Borang Program Transformasi Minda 2012
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Borang Program Transformasi Minda 2012

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Borang Program Transformasi Minda 2012 yang mengantikan KISSM

Borang Program Transformasi Minda 2012 yang mengantikan KISSM

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  • 1. BORANG PERMOHONAN BAGI MENGIKUTI PROGRAM TRANSFORMASI MINDA KEMENTERIAN PELAJARAN MALAYSIAA. BUTIR – BUTIR PERIBADI 1. Nama : ___________________________________________________________________ 2. No KP (Baru) : ___________________________________________________________________ 3. Jantina : __________________ 4. Bangsa : ____________________________ 5. Tarikh Lahir : __________________ 6. No Telefon (P) : ____________________________ No Telefon (R) : ____________________________ 7. Agama : __________________ Bimbit : ____________________________ Faks : ____________________________ 8. Kecacatan (fizikal, fizikal (tangan), bisu, penglihatan): _________________________________________ 9. Alamat Pejabat : __________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 10. Alamat Rumah : __________________________________________________________________ __________________________________________________________________ __________________________________________________________________B. BUTIR – BUTIR PERKHIDMATAN 1. Skim Perkhidmatan : __________________ 2 Gred Jawatan :______________ 3 Tarikh Lantikan : __________________ (Ke Skim Sekarang) 4. Lantikan :___________________ 5. Jika lantikan KPSL(Nyatakan Nama Jawatan Sebelum dan Tarikh Lantikan) Jawatan : ___________________ Tarikh Lantikan : ________________ * Sila sertakan salinan Surat Pengesahan Lantikan atau Surat Tawaran LantikanC. BUTIR – BUTIR MENGENAI KURSUS INDUKSI YANG PERNAH DIIKUTI SEBELUM INI 1. Tahun : ______________________ 2. Anjuran : ______________________ 3. Keputusan Lulus Kandas (*Sila tandakan / pada petak berkenaan)D. PENGAKUAN PEMOHON Saya akui bahawa keterangan yang diberikan adalah benar dan saya bertanggungjawab terhadapnya. Tarikh : ________________ _____________________ (Tandatangan Pemohon)E. PENGESAHAN KETUA JABATAN _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Tarikh : ________________ ______________________ (Tandatangan Ketua Jabatan)