PSMB/GRIP/1/15

1MALAYSIA GLOBALLY RECOGNISED INDUSTRY AND PROFESSIONAL

CERTIFICATION
(1MALAYSIAGRIP)
APPLICATION FORM

CATEGORY OF EMPLOYEE
Employee of HRDF Registered Employer
Employee of Non Registered Employer with HRDF

Please tick () where applicable

SUPPORTING DOCUMENTS TO BE ATTACHED

Copy of MyID (Identity Card)

Copy of Latest 1 Month Pay Slip

Please tick ()

A.

TRAINING INFORMATION

Course Title

Autodesk AutoCAD Certified Professional

Start Date

24.8.2015

Completion Date

28.8.2015

Venue

Block A1, Level 9, Unit 82, Leisure Commerce Square, Jalan PJS 8/9,
46150 Petaling Jaya, Selangor

Training Provider

IM Foremost Sdn Bhd [ CG Skill ]

B)TRAINEE INFORMATION

Name

MyID Card No.

3
4

Z U L H A Z A Z I
U

B I

9 0 1 0 2 4 -

0 7 -

5 8 3 1

Gender

/ Male

Female

Address

C H E
E

EM

B I

10, LALUAN CHEMOR MAJU 15

TAMAN CHEMOR IDAMAN
31200 CHEMOR
Postcode

State:

31200

PERAK

Tel. No (Office)

Tel. No (Handphone)

Email

zulhazazi@gmail.com

Social Media

LinkedIn : ..

Preference

019-4520912

Facebook : Hazazi XI

(please provide ID)

Others : ..
9

Academic

Sijil Pelajaran Malaysia (SPM)

Qualification
Sijil Tinggi Pelajaran Malaysia (STPM)
Certificate / Skills Certificate
Diploma

Bachelor Degree
Master Degree
Doctoral Degree
Others:

10

Specify

Highest

Academic

BACHELOR OF ENGINEERING (MECHANICAL-MARINE TECHNOLOGY)

Qualification;
eg. Bachelor of Economics

11

Current Position

Manager

Professional

Technicians & Associate

Clerical Support Workers

Service and Sales Workers

Skilled Agricultural, Forestry & Fishery Workers

Craft and Related Trades

Elementary Occupations

Plant and Machine Operators and Assemblers

12

Exact Position

13

Current

CLERICAL SUPPORT (PART TIME)

Monthly :

Below RM800 for Sabah and Sarawak

Salary Range

Below RM900 for Peninsular Malaysia

RM800 to RM1,999 for Sabah & Sarawak
RM900 to RM1,999 for Sabah & Sarawak
RM900 to RM1,999 Peninsular Malaysia
RM2,000 to RM3,999
RM4,000 to RM5,999
RM6,000 to RM7,999
RM8,000 to RM9,999
RM10,000 and above

(C)

EMPLOYER INFORMATION

Name of Employer

MyCoID

(Company :

NBH SINAR RESOURCES

AS0320354-V

Registration Number) Compulsory

3

Industry

Manufacturing

Construction
Specify Sub sector:
4

Address

Agriculture

Service

Mining & Quarrying

INSTRUMENT SUPPLY

D6-3A-7, D6 @ SENTUL EAST,

801, JALAN SENTUL,
51000, KUALA LUMPUR
Poscode

State

51000
3

KUALA LUMPUR

Tel. No (Office)

Fax . No.

Contact Person (HR)

HR Email Address

D.

018-6339 639

013-465 3963 (Mr. Saiful Naim)

hr.nbhsinar@gmail.com

EMPLOYER ENDORSEMENT

I hereby declare that the above mentioned trainee is an employee of our company

Signature

Name

Company Stamp:

: .............................................

: AHMAD SAIFUL NAIM BIN MOHD SAH

Position : HR MANAGER

Date

E.

EMPLOYEE ENDORSEMENT

I declare that the facts stated in this application and the accompanying information are true and correct and
I have not withheld / distorted any material fact.

Signature

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

Name

ZULHAZAZI BIN CHE EMBI

MyID Card No.

: 901024-07-5831

Date

:...