BORANG P2 - Universiti Brunei Darussalam



|UNIVERSITI BRUNEI |

|DARUSSALAM |

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|UNIVERSITI BRUNEI DARUSSALAM | |Photo |

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| | |Borang permohonan untuk jawatan Teknikal Kanan / Pentadbiran / Perpustakaan Bahagian I dan II| | |

| | |bagi pemohon yang terdiri dari rakyat Kebawah Duli Yang Maha Mulia Paduka Seri Baginda Sultan| | |

| | |dan Yang Di-Pertuan Negara Brunei Darussalam. | | |

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| | |BAHAGIAN I / SECTION I | | |

|Nama dan bidang jawatan: |

|Name and discipline of post applied for: |

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|CHECKLIST PERMOHONAN JAWATAN-JAWATAN KOSONG |

|UNIVERSITI BRUNEI DARUSSALAM |

|1 |BORANG PERMOHONAN (1 KEPING) | |

|2 |GAMBAR PEMOHON (1 KEPING) | |

|3 |SALINAN KAD PINTAR YANG SAH (1 KEPING) | |

|4 |SALINAN SIJIL-SIJIL AKADEMIK / DIPLOMA / IJAZAH (STATEMENT OF RESULTS BOLEH DITERIMA) | |

|5 |SALINAN BORANG PENILAIAN PRESTASI BAGI TIGA (3) TAHUN KEBELAKANGAN YANG DISAHKAN OLEH KETUA JABATAN | |

| |[ BAGI PEMOHON YANG BERKHIDMAT DENGAN KERAJAAN ] | |

|6 |SALINAN REKOD PERKHIDMATAN GEMS YANG LENGKAP, TERKINI (UPDATE) YANG DISAHKAN OLEH KETUA JABATAN | |

| |[ BAGI PEMOHON YANG BERKHIDMAT DENGAN KERAJAAN ] | |

|7 |MEMORANDUM DAN LAPORAN SULIT YANG TERKINI (UPDATE) DARI KETUA JABATAN | |

| |[ BAGI PEMOHON YANG BERKHIDMAT DENGAN KERAJAAN ] | |

|8 |SALINAN SIJIL TAMAT PERKHIDMATAN BEKAS ABDB / POLIS / WADAR [ JIKA BERKENAAN ] | |

| |TERMASUK MAKLUMAT PENCEN BULANAN YANG DITERIMA. | |

|JIKA MEMOHON LEBIH DARIPADA 1 JAWATAN, PEMOHON HENDAKLAH MENGISIKAN BORANG YANG BERASINGAN BERSERTA DENGAN DOKUMEN-DOKUMEN YANG DIPERLUKAN. |

|BORANG PERMOHONAN HENDAKLAH DIISIKAN DENGAN LENGKAP. BORANG YANG TIDAK LENGKAP TIDAK AKAN DIPROSES. |

Perhatian :

Bagi Pegawai dan kakitangan yang telah berkhidmat, hendaklah menghadapkan laporan sulit dan catatan Rekod Perkhidmatan yang lengkap dan bagi permohonan yang tidak lengkap tidak akan diproses.

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|BAHAGIAN II / SECTION II |

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|BUTIR PERIBADI / PERSONAL PARTICULARS: |

|NAMA PENUH – Termasuk nama lain (seperti yang terdapat dalam kad pengenalan); gunakan huruf besar |

|FULL NAME – Including aliases (as shown in the identity card) in block letters. |

|ALAMAT TETAP / |

|PERMANENT ADDRESS: |

|TELEFON / | |FAKSIMILI / | |

|TELEPHONE: | |FACSIMILE: | |

|ALAMAT PERHUBUNGAN / |

|POSTAL ADDRESS: |

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|TELEFON / | |FAKSIMILI / | |

