USMDG1_Borang Permohonan_ by lanyuehua

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									                                                                                    USM DG1/2010




        BORANG SEMAKAN PERMOHONAN KENAIKAN PANGKAT

Sudahkah Anda :

1.     Melengkapkan Borang Kenaikan Pangkat USM GB1/2010 ?


2.     Melengkapkan Borang Butir Jaya Diri USM GB2/2010 ?


3.     Melampirkan salinan dokumen/bahan yang berkaitan dengan tugas dan aktiviti
       seperti yang anda senaraikan dalam butir jaya diri anda ?




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                                                                                                                               USM DG1/2010




        BORANG PERMOHONAN KENAIKAN PANGKAT GURU BAHASA

     I. GRED DG44                                II. GRED DG48                       III. GRED DG52


  A.     Butiran Peribadi



  1.     Nama Penuh: __________________________________________________________________________


  2.     Jawatan dan Gred Sekarang: __________ _________________Bidang : _______________________


  3.     No. Staf :_______________________                      _________________________________________________


  4.     Pusat Pengajian: ________________________________________Kampus : _____________________


  5.     No. Telefon Pejabat/Tel. Bimbit: ___________________                _______________No. Faksimili: ___________


  6.     E-mel:                ______________________________________________________________________


  7.     Tarikh Lantikan ke Skim Sekarang:                      _________________________________________________


  8.     Tarikh Lantikan Sekarang : ____________________________________________________________


  9.     Tarikh Pengesahan Jawatan:                             _______________________________________________


  10.    Keputusan Penilaian Tahap Kecekapan (PTK)/CPD : ________________________________________




Saya mengakui bahawa semua maklumat yang diberikan di dalam borang USMDG1/2010 dan USMDG2/2010 adalah
benar.



Tandatangan Pemohon : ................................................                Tarikh : .........................................




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                                                                                                    USM DG1/2010




B. Ringkasan Aktiviti                                                                      Ulasan Penilai

      Berdasarkan pencapaian yang anda senaraikan di dalam borang butir jaya diri, sila
      berikan ringkasan/garis kasar tentang pencapaian terbaik anda dalam tugas dan
      aktiviti yang dijalankan (lebih kurang setengah halaman untuk setiap kategori) dan
      penilaian kendiri terhadap sumbangan terbaik anda.



1.    Pengajaran

      Berikan ringkasan aktiviti anda yang berkaitan dengan pengajaran, pembangunan
      kurikulum, sumbangan inovatif, kaedah pengajaran kreatif serta keupayaan dan
      pencapaian anda dalam peningkatan kemajuan dan pencapaian pelajar.

      _______________________________________________________________

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2.    Inovasi/Kreativiti dan Penerbitan/Penyelidikan

      Nyatakan secara ringkas kesan dan sumbangan inovasi/kreativiti yang anda
      laksanakan dalam pengajaran dan aktiviti/hasil penerbitan dan penyelidikan anda
      terhadap pembangunan dan pemajuan ilmu.

     _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________




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                                                                               USM DG1/2010




3.   Sanjungan Kepakaran dan Kepemimpinan

     Nyatakan kekuatan anda dalam bidang khusus pengajaran anda dan persepsi
     komuniti akademik terhadap diri anda.

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

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     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________



4.   Perundingan

     Berikan ulasan tentang pencapaian dan sumbangan anda dari segi kualiti,
     kepentingan dan hasil perundingan termasuk persepsi klien/masyarakat
     terhadap perundingan anda.

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

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                                                                                USM DG1/2010




5.   Khidmat Kepada Universiti

     Berikan ulasan tentang peranan dan sumbangan anda dalam perancangan dan
     pelaksanaan dasar akademik dan pentadbiran pada peringkat Unit/
     Bahagian/Jabatan/Universiti.

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

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     _______________________________________________________________



6    Khidmat Kepada Masyarakat

     Berikan ulasan tentang peranan dan sumbangan anda terhadap masyarakat. .
     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

     _______________________________________________________________

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                                                                                      USM DG1/2010




C. Rumusan

   Jelaskan justifikasi anda memohon kenaikan pangkat ini. (maksimum satu muka
   surat).

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Tandatangan Pemohon:   …………………………………………………….                       Tarikh:   ………………………………




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                                                                                                                                                          USM DG1/2010




  D.     Ulasan Ketua Jabatan



         _____________________________________________________________________________________

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Penilaian Ketua Jabatan (Bulati angka yang berkenaan).



                 0             1             2             3               4           5             6              7             8              9       10


                                       Lemah                                       Sederhana                    Baik                         Cemerlang




Saya mengesahkan bahawa segala maklumat yang diberikan di dalam borang USMGB1/2010 dan USM GB2/2010
adalah benar.


Tandatangan dan Cap Rasmi Ketua Jabatan:                                   ...........................................................................



Tarikh :     ...........................................................




Borang KP DG1/2010




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