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MY APPLICATION FORM
KOLEJ KEMAHIRAN TINGGI MARA KUANTAN
OPEN INTAKE
1. Please fill in the form carefully. We will not process if the form is incomplete/information not valid
2. Please attach: a. Copy of relevant academic certificates
b. Copy of IC of the applicant & parents/guardian
c. Copy of birth certificate of the applicant & parents/guardian
3. Please tick (√) where appropriate

PART I - PERSONAL DETAILS

1. Program Selection : Diploma In Manufacturing Engineering (Industrial, Automation & Robotic)

2. Color Blind : Yes No

3. Full Name :

4. IC Number : 5. Age : years old

6. Permanent Address :

7. Mailing Address :
(If different from above)

8. Email :

9. Phone (House) : 10. Mobile :

11. Gender : Male 12. Status : Single

Female Married

13. Race : 14. Religion :

15. Major illness : No major illness 16. Malaysian : Yes

Yes Citizen No
Please Specify Please Specify

17. Sponsorship : No
Yes
Please Specify
 PART II - PARENTS / GUARDIAN DETAILS

18. Father's Name :

19. IC Number : 20. Income : RM

21. Phone (H) : Phone (H/P) :

Phone (O) :

22. Race : 23. Religion :

23. Working Status : 25. No. of :

Dependent
26. Malaysian Citizen : Yes
No
Please Specify

27. Mother's Name :

28. IC Number : 29. Income : RM

30. Phone (H) : Phone (H/P) :

Phone (O) :

31. Race : 32. Religion :

33. Working Status : 34. No. of :

Dependent

35. Malaysian Citizen : Yes

No
Please Specify

PART III - ACADEMIC / EXPERIENCE

Result
Highest Education Level / Certificate Duration
(CGPA/Grade)

Working Experience Duration Field

DECLARATION

I hereby declare that the information given by me in this form is correct and true to the best of my knowledge
I fully understand and accept that if at any time after engagement it is found that a false has been made
in this form, UMW and MARA have the absolute right to terminate the offer and allowance.

Signature Date
( )