PART A: ACADEMIC PROGRAMME University : Please attach your recent passport photo here Degree : Majoring (if any) Current Semester : Total Semester : Intake : month _________________ year _________________ Target Date of Completion : month _________________ year _________________ Current CGPA : PART B: PERSONAL DETAILS Full Name (as in NRIC) : NRIC No. : - (Please attach Copy of NRIC) Gender : MALE - Date of Birth : FEMALE d d m m y y Marital Status : Race : Religion : (H) Contact No. : (M) Email Address : Permanent Address : Correspondence Address : PART C: ACADEMIC QUALIFICATIONS (Please attach certified copies of your results and certificates) Level Name of School/ Institution Grade Obtained A SPM/SPMV B C D Completion Year Others STPM/A-Level Matriculation Diploma FOR HR USE ONLY Date Received _______________ Application No. _______________ Status _______________ Scoring _______________ HRD-LHCD/June2014.yan PART D: FAMILY BACKGROUND (Please attach certified copies of latest Payslips/Pension card) No. Name of Father/Mother/Guardian No. Name of Siblings Relationship Age Occupation Occupation / Age Form/Standard Company/ School Monthly Income Monthly Income *Additional Info for Children of Agrobank Employees (Kindly ignore this if NOT applicable) Name of Father/Mother : Staff No : Designation/Grade : Unit/Department : Division : Joined Date : Does your spouse works for Agrobank? NO YES (Please specify): Name : Staff No. : Unit/Department : Division FOR HR USE ONLY Date Received _______________ Application No. _______________ Status _______________ Scoring _______________ HRD-LHCD/June2014.yan PART E: EXTRA CURRICULAR ACTIVITIES (Please attach certified copies of certificates) - PAST 2 YEARS ONLY No. Name of Club/Society/Association/Activities Position Held/Level Presented Achievement Year PART D: OTHER INFORMATION (Please attach certified copies of Offer Letter of Loan/Scholarship) Are you holding PTPTN Loan? NO YES (If yes, please state amount (RM) per year): Are you holding other sponsorship? NO YES (If yes, please state amount (RM) per year): Name of Organization/Sponsorship : PART E: DECLARATION I, _________________________________________, (NRIC No.)________________________________, hereby declare that the information given in this application form is complete, accurate and I agree to abide by the above conditions. I understand that any information given falsely or withheld will affect the decision of my application, and may result in my inegilibility for the scholarship award. ……………………………………………………….. Name of Applicant : Date : …………………………………………………………………… Name of Parent/Guardian : Date : The complete application form with relevant documents should be addressed to: HR Learning & Human Capital Development Human Resource Division ,Level 12, Menara Agrobank Leboh Pasar Besar,P.O.Box 10815, 50726, Kuala Lumpur Please indicate AGROBANK SAP 2015 at the top right hand corner of envelope. For further clarification, please contact En Mohd. Zamil at 03-2731 1600 etxn 1244 FOR HR USE ONLY Date Received _______________ Application No. _______________ Status _______________ Scoring _______________ HRD-LHCD/June2014.yan
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