|TELEPHONE: | |FACSIMILE: | |

|Bilangan Kad Pengenalan Brunei/ |Tarikh dikeluarkan/ |

|Brunei Identity Card Number: |Date of issue: |

|Tarikh Lahir/ |Tempat lahir/ |

|Date of Birth : |Place of birth: |

|Jantina/ |Taraf kelamin/ |

|Sex: |Marital status : |

|Bangsa/ |Ugama/ |

|Race: |Religion: |

|Kerakyatan/ |Bilangan pasport/ |Jika boleh memandu, sila |

|Citizenship: |Passport number |nyatakan jenis lesen / |

| | |If you can drive, state details |

| | |of driving license held: |

|Bilangan Sijil Kerakyataan/ | | |

|Citizenship Certificate number: |Tarikh mansuh/ | |

| |Expiry date: | |

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|Jenis Sijil Kerakyatan / Type of Citizenship: | | |

|Pendaftaran / Registration: | | |

|Penaungan / Neutralisation: |Tempat dikeluarkan/ | |

|Sepintas lalu / Descendent: |Place of Issue: | |

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|Tarikh Sijil Kerakyatan/ | | |

|Date of Citizenship Certificate: | | |

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|BAHAGIAN III / SECTION III |

|KELAYAKAN / QUALIFICATION |

|Persekolahan (Peringkat Menegah Atas) dan kelulusan yang diperolehi/ |

|Schools attended (Upper Secondary) and qualifications obtained. |

|Sijil Am Pelajaran Peringkat Biasa atau yang sebanding dengannya/ |

|General Certificate of Education Ordinary level or its equivalent. |

|Nama peperiksaan/ |Sekolah/Maktab |

|Name of Examination |School/College: |

|Keputusan/ |Tarikh Sijil/ |

|Results: |Date of Ceritificate: |

|Matapelajaran/ |Gred/ |

|Subjects: |Grades: |

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|Nama peperiksaan/ |Sekolah/Maktab |

|Name of Examination |School/College: |

|Keputusan/ |Tarikh Sijil/ |

|Results: |Date of Ceritificate: |

|Matapelajaran/ |Gred/ |

|Subjects: |Grades: |

|2. Sijil Am Pelajaran Peringkat tertinggi/Diploma Kebangsaan Biasa atau yang sebanding dengannya/ |

|General Certificate of Education Advance Level/Ordinary National Diploma or its equivalent. |

|Nama peperiksaan/ |Sekolah/Maktab |

|Name of Examination |School/College: |

|Keputusan/ |Tarikh Sijil/ |

|Results: |Date of Ceritificate: |

|Matapelajaran/ |Gred/ |

|Subjects: |Grades: |

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|Nama peperiksaan/ |Sekolah/Maktab |

|Name of Examination |School/College: |

|Keputusan/ |Tarikh Sijil/ |

|Results: |Date of Ceritificate: |

|Matapelajaran/ |Gred/ |

|Subjects: |Grades: |

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|PENDIDIKAN TINGGI DAN KELAYAKAN IKHTISAS/ |

|HIGHER EDUCATION AND PROFESSIONAL QUALIFICATIONS |

|Ijazah atau Diploma Kebangsaan Tertinggi atau yang sebanding dengannya/ |

|First Degree or Higher National Diploma or its equivalent. |

|Nama Peperiksaan/ |Keputusan peperiksaan / |Tarikh dianugerahkan / |

|Name of Examination |Result of Examination |Date awarded |

|Universiti / Maktab |Tarikh mula kursus/ |Tarikh tamat kursus/ |

|University / College |Date of commencement: |Completion date: |

|Matapelajaran-matapelajaran di dalam peperiksaan terakhir, nyatakan keputusan jika ada / |

|Subject taken in the final examination. Please state results if applicable. |

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|Ijazah Tertinggi atau Diploma Lepasan Ijazah / Higher Degree or Post-Graduate Diploma |

|Nama Peperiksaan/ |Keputusan peperiksaan / |Tarikh dianugerahkan / |

|Name of Examination |Result of Examination |Date awarded |

|Universiti / Maktab |Tarikh mula kursus/ |Tarikh tamat kursus/ |

|University / College |Date of commencement: |Completion date: |

|Matapelajaran-matapelajaran di dalam peperiksaan terakhir, nyatakan keputusan jika ada. Sila nyatakan tajuk thesis, jika ada / Subject taken in the|

|final examination. Please state results if applicable. Give title of your thesis, if applicable. |

