<p style="text-align: justify;">This research was aimed to determine the level of knowledge, skills and attitude of pre-service Mathematics teachers in Universiti Pendidikan Sultan Idris (UPSI) towards higher-order thinking skills (HOTS) and whether the elements of HOTS were translated into the teaching courses. The research was also designed to analyze the relationship between the pre-service Mathematics teachers’ exposure to HOTS through the teaching courses and their level of knowledge, skills and attitude towards HOTS. The study utilized a quantitative approach by administration of a survey to a simple random sample of 110 pre-service Mathematics teachers from UPSI. A questionnaire with five different parts was used as the research instrument with a reliability value of .979. The collected data were then analyzed using descriptive and inferential statistics. The descriptive statistics were used to determine the mean scores of the level of knowledge, skills and attitude among the pre-service Mathematics teachers, whereas inferential statistics using Pearson-r correlation was implemented to describe the relationship between the studied variables. The findings demonstrated that the knowledge and skills of pre-service Mathematics teachers towards HOTS were at a moderate level as opposed to their attitude and exposure to HOTS which were found to be at a high level. The data analysis using Pearson correlation illustrated a significant positive relationship with <em>r</em> = .727, <em>r</em> = .757 and <em>r</em> = .667 between the exposure to HOTS through the teaching courses and the level of knowledge, skills and attitude regarding HOTS of pre-service Mathematics teachers at UPSI, respectively. In conclusion, the research here indicates that pre-service Mathematics teachers in general, are positive towards the implementation of HOTS but they are lacking in terms of knowledge and skills. This research is useful in the field of Mathematics education as it can serve as a guidance to further enhance the knowledge, skills and attitudes especially for future Mathematics teachers in implementing HOTS effectively and improving the quality of the teaching program offered by the university indirectly.</p>