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    PT Perusahaan Pelayaran EQUINOX Application Form: Photo

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    indoseafarer
    This document is an application form for a position at PT Perusahaan Pelayaran EQUINOX. It requests personal information such as name, date of birth, address, contact details, as well as size information for work clothes and shoes. It also requests details on citizenship, religion, marital status, and number of children. The form requests information on certifications and licenses held, medical records, courses completed, sea service history, and an area for interview results and signatures.

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    PT Perusahaan Pelayaran EQUINOX Application Form: Photo

    Uploaded by

    indoseafarer
    104 views2 pages
    This document is an application form for a position at PT Perusahaan Pelayaran EQUINOX. It requests personal information such as name, date of birth, address, contact details, as well as size information for work clothes and shoes. It also requests details on citizenship, religion, marital status, and number of children. The form requests information on certifications and licenses held, medical records, courses completed, sea service history, and an area for interview results and signatures.

    Original Description:

    Application Form

    Original Title

    Equinox Application Form

    Copyright

    © © All Rights Reserved

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    This document is an application form for a position at PT Perusahaan Pelayaran EQUINOX. It requests personal information such as name, date of birth, address, contact details, as well as size information for work clothes and shoes. It also requests details on citizenship, religion, marital status, and number of children. The form requests information on certifications and licenses held, medical records, courses completed, sea service history, and an area for interview results and signatures.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    104 views2 pages

    PT Perusahaan Pelayaran EQUINOX Application Form: Photo

    Uploaded by

    indoseafarer
    This document is an application form for a position at PT Perusahaan Pelayaran EQUINOX. It requests personal information such as name, date of birth, address, contact details, as well as size information for work clothes and shoes. It also requests details on citizenship, religion, marital status, and number of children. The form requests information on certifications and licenses held, medical records, courses completed, sea service history, and an area for interview results and signatures.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 2

    PT Perusahaan Pelayaran EQUINOX

    APPLICATION FORM
    Photo

    A. PERSONAL
    Name

    Date of Birth & Place

    Nationality

    Religion

    Address

    Telephone number

    Email Id
    Marital Status

    :
    :

    KPI No.

    Number of children

    Height
    Weight

    :
    :

    Next of Kin (NOK)

    Address

    Size of working cloth :

    Telephone number

    Size of Shoes :

    Email Id

    Position applied :

    B. PERSONAL DOCUMENT
    Description

    Number

    Date of issue

    Date of expiry

    Description

    Date of issue

    Certificate No.

    Validation

    Passport
    Seaman's Book
    Flag State License

    C. COURSES

    Advanced Tanker Safety - Oil


    Advanced Tanker Safety - Chemical
    Advanced Tanker Safety - Gas
    Tanker Familiarization
    COW - IGS
    Deck Watch Keeping
    Engine Watch Keeping
    Medical First Aid Training
    Medical Care
    Advanced Fire Fighting
    Basic Safety Training
    Survival Craft Rescue Boat
    GMDSS - GOC
    ARPA simulator
    Radar Simulator
    ISM Code Training
    Bridge Team Management
    Bridge Resource Management
    Engine Team Management
    Ship Security Officer (SSO)

    PT PP Equinox Application Form

    Page 1 of 2

    D. MARITIME LICENSE
    Type

    Certificate No.

    Date of issue

    Issued by

    Period

    Management

    E. SEA SERVICE RECORD


    Position

    Vessel

    IMO type

    GRT/BHP

    Flag

    F. MEDICAL RECORD
    Last Medical Check Up:
    Date Taken
    MCIS
    Extensive
    Medical

    Date Taken
    Vaccination

    Simple
    Test Drugs

    Yellow Fever
    Cholera
    Typhoid

    Clinic

    Form
    Clinic

    G. INTERVIEW RESULT
    Personality

    Work understanding

    English

    Ability to Expr Himself

    Attitude

    Record of Experience

    Team Work

    Education

    1 : Poor

    2 : Below Average

    3 : Averange

    4 : Good

    5 : Very Good

    6 : Excellent

    Date,

    Applicant / Signature

    PT PP Equinox Application Form

    Page 2 of 2

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