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|Kelayakan ikhtisaas atau lain-lain / Professional and other qualification. |

|Nama Peperiksaan/ |Keputusan peperiksaan / |Tarikh dianugerahkan / |

|Name of Examination |Result of Examination |Date awarded |

|Universiti / Maktab |Tarikh mula kursus/ |Tarikh tamat kursus/ |

|University / College |Date of commencement: |Completion date: |

|Matapelajaran-matapelajaran di dalam peperiksaan terakhir, nyatakan keputusan jika ada. Sila nyatakan tajuk thesis, jika ada / Subject taken in the|

|final examination. Please state results if applicable. Give title of your thesis, if applicable. |

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|Kebolehan menulis dan/atau bertutur dalam bahasa/loghat. Tuliskan bahasa ibunda dahulu/ |

|Ability to write and/or speak languages/dialects. State mother-tongue first. |

|Bahasa/Loghat |Kebolehan menulis/ |Kebolehan bertutur/ |

|Language/Dialects |Written ability |Spoken ability |

| |Fasih |Baik |Sederhana |Fasih |Baik |Sederhana |

| |Fluent |Good |Fair |Fluent |Good |Fair |

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|BAHAGIAN IV / SECTION IV |

|BUTIR LATIHAN DAN PERSIDANGAN / TRAINING AND CONFERENCES DETAILS |

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|Sila nyatakan jenis latihan/persidangan dengan mengunakan kod-kod berikut. |

|State types of training/conferences using the following codes. |

|Latihan Dalam Perkhidmatan/ |- |LDP |Cuti Belajar/ |- |CB |

|In-Service Training | | |Study Leave | | |

|Cuti Tanpa Gaji (Dermasiswa)/ |- |CTGD |Cuti Tanpa Gaji (Tanpa Elaun)/ |- |CTGTE |

|Leave Without Pay (Scholarship) | | |Leave Without Pay (No allowance) | | |

|Belajar Persendirian/ |- |BP |Persidangan/ |- |P |

|Study Leave | | |Conferences | | |

|Latihan Tempatan/ |- |LT |Lain-lain/ |- |LL |

|Local Training | | |Others | | |

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|Nama latihan/persidangan / Name of training/conferences: |

|Tempat berkursus/persidangan / Course/conference held: |

|Tarikh mula / Date of commencement: |

|Tarikh tamat / Completion date: |

|Jenis latihan/persidangan / Training/Conference Types (gunakan kod / use code): |

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|BAHAGIAN V / SECTION V |

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|Sebutkan butir-butir mengenai pekerjaan dahulu. Sila berikan maklumat tersebut mengikut susunan tarikh yang awal sekali nyatakan dahulu / |

|Giveparticulars of all previous employments in chronological order. |

|Nama Jawatan/ |Nama dan alamat majikan / |Tariklh mula/ |Tarikh berhenti/ |Butir mengenai pekerjaan|Sebab-sebab berhenti / |

|Name of Post |Name and address of Employer|Date of commencement |Termination date |/ Nature of emploment |Reasons for leaving |

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|Pekerjaan sekarang / Current employment |

