Application For Air Traffic Controller Licence - Department Of Civil Aviation Malaysia
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3DCA/BIT/LIC 01.2
DEPARTMENT OF CIVIL AVIATION MALAYSIA
Jabatan Penerbangan Awam Malaysia
APPLICATION FOR AIR TRAFFIC CONTROLLER LICENCE
Permohonan Lesen Pengawal Trafik Udara
1.
PERSONAL PARTICULARS OF APPLICANT (Maklumat Diri Pemohon):
(as per MyKad / MyTentera)
Name
Photo (Gambar)
(Nama)
(MyKad / MyTentera)
I/C No. (No. K/P.)
To submit one (1)
copy of latest colour
photo (I/C size) in
Age
office attire.
(Umur)
Date of Birth
(Do not paste it
onto this form)
(Tarikh Lahir)
Place of Birth
(Tempat Lahir)
Permanent Address
(Alamat Tetap)
Office Address
(Alamat Pejabat)
e-Mail
Mobile No.:
(e-Mel)
(No. Tel Bimbit)
(Please ensure that a photocopy of IC (MyKad / MyTentera) is attached)
2.
MEDICAL ASSESSMENT INFORMATION (Maklumat Pemeriksaan Perubatan):
Date of Assessment
(Tarikh Pemeriksaan)
Name of Medical Examiner
(Nama M.E.)
Sickness (if any) (Penyakit: jika ada)
3.
APPOINTMENT / DESIGNATION (Lantikan / Perjawatan):
Date of First Appointment Into The Service
(Tarikh Lantikan Pertama Dalam Perkhidmatan)
Present Grade / Position
(Gred / Pangkat Sekarang)
Date of Appointment / Promotion to Present
Post
(Tarikh Lantikan / Kenaikan Pangkat Sekarang)
Confirmation Date of Present Post
(Tarikh Disahkan Dalam Jawatan Sekarang)
(15.04.2017)
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