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(
*
) denotes field that is a MUST to complete.
PERSONAL PARTICULARS
First Name
*
Family Name
*
Ethnic Origin
*
Address
*
City
*
Province
*
Postcode
*
Tel. No. (Res)
*
(Please include Country and state code (xxx-xxxxxxxx))
Mobile No.
(Please include Country and state code (xxx-xxxxxxxx))
Email Address
*
NRIC No.
*
(e.g. 830726-08-7890, please do NOT remove the '-')
Passport No
*
Date expire
*
(dd/mm/yy)
Gender
Male
Female
EDUCATION
Course
eg. Chemical/Mechanical Engineering, others please specify
Level of study
--- Select One ---
High School
Certificate
Diploma
Degree
Bachelor
Master
PhD
Date start
(mm/yy)
Date of completion
(mm/yy)
University/College
Date of arrival in Canada
(dd/mm/yy)
Years of study
Less than 6 months
1 year
2 years
3 years
4 years
5 years
> 6 years
Sponsored by
JPA/Sime Darby/Petronas/MARA/Private/etc.
PERSON TO BE CONTACTED IN CASE OF EMERGENCY
First contact
Name
Relation
Contact No
(Please include Country and state code (xxx-xxxxxxxx))
Second contact
Name
Relation
Contact No
(Please include Country and state code (xxx-xxxxxxxx))
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