Personnel Data

Application FormPT Perusahaan Pelayaran EQUINOXAPPLICATION FORMA. PERSONALName:Date of Birth & Place:Nationality:Religion:Address:Telephone number:Position applied:Email Id:KPI No.:Marital Status:Number of children:Height:Weight:Next of Kin (NOK):Address:Size of working cloth:Telephone number:Size of Shoes:Email Id:B. PERSONAL DOCUMENTDescriptionNumberDate of issueDate of expiryPassportSeaman's BookFlag State LicenseC. COURSESDescriptionDate of issueCertificate No.ValidationAdvanced Tanker Safety - OilAdvanced Tanker Safety - ChemicalAdvanced Tanker Safety - GasTanker FamiliarizationCOW - IGSDeck Watch KeepingEngine Watch KeepingMedical First Aid TrainingMedical CareAdvanced Fire FightingBasic Safety TrainingSurvival Craft Rescue BoatGMDSS - GOCARPA simulatorRadar SimulatorISM Code TrainingBridge Team ManagementBridge Resource ManagementEngine Team ManagementShip Security Officer (SSO)D. MARITIME LICENSETypeCertificate No.Date of issueIssued byE. SEA SERVICE RECORDPositionVesselIMO typeGRT/BHPFlagPeriodManagementF. MEDICAL RECORDLast Medical Check Up:Date TakenVaccinationDate TakenMedicalMCISYellow FeverExtensiveCholeraSimpleTyphoidTest DrugsClinicFormClinicG. INTERVIEW RESULTPersonalityWork understandingEnglishAbility to Expr HimselfAttitudeRecord of ExperienceTeam WorkEducation1 : Poor2 : Below Average3 : Averange4 : Good5 : Very Good6 : ExcellentDate,Applicant / Signature

&L&"Times New Roman,Regular"&8PT PP Equinox Application Form&R&"Times New Roman,Regular"&8Page &P of &NPhoto