MALAYSIAN MARITIME ACADEMY SDN.

BHD
(AKADEMI LAUT MALAYSIA)
COURSE APPLICATION FORM/BORANG PERMOHONAN KURSUS

Application for: Diploma in Marine Engineering (Marine Engine Cadet)

Permohonan untuk:

A) PERSONAL PARTICULARS/MAKLUMAT PERIBADI

Name (in full): MUHAMMAD FIRDAUS ALIF BIN KHAIROL SALLIH

Nama penuh:
Address: KAMPUNG CHANGKAT RAMBAI,KAMPUNG GAJAH,36800,PERAK
Alamat:
Postcode 36800
Poskod
Town / City: KAMPUNG GAJAH
Bandar
State: Perak
Kawasan:
Telephone (Home): 05-6311353 Gender: Male
Telefon (Rumah): Jantina:
Mobile Phone: 013-5275482
Telefon Bimbit:
Date of Birth (dd/mm/yyyy): 18/11/1999 Age: 18
Tarikh Lahir : Umur:

Citizenship / Warganegara : Malaysian Height (cm): 175

Tinggi (cm):
Weight (kg): 59
Berat (kg):
Place of Birth: HOSPITAL MELAKA,BANDAR MELAKA BMI: 19.27
Tempat Lahir:
Religion: Islam NRIC: 991118-04-5299
Agama: No.Kad Pengenalan:
Email Address: kfirausalif@gmail.com Ethnic / Race: Malay
Alamat Emel: Kaum/Bangsa:

B) ACADEMIC REQUIREMENTS/KELAYAKAN AKADEMIK:

SPM Exam Result Year: 2016

Tahun Keputusan SPM :
School Name : SEKOLAH MENENGAH SAINS BAGAN DATOH
Nama Sekolah:
Subject/Subjek Level Obtained in SPM/Keputusan Diperolehi
1) Malay Language/Bahasa Melayu C+
2) English Language/Bahasa Inggeris B+
3) Mathematics/Matematik A
4) Additional Mathematics/Matematik Tambahan C+
5) Physics/Fizik B+
6) Chemistry/Kimia B
7) Biology/ Biologi B
Other subject / Subjek Lain
*Please state below / Sila nyatakan di bawah
7) History/ Sejarah B
8) Islamic Studies/Pendidikan Islam A+
10)
11)

C) QUESTIONS:
1) Are you a swimmer? Anda perenang?
Answer/Jawapan: No

2) Are you wearing visual aids (spectacles or contact lens)? Adakah anda memakai kacamata/kanta lekap?
Answer/Jawapan: Yes
If "Yes", please advise the degree of your visual aid : 150 (must be <200)
Jika ya,sila nyatakan tinggi kuasa: (mesti <200)
3) Are you colour blind? Adakah anda rabun warna?
Answer/Jawapan: No

4) Are you suffering from any illness that may hinder you from attending any course? Adakah anda menghidapi sebarang penyakit yang boleh menghalang anda dari mengikuti
kursus?
Answer/Jawapan: No

5) Co- Curricular/Ko-kurikulum
5.1) Uniform Body/Badan Berunifom Pengakap
Position / Rank /Jawatan/Pangkat

5.2) Non-Uniform Body/Badan Bukan Berunifom

Position / Rank /Jawatan/Pangkat

5.3) Sports/Sukan
Representation / Wakil

6) Hobbies/Hobi:
Answer/Jawapan:
D) PARENTS / GUARDIAN INFORMATION/MAKLUMAT IBUBAPA/PENJAGA
Father / Guardian's Name:
Nama Bapa/Penjaga:
NRIC/No.Kad Pengenalan:
Occupation/Pekerjaan:
Citizenship/Warganegara:
Telephone (Home)/Telefon (Rumah):
Mobile Phone/Telefon Bimbit:
Monthly Income/Pendapatan Bulanan:

Mother / Guardian's Name:

Nama Ibu/Penjaga:
NRIC/No.Kad Pengenalan:
Occupation/Pekerjaan:
Citizenship/Warganegara:
Telephone (Home)/Telefon (Rumah):
Mobile Phone/Telefon Bimbit:
Monthly Income/Pendapatan Bulanan:

Number of Dependent/Jumlah Tanggungan

E) EMERGENCY CONTACT DETAILS FOR NEXT OF KIN/NAMA WARIS YANG BOLEH DIHUBUNGI SEKIRANYA BERLAKU KECEMASAN

Name/Nama:

Address/Alamat:

Telephone (Home)/Telefon (Rumah):

Mobile Phone/Telefon Bimbit:

Relationship/Hubungan:

F) OTHERS/LAIN-LAIN:
1) If you are not successful to get a sponsorship, would you consider paying on your own for this programme?
Sekiranya anda tidak berjaya untuk mendapatkan tajaan, adakah anda akan pertimbangkan untuk membiayai sendiri program ini?
Answer/Jawapan:

G) INSTRUCTIONS TO APPLICANTS / ARAHAN KEPADA PEMOHON

1) Please save your completed application form and name the file as ALAM YOUR IC NO DME (eg. ALAM-970802-01-XXXX-DME)
Sila simpan borang permohonan anda yang telah lengkap dan namakan fail tersebut ALAM - NO IC ANDA - DME (contoh: ALAM-970802-01-XXXX-DME)

2) When emailing your application form, please use the same name as the Subject: ALAM YOUR IC NO DME (eg. Subject: ALAM-970802-01-XXXX-DME)
Semasa e-mel borang permohonan anda, sila gunakan nama yang sama sebagai Subjek: ALAM - NO IC ANDA - DME (contoh: Subjek: ALAM-970802-01-XXXX-DME)

3) This form must be completed and submitted via email to (alamintake@alam.edu.my) before 5:00pm on 9th April 2017 and a printed copy is to be brought along on the interview
day (if you are shortlisted) .

Borang ini perlu dilengkapkan dan dihantar melalui emel kepada (alamintake@alam.edu.my) sebelum 5.00 PM 9hb April 2017 dan sila bawa satu salinan borang
yang telah dicetak semasa hari temuduga (sekiranya nama anda disenarai pendekkan).

4) Please also ensure that you submit the application form together with the completed PDPA Form. Application forms submitted without the PDPA Form
will not be processed.
Sila pastikan juga bahawa borang permohonan anda di hantar beserta dengan Borang PDPA yang telah lengkap diisi. Borang permohonan yang dihantar
tanpa Borang PDPA tidak akan diproses.

5) ONLY shortlisted candidates will be notified for an interview via email.

HANYA calon yang disenarai pendekkan sahaja akan dihubungi melalui emel untuk panggilan temuduga.