CREW APPLICATION – CRUISE VESSEL

Interview Location

Position/Rank Applied :

Crew Status

Date of Application

First Name

Last Name

Place of Birth

Date of Birth

Sex

Civil Status

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Telp/ WA No.

Email

National ID Card (KTP)

Place of Issued

Date of Issued

Nex of Kin Name

Relationship

Address

Phone/ WA No.

Passport

Passport No.

Place of Issue

Date of Issued

Date of Expired

Seaman Book

Seaman Book No.

Place of Issue

Date of Issued

Date of Expired

C1D & Schengen Visa

Do you have C1D Visa

Place of Issue

Date of Issued

Date of Expired

Do you have Schengen Visa

Place of Issue

Date of Issued

Date of Expired

Basic Safety Training

BST Number

Place of Issue

Date of Issued

Security Awareness Training

SAT Number

Place of Issue

Date of Issued

Crisis & Crowd Management

Crisis Management Number

Place of Issue

Date of Issued

Crowd Management Number

Place of Issue

Date of Issued

For Deck & Engine Personal Only

Advance Fire Fighting No.

Place of Issue

Date of Issued

Able Seafarers No.

Place of Issue

Date of Issued

Fast Rescue Boat No

Place of Issue

Date of Issued

Sea Services

Please put your last Vessel in Sea Service No 1, 2nd Last in No. 2.... Etc

Sea Services 1

Name of Vessel

Position

Sign on Date

Sign off Date

Company/ Manager

Sea Services 2

Name of Vessel

Position

Sign on Date

Sign off Date

Company/ Manager

Sea Services 3

Name of Vessel

Position

Sign on Date

Sign off Date

Company/ Manager

Sea Services 4

Name of Vessel

Position

Sign on Date

Sign off Date

Company/ Manager

Sea Services 5

Name of Vessel

Position

Sign on Date

Sign off Date

Company/ Manager

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Application Status