|Nama jawatan / Name of post: |

|Nama dan alamat majikan / Name and address of employer: |

|Tarikh mula / Date of commencement: |

|Butir mengenai pekerjaan / Nature of employment: |

|Gaji sebulan / Monthly salary: |

|Elaun-elaun / Allowances: |

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|BAHAGIAN VI / SECTION VI |

|BUTIR KELUARGA / FAMILY PARTICULARS |

| |Suami/Isteri Pemohon / |Bapa Pemohon / |Ibu Pemohon / |

| |Applicant’s Wife/Husband |Applicant’s Father |Applicant’s Mother |

|Nama penuh / | | | |

|Full Name | | | |

|Bilangan Kad Pengenalan / | | | |

|Identity.Card Number. | | | |

|Nama-nama lain / | | | |

|Aliases | | | |

|Tarikh lahir / | | | |

|Date of birth | | | |

|Tempat lahir / | | | |

|Place of birth | | | |

|Pekerjaan / | | | |

|Occupation | | | |

|Alamat Penuh / | | | |

|Full Address | | | |

|Tarikh meninggal, jika bekernaan / | | | |

|Date of demise, if applicable | | | |

|Perhatian / Note: |

|Sila berikan maklumat berikut dalam kertas yang berasingan/ |

|Please give the following details on a separate sheet of paper. |

|Berikan keterangan yang berkaitan mengenai bekas suami/isteri pemohon, jika berkenaan/ |

|Give details on any former wife/husband, if applicable. |

|Jika pemohon adalah anak angkat secara undang-undang, nyatakan butir ibu bapa angkat pemohon dan umur pemohon semasa diangkat. Jika dipelihara oleh|

|ibubapa tiri, penjaga, atau orang-orang yang selaku ibu/bapa beri butir yang bersangkutan. / |

|If applicant is legally adopted, give details of adopted parents and state your age when adopted. If brought up by step parent(s), guardian or any |

|acting as a parent, please give details. |

|Jika yang berkenaan telah meninggal dunia, nyatakan kerakyatan semasa meninggal / |

|If deceased, state nationality at time of death. |

|Butir anak / Particulars of children |

|Nama penuh / |Tarikh lahir / |Jantina/ |Bil Kad Pengenalan/ |Taraf/ kelamin/ |

|Full Name |Date of birth |Sex |Identity.Card No. |Marital status |

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|Adakah pemohon pernah memohon jawatan yang sama atau jawatan lain di UBD dalam tempoh dua belas bulan yang lalu? Jika ‘Ya’, sila nyatakan |

|butir-butir tersebut dibawah. |

|Have you applied for the same post or any other post in UBD during the last twelve months? If ‘Yes’, give details as required below. |

|Nama jawatan yang dipohon / |Jabatan / |Keputusan / |

|Post applied for |Department |Result |

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|BAHAGIAN VII / SECTION VII |

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|BUTIR PENJAMIN / DETAILS OF REFEREES |

|1. |Nama / |

| |Name: |

| |Pekerjaan / |

| |Occupation: |

| |Berapa tahun kenal / |

| |Years known: |

| |Alamat / |

| |Address: |

| |Telefon / |Faks / |

| |Telephone: |Fax: |

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|2. |Nama / |

| |Name: |

| |Pekerjaan / |

| |Occupation: |

| |Berapa tahun kenal / |

| |Years known: |

| |Alamat / |

| |Address: |

| |Telefon / |Faks / |

| |Telephone: |Fax: |

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|3. |Nama / |

| |Name: |

| |Pekerjaan / |

| |Occupation: |

| |Berapa tahun kenal / |

| |Years known: |

| |Alamat / |

| |Address: |

| |Telefon / |Faks / |

| |Telephone: |Fax: |

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|Perhatian / Note: |

|Penjamin-penjamin hendaklah terdiri dari tenaga akademik, guru ahli pengajar maktab, pengurus majikan, ketua jabatan siapa yang boleh dihubungi |

|mengenai dengan kerja atau kelakuan pemohon / |

|The referees should be acadmic staff, teachers or teaching staff of college, head of employing body, heads of department who can be contacted for |

|academic and character reference. |

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|PENGAKUAN / DECLARATION |

|Saya bersumpah bahawa butir-butir dalam Borang Permohonan ini dan di dalam kertas yang disertakan adalah benar sejauhmana yang saya ketahui dan |

|percaya saya tidak senghaja menyembunyikan sebarang kenyataan / |

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|I declare that the particulars in this application and the attached sheets hereto are true to the best of my knowledge and belief, and that I have |

|not willfully withheld any material fact. |

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|Tandatangan / Signature | |Tarikh / Date |

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