INSTITUT PENYELIDIKAN DAN KEMAJUAN PERTANIAN MALAYSIA MALAYSIAN AGRICULTURAL RESEARCH AND DEVELOPMENT INSTITUTE http://www.mardi.gov.my SILA LEKATKAN GAMBAR UKURAN PASPOT (PLEASE PASTE YOUR PASSPORT PHOTO)
(INDUSTRIAL TRAINING APPLICATION FORM)
A. MAKLUMAT PERIBADI ( PERS PERSONAL I NFORMATI ON) NAMA PELAJAR (STUDENT NAME)
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NO KP (IC (IC NO )
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NO PELAJAR (STUDENT (STUDENT ID)
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JANTINA (GENDER) (GENDER)
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KEWARGANEGARAAN (NATIONALITY)
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ALAMAT (ADDRESS) ALAMAT (ADDRESS)
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NO HP / (HP NO )
PERHUBUNGAN (CONTACT)
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EMAIL (EMAIL) (EMAIL)
B. MAKLUMAT PENGAJIAN (STUDIES ( STUDIES INFORMATION) NAMA INSTITUSI INSTITUSI (INSTITUTIONAL)
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STATUS UNIVERSITI UNIVERSITI ( UNIVERSITY STATUS)
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UNIVERSITI AWAM (PUBLIC ( PUBLIC UNIVERSITY)
Please tick (√) ) *Sila pilih ( Please )
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LAIN-LAIN (NYATAKAN) (OTHERS (OTHERS (SPECIFY)
PERINGKAT PENGAJIAN (EDUCATION LEVE)L
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SIJIL (CERTIFICATE) (CERTIFICATE)
DIPLOMA
Please tick (√ )) *Sila pilih ( Please
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IJAZAH (BACHELOR) (BACHELOR)
IJAZAH SARJANA (MASTERS)
BIDANG PENGAJIAN (FIELD (FIELD OF STUDY)
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PENGKHUSUSAN (MAJORING)
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PILIHAN TEMPAT LATIHAN (PLACEMENT)
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TEMPOH LATIHAN INDUSTRI (INDUSTRIAL TRAINING PERIOD)
C. PENGESAHAN PELAJAR / PELAJAR / STUDENT VERIFICATION VERIFICATION Saya sahkan bahawa maklumat yang diberikan adalah benar dan saya bersetuju sekiranya maklumat yang diberikan bercanggah saya boleh dikeluarkan daripada menjalani Latihan Industri di MARDI ( I certify that the information given is correct and agreed to be removed from the industrial training if I had given the false statement)
Tandatangan Pelajar (Student (Student Signature)
Tandatangan Penyelaras Latihan Industri ( Industrial Industrial Training Coordinator Signature)
