MAKLUMAT PERIBADI CALON

1. Nama : .................................................................................................. No. KP : ....................................................

Alamat surat menyurat : .........................................................................................................................................

.................................................................................................................................................................................

Alamat Kediaman : .................................................................................................................................................

............................................................................................................. No. Tel : ..................................................

Tempat Kelahiran : .................................................................................................................................................

2. (a) Pekerjaan Sekarang : .................................................................... Tarikh dilantik : .......................................

(b) Jabatan/Majikan : .............................................................................................................................................

.................................................................................................................................................................................

(c) No. Tel : ....................................................... (d) Kumpulan Perkhidmatan : ................................................

(e) Taraf Perkhidmatan : ....................................................... (f) Gaji : ............................................................

(g) Adakah permohonan melalui Ketua Jabatan : Ya / Tidak *

(Jika tidak melalui nyatakan sebab – sebab) : ....................................................................................................

3. (a) Taraf Perkahwinan : ................................................................ (b) Bil. Isteri : .............................................

(c) Nama-nama Suami / Isteri : (i) ..........................................................................................................................

(ii) ..........................................................................................................................

(d) Pekerjaan Suami / Isteri : (i) .............................................................................................................................

(ii) .............................................................................................................................

(e) Alamat Majikan : ..............................................................................................................................................

...........................................................................................................................................................................

4. Kebolehan Bahasa Pertuturan dan Tulisan : ............................................................................................................

5. Lesen Memandu / Kelas : .........................................................................................................................................

6. Kebolehan Komputer : Boleh / Tidak *

7. Adakah anda pernah berkhidmat dalam mana-mana Jabatan Kerajaan? Jika pernah, sila nyatakan butir-butir berikut:-

(a) Nama Jabatan : .................................................................................................................................................

(b) Tarikh Lantikan : ...............................................................................................................................................

8. Soalan bersabit penglibatan jenayah dan penyalahgunaan dadah :-

(a) Adakah anda pernah dituduh di mahkamah dan masih ada kes yang belum selesai? ( Ya / Tidak )*

(b) Adakah anda pernah dihukum di mahkamah kerana kesalahan? ( Ya / Tidak )* Jika ada sila nyatakan

butir-butir dan hukumannya:- ............................................................................................................................

9. Keterangan Sekolah dan Institut Pengajian yang dihadiri:-

Tahun
Bil. Nama Sekolah / Institut / Universiti Tempat
Masuk Keluar

9.1

9.2

9.3

9.4

10. Keterangan Ibu bapa dan Waris terdekat:-

Waris Terdekat
Bil. Perkara Bapa Ibu
(selain ibu bapa)

10.1 Nama

10.2 No. K/P

10.3 Tempat Lahir

10.4 Warganegara

10.5 Pekerjaan

10.6 Alamat

10.7 No. Telefon

11. Senarai Nama Adik Beradik.

No. Tel
Bil. Nama Umur Pekerjaan
(jika ada)

11.1

11.2

11.3

11.4

11.5

11.6

11.7

11.8

11.9

11.10

11.11

11.12

Semua Maklumat Di Atas Adalah Benar.

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(Tandatangan Calon) Tarikh:............................................