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1/2015)
The information given in this form must be completed and clearly filled.
2.
3.
4.
Application from government servants (Malaysians only) shall be submitted through their Head
of Department who shall forward the application to us together with the required particulars of
service and comments by the Head of Department.
5.
Application received after the closing date, or is incomplete or is without a copy of the
IC/Certificates/ Diploma/Degree/relevant documents will not be entertained.
6.
Only qualified and short-listed candidates will be called for an interview. The University is not
responsible for any expenses incurred in the process of attending the interview.
7.
Applicants who do not receive any response after six (6) months from the closing date of this
advertisement/application, shall assume that their application is unsuccessful.
8.
The University will not pay any expenses incurred for this application or for attending interview.
9.
Please state the position, name of the faculty and field of interest applied on the top left corner
of the envelope and submit your application to :-
Please attach a
recent passport
size photograph
here
Position :
School/Institute :
Field :
B. PERSONAL DETAILS
1. Full Name (Capital Letter)
2. Gender :
Male
Female
3. Religion :
4. Race :
5. Date of Birth
(dd/mm/yy) :
6. Identification No. /
Passport No. :
7. Age :
8. Marital Status :
10. Nationality :
Single
Married
C. CONTACT INFORMATION
1. Primary Email :
4.
Address :
Postal
2. Mobile No. :
3. Office
No. :
Postal Code
City
State/Region
Country
Telephone
D. EDUCATIONAL QUALIFICATIONS
1. University/Institute/Schools Attended (SPM/Bachelor/Master/PhD)
Field of Study
Grade/
CGPA
School/Institute/University
Graduation
Date
2. Publication
a)
Jurnal
(Please use extra sheet if needed)
Year
Title of article in jurnal
b) Proceeding
(Please use extra sheet if needed)
Year
Title of article in jurnal
Year Obtained
Status
(ISI/SCOPUS)
Author/CoAuthor/
Corresponding
Author
Quantum
(Q1,Q2,Q3,Q
4)
Status
(ISI/SCOPUS)
Author/CoAuthor/
Corresponding
Author
Quantum
(Q1,Q2,Q3,Q
4)
4. Language Proficiency
State your Bahasa Melayu and English Test Result
during SPM and MUET.
Type Language
Grade
Year
Bahasa Melayu (SPM)
English (SPM)
English (MUET)
Date
Appointed
Gross
Salary Per
Month
Salary
Grade
Organization Address/postal
code
Telephone No.
2. Previous Job
Fax No.
Salary Increment
Date
EPF/ Pension
No.
Company Name
Date
Start
Date End
Monthly Salary
F. CO-CURICULLAR ACTIVITIES
Name of Activities
Level of Achievement
(National/State/University/School)
G. REFERENCES
References must not a relative with the applicant and he/she can describe about applicants academic qualification.
REFERENCE 1
REFERENCE 2
Name
Name
Relationship
Relationship
Telephone No.
Telephone No.
Position
Position
Company Name
Company
Name
H. WORKING AVAILABILITY
I. DECLARATION
Yes
No
I hereby declare that all of the statements that have been filled in this application are true. If any
of the statement is false or the application is incomplete, UMT is entitled to revoke the approval of
this application.
Signature:
Date :
Identification/Passport No.
Position Applied
Name of Referee
Referee s Position
Referees Organization
Name
School/Institute :
2. Please discuss the applicants ability and suitability for the position he/she is
applying for.
3. Please provide your views on the applicants qualities in the following areas : (Use
additional sheet if necessary)
Academic Qualifications
Leadership Qualities
Willingness to Cooperate
Personal Qualities
4.
Based on the above, would you recommend the applicant to the position he/she is
applying for?
Signature
Date
Name of Referee
Position
Identification/Passport
No.
Name of Institution
Office Address
Fax No.
Identification/Passport No.
Position Applied
Name of Referee
Referee s Position
Referees Organization
Name
School/Institut
e:
2. Please discuss the applicants ability and suitability for the position he/she is
applying for.
3. Please provide your views on the applicants qualities in the following areas : (Use
additional sheet if necessary)
Academic Qualifications
Leadership Qualities
Willingness to Cooperate
Personal Qualities
4.
Based on the above, would you recommend the applicant to the position he/she is
applying for?
Signature
Date
Name of Referee
Position
Identification/Passport
No.
Name of Institution
Office Address
Fax No.