati on Year

Education level Category*

Field Area

1 2 3 4 5 6 7 8 9 10 *Please use the correct side as stated below

Higher Instituition Category Code Meaning IPTA Malaysian Government Higher Learning Institution IPTS Malaysian Private Higher Learning Institution Oversea Polytechnics Community College Oversea Higher Learning Institution Polytechnics community college

Education Level Category Code Meaning CERT Certificate DIP Diploma ADV DIP Advance Diploma BCH Bachelor MAS PHD PRO masters Philosophy doctor Profesional

Career No Category* Organization Name 1 2 3 4 5 6 7 8 9 10 *Please use the correct side as stated below Job Position Month Start Year Start Year End Field Area

Career Category Code Meaning GOV Government agencies PRT Private Agencies / Company ETR Entrepreneur / Self-employeed