IEM PI Form A100 - Application Form - Report

 

IEM PI A100

THE INSTITUTION OF ENGINEERS MALAYSIA   Professional Interview Application Form April 2015

Personal Details Details A - Personal

Title

Mr.

Full Name :

Nationality :

Malasian

Place of Birth :

%&ching

Ho Chee Che e Yong Yong  Age : !5

"20"2#$1!$5025

IC No : Date of Birth

2#$0"$1'"2

DD/MM/YYYY Contact  Address

 (o.1)*+ ,--(/ 11+ A,A( *,,I+ *,,I+ '!!00 %CHI(/+ AA3A%+ AA3A%+ MA,A MA,AYIA. YIA.

AA3A% 

tate

0"2$250)!4

!ome Phone

Postcode M o" ile

'!!00

Country

012$!!'""'5

MA,AYIA

hocheeong6hotmail.com

#mail

Preferred $enue for Inter%ie& Please specify your gender:

Male

Female

Please specify your language:

#nglish

B Malaysia

(Please tick one only)

Current Employment Employment B - Current nite7 Pro8ect Cons<ants Pte ,t7

#m'loyer

(o" Title

Mechanical *ngineer 

Business Address

#!2 9A,*:I* -A; I,I-(+ F:* C-MM(I:Y FACI,I:I*+ FA CI,I:I*+ C-MM*CIA,+ C C*(:* -( ,-: 014#!% ?P:.@ M%IM 1# A: 9%I: PA(A(/ (*I/H9-H--; # C-(:AC: 15 A: FAA -A;.   3(2C1)1"  P-P-*; P9,IC H-I(/ ;*>*,-PM*(: C-MPII(/ -F " 9,% -F 15$:Y *I;*(:IA, 9I,;I(/ ?:-:A, ?:-:A, "10 (I:@ A(; 1 9,%  -F M,:I :-*Y CAPA% CAPA% 3I:H ,A(;CAP* --F /A;*(+ C-MM(I:Y FACI,I:I*+ FACI,I:I*+ P*CI(C: PA>I,I-( A(; * -( ,-: 0!)2!% P:+ 1!5#M P:+ #512> P:+ 21)1: P:+ P :+ 1)!1: P: M%IM 04 A: 9--( ,AY A>*(* A>*(* ?-(/ 3*: P,A((I(/ A*A ?-(/ 3*: (2 C1) D C1"@. 3,(1C242)  P-P-*; P9,IC H-I(/ ;*>*,-PM*(: C-MPII(/ -F A 1$9,% -F 2"!2 :Y+ 2$9,% -F 22 :Y+ 1$ 9,% -F 2' :Y+ 1$9,% -F 2" :Y+ 1 9,% -F 2!2' :Y+ 1 9,% -F 1"2# :Y+ 1 9,% -F 202) :Y D 1 9,% -F 20!0 :Y *I;*(:IA, F,A: ?:-:A, 1)#4 (I:@ 3I:H 1 9,% -F ) :Y CAPA%+ CAPA%+ 1 9,% -F " :Y CAPA%+ CAPA%+ C-MM*CIA, FACI,I:I* FACI,I:I* ?H-P+ *A:I(/ *A: I(/ H-* A(; P*MA%*:@ D C-MM(A, FACI,I:I*+ 2 9,% -F 1 :Y P*CI(C: PA>I,I-( 3I:H D 1 9,% -F * -( ,-: 0#'4#A P: M%1! A: 3--;,A(; :**: C-(:AC: C242) ?MAI,I(/ P,A((I(/ A*A@.

Note: 67 The information 'ro%ided a"o%e &ill "e used to carry out an initial assessment of your a''lication9 As a result of this initial assessment you may "e re8uired to 'ro%ide further information to su''ort your a''lication 6-7 The u''orters are ty'ically the u'er%ising #ngineers or &ho of areu''orters9 'rofessional engineers or cor'orate mem"ers of I#M9 Please refer to the 3uidance Notes on PI A''lication on Mentors the definition

Page 6 of 9

 

$E P$ A*++

THE INSTITUTION OF ENGINEERS, MALAYSIA Professional Inter%ie& A''lication Form  A'ril -.0

$ - Declaration I declare declare that I do not 'lagiaris 'lagiarise e in this a''lication a''lication99 I understan understand d and consent to the infor informatio mation n 'ro%ided on this form "eing 'rocessed "y the I#M for its sole use and that of its associated organisations4 including the Board of #ngineers4 Malaysia 6B#M77 for 'rofess 6B#M 'rofessional ional inter%i inter%ie& e& 'ur'ose9 I decla declare re that the statemen statements ts made on this form are to the "est of my