PSMB Gig 1 20 - Trainee Registration Form

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PSMB/GIG/1/20

TRAINEE REGISTRATION FORM


PENJANA HRDF – GERAK INSAN GEMILANG INITIATIVE (GIG)

SUPPORTING DOCUMENTS TO BE ATTACHED FOR TRAINEE


Copy of NRIC

A. TRAINING INFORMATION

1 Course Title :
……………………………………………………………………….........…………….....

……………………………………………………………………….........…………….....

……………………………………………………………………….........…………….....
2 Training Delivery : Classroom Virtual Blended Others :
Please specify……………………
3 Total Duration :
Days Hours
4 Start Date :
……………………………………………………………………….........…………….....
5 Completion Date :
……………………………………………………………………….........…………….....
6 Venue :
……………………………………………………………………….........…………….....

……………………………………………………………………….........…………….....
7 Mode of Training :
Full Time Part-Time
8 Training Provider :
……………………………………………………………………….........…………….....

B. TRAINEE INFORMATION

1 Name :
……………………………………………………………………….........…………….....

……………………………………………………………………….........…………….....
2 NRIC No. :
……………………………………………………………………….........…………….....
3 Gender :
Male Female
4 Race : Malay Chinese Indian Others :
Please specify……………………
5 Address :

……………………………………………………………………….........…………….....

……………………………………………………………………….........…………….....

……………………………………………………………………….........…………….....

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6 Tel. No :
……………………………………………………………………….........…………….....
7 Email :
……………………………………………………………………….........…………….....

8 Academic : 01 Sijil Pelajaran Malaysia (SPM)


Qualification
02 Sijil Tinggi Pelajaran Malaysia (STPM)

03 Certificate / Skills Certificate

04 Diploma

05 Bachelor Degree

06 Master Degree

07 Doctoral Degree

08 Others (Please specify) :

I declare that the facts stated in this application and the accompanying information are true and correct
and that I have not withheld / distorted any material facts. I understand that if I obtain the grant by
false or misleading statements, I may be prosecuted.

Signature :
…………………………………………………………

Name :
…………………………………………………………

NRIC No. :
…………………………………………………………

Date :
…………………………………………………………

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