BORANG PENGADUAN SALAHLAKU KAKITANGAN

1
A
BORANG PENGADUAN SALAHLAKU KAKITANGAN COMPLAINT
FORM ON PERSON
1.0 Butir-butir pegawai yang diadu / Details of
officer to be reported 1.1 Nama / Name
__________________________________________________
____ 1.2 Jawatan / Designation
_______________________________________________ 1.
3 No kakitangan / Staff no ____________________
_________________________ 1.4 Tempat bertugas /
Place of duty _________________________________
______ 2.0 Butir-butir kesalahan / Details of
misconduct 2.1 Tarikh / Date
____________________ 2.2 Waktu / Time
____________________ 2.3 Tempat kejadian /
Location of misconduct _________________________
_______ 2.4 Keterangan salahlaku / Explanation of
misconduct __________________________________
___________________________________ ______________
__________________________________________________
_____ ____________________________________________
__________________________________________________
____________________________________________ _____
__________________________________________________
_____________ 3.0 Dokumen maklumat sokongan /
Supporting document evidence 3.1 Dokumen
sokongan yang disertakan (sekiranya ada) /
Supporting documents attached (if
any) i. __________________________________________
_____________________ ii. ________________________
_______________________________________ iii. _____
__________________________________________________
________ iv. _____________________________________
__________________________ ( Sila sertakan
lampiran keterangan jika ruang tidak mencukupi /
Please use additional paper should the space
provided is insufficient )
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3.2 Nama saksi yang melihat kejadian (sekiranya
ada) / Name of witness (if any) i. _______________
________________________________________________ i
i. _______________________________________________
________________ 4.0 Butir-butir pelapur /
Details of complainant 4.1 Name / Name
______________________________________________ 4.2
NRIC No. / Passport No. _______________________
_______________________ 4.3 Jawatan/Designation
___________________________________________
___ 4.4 Alamat/Address
______________________________________________ __
__________________________________________________
_______________ _________________________________
__________________________________ 4.5 Tel
________________________ Saya mengaku bahawa
segala keterangan di atas adalah benar./ I
certify that all details given above are true.
Tandatangan / Signature
____________________ Tarikh / Date
___________________________________________
________________________________ Hantarkan aduan
anda kepada/ Address your complaint to The
Chairman Remedial Grievance System c/o Deputy
Rector (Student and Alumni Affairs) Level 4,
Administration Block International Islamic
University Malaysia Jalan Gombak, 53100 Kuala
Lumpur
UNTUK KEGUNAAN PEJABAT / FOR OFFICE USE No
rujukan kes / Case reference No Tarikh terima /
Date received