SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM STAFF ATTACHMENT APPLICATION FORM

(1)

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM STAFF ATTACHMENT APPLICATION FORM

Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.

Tel: 09-591 2500

SASMEC-GA-F019 VER: 01 REV: 01 EFFECTIVE DATE: 07 APRIL 2023

I. Application for Staff Attachment must be submitted at least three (3) months before the commencement date of the attachment.

II. Duration: - Short-term – Three (3) months or less

-Long-term – More than three (3) months and up to a maximum of twelve (12) months A. STAFF INFORMATION

Name Staff Number

Identification Number Age

Position Department Email Address Date of Appointment Job Status

Contact Number

B. DETAILS OF ATTACHMENT Objectives of the

attachment

(Kindly attach relevant supporting document for reference)

Programme Date & Duration of Attachment

Date : From ____________ to ____________

Duration : ______ month(s) _________ day(s) Venue

C. FINANCIAL IMPLICATION

i. Fees

ii. Subsistence allowance (If applicable)

iii. Travelling

iv. Accommodation/Lodging v. Meals

Total

Other claimable expenses shall be paid to the staff accordingly based on eligibility.

The budget allocation for the above expenses will be borne by Sultan Ahmad Shah Medical Centre @IIUM and the staff shall be subjected to a period of bondage with IIUM as stipulated accordingly.

(2)

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM STAFF ATTACHMENT APPLICATION FORM

Tel: 09-591 2500

D. STAFF DECLARATION

I, hereby confirm that the above information is complete and accurate to the best of my knowledge. I understand that withholding or giving false information will make me ineligible for this programme and future application.

Applicant’s Signature : ……….

Date : ………..…………

E. RECOMMENDATION

The Sultan Ahmad Shah Medical Centre @IIUM’s authority is kindly requested to consider and approve the following application with the financial implication RM _______________.

Recommendation by Head of Department (D/U/C/W):

Yes No

Comments:

___________________________________________________________________________________________

Signature: ……….. Date: ……….

(Official Stamp)

OFFICE USE ONLY:

Recommendation by Head of Department of Human Resource and General Administration:

Yes No

Comments:

____________________________________________________________________________________________

Recommendation by Head of Department of Finance:

Yes No

Comments:

____________________________________________________________________________________________

(3)

SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM STAFF ATTACHMENT APPLICATION FORM

Tel: 09-591 2500

Recommendation by Director (Administration):

Yes No

Comments:

____________________________________________________________________________________________

Recommendation by Director (Clinical):

Yes No

Comments:

____________________________________________________________________________________________

Approved by Hospital Director:

Yes No

Comments:

____________________________________________________________________________________________