1) Applicant's Personal Particulars
Title * :
Y.B.M.
Y.M.
Professor
Doctor
Mr.
Mrs.
Mr.
Ms.
Full Name * :
Type of ID * :
IC No. * :
-
-
No. KP Lama / Polis / Tentera
* :
State of Birth * :
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Pahang
Pulau Pinang
Perak
Perlis
Selangor
Terengganu
Sabah
Sarawak
Wilayah Persekutuan (Kuala Lumpur)
Wilayah Persekutuan (Labuan)
Wilayah Persekutuan (Putrajaya)
Others
Date of Birth * :
- -
Gender * :
Marital Status * :
-- Please Choose --
Single
Married
Divorced
Race * :
-- Please Choose --
Malay
Chinese
Indian
Others
Religion * :
-- Please Choose --
Islam
Buddhism
Hindu
Christian
Others
Permanent Address * : e.g: [ NO. 1, ]
[ JALAN TAMAN 1, ]
[ TAMAN PERUMAHAN ]
City * :
Postcode * :
State * :
-- Please Choose --
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Pahang
Pulau Pinang
Perak
Perlis
Selangor
Terengganu
Sabah
Sarawak
Wilayah Persekutuan (Kuala Lumpur)
Wilayah Persekutuan (Labuan)
Wilayah Persekutuan (Putrajaya)
Others
Country * :
-- Please Choose --
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antartica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia And Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Zaire)
Congo, The Democratic Rupblic Of The
Cook Island
Costa Rica
Cote D’ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island And Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakstan
Kenya
Kiribati
Korea, Democratic People’s Republic Of
Korea, Republic Of
Kuwait
Kyrgyzstan
Lao People’s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, The Former Yugoslav Republic Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States Of
Moldova, Republic Of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Pierre And Miquelon
Saint Vincent And The Grenadines
Samoa
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia And The South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province Of China
Tajikistan
Tanzania, United Republic Of
Thailand
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S
Wallis And Futuna
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Category of Application * :
-- Please Choose --
New Application
Enhancement By Appointment (PSL)
Career Enhancement
Others
Citizenship * :
Status of Disablement * :
Type of Disablement * :
2) Contact Details
Correspondence Address *
Same as above :
e.g: [ NO. 1, ] [ JALAN TAMAN 1, ] [ TAMAN PERUMAHAN ]
City * :
Postcode * :
State * :
-- Please Choose --
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Pahang
Pulau Pinang
Perak
Perlis
Selangor
Terengganu
Sabah
Sarawak
Wilayah Persekutuan (Kuala Lumpur)
Wilayah Persekutuan (Labuan)
Wilayah Persekutuan (Putrajaya)
Others
Country * :
-- Please Choose --
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antartica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia And Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Zaire)
Congo, The Democratic Rupblic Of The
Cook Island
Costa Rica
Cote D’ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island And Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakstan
Kenya
Kiribati
Korea, Democratic People’s Republic Of
Korea, Republic Of
Kuwait
Kyrgyzstan
Lao People’s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, The Former Yugoslav Republic Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States Of
Moldova, Republic Of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Pierre And Miquelon
Saint Vincent And The Grenadines
Samoa
San Marino
Sao Tome And Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia And The South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard And Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province Of China
Tajikistan
Tanzania, United Republic Of
Thailand
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S
Wallis And Futuna
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Tel No. (Mobile) * : e.g: 16/17/19xxxxxxx
Tel No. (Home) : e.g: 7xxxxxxx
E-mail * : e.g: yourmail@mail.com (Google Mail)
Login Particulars
Login ID :
Password * :
Password Confirmation * :
Security Question * :
-- Please Choose --
What was your mother's name?
What was your father's name?
What was your best friend's name?
What was your idol's name?
What is your hobby?
What was your pet's name?
(In case you forget your password)
Your Answer * :
Enter Verification Code * :
Acknowledgment Statement
Under Section 5 of the Service Commissions Act 1957 (Revised 1 December 2012), any person who in connection with an application by any person for employment or appointment in the public service or with the exercise by a Commission of any of its functions, wilfully gives to the Commission or to any member thereof or to any person or body of persons appointed by the Commission to assist in the exercise of its functions any information which is false or misleading in any material particular shall be guilty of any offence and shall be liable to imprisonment for a term of two (2) years or to a fine of two thousand ringgit (RM2,000) or to both.
I declare that the information given here is true and if the information is found to be fraud, my application will be rejected and if I was offered, my services will be terminated immediately.
I Agree