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JPA/BMI/JANJI/J3

PERMOHONAN PELEPASAN IKATAN KONTRAK BAGI PEMEGANG BIASISWA/DERMASISWA PERSEKUTUAN

BAHAGIAN SATU (UNTUK DIISI OLEH PELAJAR) A. MAKLUMAT PELAJAR 1. 2. 3. Nama Pelajar No. Kad Pengenalan Alamat Terkini : ___________________________________ : ___________________________________ : ___________________________________ ___________________________________ ___________________________________ 4. 5. No. Telefon Emel : ______________(R)________________(HP) : ___________________________________

B.
BIL

MAKLUMAT PENGAJIAN DAN IKATAN KONTRAK
INSTITUSI PENGAJIAN KELULUSAN / CGPA TEMPOH PENGAJIAN (DARIHINGGA) TEMPOH IKATAN KONTRAK JUMLAH TUNTUTAN GANTIRUGI

C.

MAKLUMAT PERKHIDMATAN TERKINI 1. 2. Jawatan / Gred Alamat Majikan : ___________________________________ : ___________________________________ ___________________________________ 3. 4. 5. Tarikh Mula Berkhidmat Gaji Ditawarkan Nyatakan Tugasan Utama i) ii) : ____________________ : ____________________ :-

______________________________________________________ ______________________________________________________

UPJ/L/ __

/J3/ __

1

JPA/BMI/JANJI/J3 D.
BIL

SEJARAH PEKERJAAN SELEPAS TAMAT PENGAJIAN (JIKA BERKAITAN)
NAMA ORGANISASI JAWATAN TARIKH BEKERJA (DARIHINGGA)

Nota: Untuk pelajar tajaan di bawah Program Dasar Pandang Ke Timur, sila kemukakan salinan surat tawaran lengkap daripada majikan. E. PERAKUAN PELAJAR Saya dengan ini mengaku bahawasanya saya; Pernah ditawarkan pekerjaan oleh Suruhanjaya Perkhidmatan Awam pada ______________ bagi jawatan ___________________________

Tidak pernah ditawarkan sebarang pekerjaan oleh Suruhanjaya Perkhidmatan Awam

(Tandakan

pada petak berkenaan)

Tandatangan : _________________________________ Tarikh : _________________________________

PERHATIAN Borang JPA/BMI/JANJI/J3 yang telah lengkap hendaklah dikembalikan kepada:

Jabatan Perkhidmatan Awam Malaysia Bahagian Pembangunan Modal Insan Aras 3, Blok C1, Komplek C Pusat Pentadbiran Kerajaan Persekutuan 62510 PUTRAJAYA (u.p: Unit Pengurusan Perjanjian) Tel Fax : 03 – 8885 3533/3551/3574/3572 : 03- 8889 2171

(jika faks, sila pastikan salinan asal diposkan bagi tujuan pengesahan) UPJ/L/ __ /J3/ __

2

JPA/BMI/JANJI/J3

UNTUK KEGUNAAN PEJABAT PROGRAM : PILN / PIDN / PPC / JERMAN / PERANCIS / DPT / KRITIKAL / LAIN-LAIN ULASAN PERMOHONAN: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

*Tarikh Lapor Diri Di JPA *Tarikh Pendaftaran SPA

: ___________________________________ : ___________________________________

PERAKUAN PENOLONG PENGARAH: Penama memenuhi / tidak memenuhi syarat-syarat pelepasan kontrak dan disokong / tidak disokong. Tandatangan Pegawai Tarikh : : :

KELULUSAN TIMBALAN PENGARAH / KETUA PENOLONG PENGARAH Penama memenuhi / tidak memenuhi syarat-syarat pelepasan kontrak dan diluluskan / tidak diluluskan. Tandatangan Pegawai Tarikh : : :

UPJ/L/ __

/J3/ __

3

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