LAMPIRAN A

BORANG
PERMOHONAN BERKHIDMAT
SEBAGAI GURU PENDIDIKAN KHAS
DI PROGRAM PENDIDIKAN KHAS INTEGRASI
DI SEKOLAH MENENGAH / SEKOLAH RENDAH
NEGERI TERENGGANU

1.

SEKOLAH :. ..................................................................................

SILA
LEKATKAN
GAMBAR
TERKINI

DAERAH............................................

NO. TEL. SEKOLAH : .......................................................................................................................................

2.

NAMA : .............................................................................................................................................................

3.

NO.KAD PENGENALAN : .........:.......................................................................................................................

4. GRED JAWATAN : ...........................................................................................................................................

5. PENGALAMAN MENGAJAR:

BIL

NAMA SEKOLAH &

DAERAH

TAHUN

MATA PELAJARAN
DIAJAR

DARI

HINGGA

6. ALAMAT RUMAH : .......................................................................................................................................................

.....................................................................................................................................................................................
7. NO. TELEFON BIMBIT : ..............................................

NO.TEL RUMAH : ...........................................................

8. IJAZAH : ..................................................... MAJOR : .........................................

MINOR : ....................................

UNIVERSITI :............................................................................................. TAHUN : ................................................

9.

JUSTIFIKASI PERMOHONAN:
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................

10. SlLA NYATAKAN SUMBANGAN ANDA TERHADAP SEBARANG AKTIVITI YANG BERKAITAN DENGAN
MURID-MURID PENDIDIKAN KHAS / PROGRAM PENDIDIKAN KHAS INTEGRASI.
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................