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CURRICULUM VITAE

DATA DIRI

Nama : ....................................................................................
Tempat, Tgl. Lahir : ....................................................................................
Agama : ....................................................................................
NIK : .................................................................................... FOTO
Pendidikan Terakhir : ....................................................................................
Alamat : ....................................................................................
….................................................................................
Nomor Telp/Hp : ....................................................................................
E-mail : ....................................................................................

KELUARGA YANG DAPAT DIHUBUNGI DALAM KEADAAN DARURAT

Nama : ....................................................................................
Tempat, Tgl. Lahir : ....................................................................................
Agama : ....................................................................................
NIK : ....................................................................................
Alamat : ....................................................................................
….................................................................................
Nomor Telp/Hp : ....................................................................................

DETAIL DOKUMEN

Tempat
Nama Dokumen Nomor Masa Berlaku Masa Berakhir
diterbitkan
Passport
Buku Pelaut
Vaksin 1 Vaksin 2 Vaksin 3
Vaksin Covid-19

Tempat
Sertifikat Keahlian Nomor Masa Berlaku Masa Berakhir
diterbitkan
Basic Safety Training

PENGALAMAN BERLAYAR

Status Pengalaman Experience Non Experience

Nama Kapal Perusahaan Jenis Kapal Bendera Kapal Sijil Naik Sijil Turun

Warna Mata Tinggi badan Uk. Sepatu


Warna Rambut Berat Badan Uk. Kappa

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