FORM A: Industrial Training Application Form

(For ITC Administration)

Management and Science University Paste your latest colour

Faculty: ___________________________________________ photograph passport size.

Academic Session:
Feb July Sept 2 0 1

Personal Data
Students Name :

Gender : F M Student ID :

IC No : - - Age :

Permanent address:

Postcode : State :

Degree : Religion :
Major : Contact No : 0
CGPA : . E-mail :
Year : 2nd 3rd 4th Marital Status :
Weight : . kg Spouses Name :
Height : . m Hobbies
Race :

Mode of transportation: Car / Motorcycle/ Public Transportation

Family: (Next of kin)

Name Relationship Occupation Company/ Institution

In case of emergency, person to contact:

Name :

Relationship :
Address:

Contact No : 0

1
Activities in School/ College/ University/ Public (Sports, Clubs and Societies):

Club/Society/Sport Post Year Achievements

Preferred Training Locations (underline one or more): Kuala Lumpur / Selangor

Have you found your own company for the Industrial Training? Y / N

If Yes, Companys Name :

Address :

Contact No/Person :

Education
Secondary School:

Name of School Address Years Certificate and Grade

Tertiary Education (Certificate/ Diploma/ Degree/Latest transcript)

Name of School Address Years Certificate/Degree

(Please attach copies of your certified relevant certificates)

Working Experience
Previous Working Experience: (3months and above)

Company Name Post Duration/ Responsibility

Year

Special Skills:

I hereby declare that the information I give is accurate to the best of my knowledge.
I understand that the Industrial Training Committee will be assisting me in finding a company to do my
industrial training. Under no circumstances will I hold the committee nor MSU responsible if no such company
is found.

Students Signature: Date: