BORANG PERMOHONAN PERMIT PEKERJA LUAR (WARGANEGARA)
BORANG PERMOHONAN PERMIT PEKERJA LUAR (WARGANEGARA)
BAHAGIAN KESELAMATAN
UNIVERSITI TUN HUSSEIN ONN MALAYSIA
No Pekerja :
A. MAKLUMAT PERIBADI PEMOHON.
1. Nama : …………………………………………………………………………………………………………
2. No. K/Pengenalan :………………………………………………………. Umur : ……………………………
3. Alamat Surat-Menyurat :……………………………………………………………………….........................
…………………………………………………………………………………………………………………. 4. No. Tel (R) :……………………………… No. Tel (H/P) :………………………………………..
5. Agama :………………… Keturunan : Taraf Perkahwinan : Bujang/Xxxxxxxxx
(Potong Yang Tidak Berkaitan)
6. Nama &Alamat Waris : ………………………………………………………………………………………..
………………………………………………………………………………………………………………….
B. MAKLUMAT SYARIKAT:
1. Rujukan UTHM/Kontrak UTHM/.....................................................................................................................
2. Nama Syarikat :…………………………………………………………………………………………...........
3. Alamat Syarikat :……………………………………………………………………………………………….
4. Xxxxxx Xxxx Xxxxxxx :……………………… (Tamat) : .................................Tempoh Kontrak: ......................
5. Jenis Perkhidmatan : ...........................................................................................................................................
6. Nama Pengurus : .................................................................................... No Telefon : ………………….........
7. Email syarikat : ....................................................................................................................................................
C. MAKLUMAT KENDERAAN :
1. Jenis Kenderaan : Kereta
Motosikal
Lain-lain
2. No Kenderaan : ……………………………………
(sila lengkapkan maklumat kenderaan bagi memudahkan permohonan Pelekat Kenderaan)
Pengesahan Majikan :
……………………… …………………………
(Tandatangan Pekerja) Cop Rasmi & Tandatangan
Pengurus/ Penyelia Syarikat
Disemak Oleh: Disahkan Oleh:
…………………………… …………………………..
Pegewai Yang Bertugas Pengarah Keselamatan/Ketua Unit
ARAHAN :
1. Sila isikan borang dengan menggunakan dakwat HITAM/BIRU
2. Sila cetak menggunakan kertas berwarna BIRU
3. Sila serahkan borang permohonan ke Pejabat Bahagian Keselamatan SELEWAT-LEWATNYA TIGA (3) BERKERJA
4. Setiap Permit Pekerja dikenakan bayaran sebanyak RM10.00
5. Sila sertakan salinan KAD PENGENALAN DAN E-Vetting
6. SILA LENGKAPKAN MAKLUMAT YANG DIPERLUKAN BAGI KELULUSAN PERMOHONAN
7. PERMOHONAN HENDAKLAH DISERTAKAN SALINAN SURAT SETUJU TERIMA KONTRAK OLEH PIHAK SYARIKAT
SECURITY DIVISION
UNIVERSITI TUN HUSSEIN ONN MALAYSIA
NEW WORK PERMIT FOR FIELD WORKER APPLICATION FORM (MALAYSIAN)
Staff No:
A. APPLICANT PERSONAL DETAILS.
1. Name: ………………………………………………………………………......…………………………………
2. I/C no.:…………………………………………….....…………. Age: ……………………………
3. Corresponding Address:…………………………………….....………………………………….........................
……………………………………………………………....……………………………………………………. 4. Tel No. (H) :……………………………… Tel No. (H/P) :………………………………………..
5. Religion :………………… Race : …………………..… Marital Status : Single/Married
(Strikethrough if not relevant)
6. Name & Address of Next of Kin: ………………………………………………………………………………..
……………………………………………………………………………………………………...…………….
B. COMPANY INFORMATION:
8. UTHM Reference/ UTHM Contract:....................................................................................................................
9. Company Name:…………………………………..………………………………………………………...........
10. Company Address:……………………………………………………………………………………………….
11. Contract Start Date:…………………… (Expiry Date) : .............................Contract Duration: .......................
12. Type of Service : ...........................................................................................................................................
13. Name of Manager: .................................................................................... Telephone No.: ……………….........
14. Email Company : ...................................................................................................................................................
C. VEHICLE INFORMATION:
1. Type of Vehicle: Car
Motorcycle
Others
2. Vehicle Plate No.: ……………………………………
(Please complete the vehicle information section to obtain the Vehicle Sticker)
Employer Verification:
……………………… …………………………
(Applicant Signature) Official Stamp & Signature
Company Manager/Supervisor
Checked by: Endorsed by:
…………………………… …………………………..
Officer on Duty Security Director/Head of Unit
INSTRUCTIONS :
8. Please complete this form using BLACK/BLUE ink.
9. Please print this form on a BLUE paper.
10. Please submit this form to the Security Department Office AT LEAST THREE (3) WORKING DAYS.
11. A charge of RM10.00 will be imposed on each work permit.
12. Please attach a copy of your IDENTIFICATION CARD AND E-Vetting
13. Pleas complete ALL THE REQUIRED INFORMATION FOR THE APPROVAL OF THIS APPLICATION.
14. THE LETTER OF ACCEPTANCE OF THE CONTRACT BY THE COMPANY MUST BE ATTACHED TO THIS APPLICATION