Number : FM-06B-REC

APPLICATION FORM / PERSONAL INFORMATION – HOTEL DEPARTMENT Rev. : 01

Date : 4 April 2014

PERSONAL DETAILS:

Applied position Galley Steward Nationality indonesia

First Name Ricky Home Airport
Last Name Artanto Home Address incl. post code Perumahan ketapang blok veteran no A109 (53234)
Place & Date of Birth Cilacap, 01 april 1995 Telephone 085803905949
Weight & Height 50kg & 165cm Email address Ricky.artanto22@gmail.com

RECORDS OF PREVIOUS EXPERIENCES:

Ship, Hotel or Restaurant Facility & services Address of the hotel, Position Salary in IDR Employment Employment Reason for leaving
Name * rated (4 or 5 star)* restaurant or agency Start End start date end date or current status

Surya kencana seaside 3star hotel Pantai barat pananjung Room Boy 1.000.000 1.800.000 6 august 5 october I want to work
1 hotel pangandaran 46396 west 2014 2016 on the cruise
java -indonesia ship
a))
Job Scope/
b)
Description
c)

2
a)
Job Scope/
b)
Description
c)

3
a)
Job Scope/
b)
Description
c)

4
a)
Job Scope/ b)
Description c)
*Starts from the most recent workplace. Facility services rating for hotel and restaurant.

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 Number : FM-06B-REC
APPLICATION FORM / PERSONAL INFORMATION – HOTEL DEPARTMENT Rev. : 01
Date : 4 April 2014

CERTIFICATES:

Course Institution Place Cert. Number Date of Issue

Basic safety training (BST) Binasena maritime nusantara bogor 6211560671011115 Jakarta 30 november
2015
Crow management (CCM)
Crisis management (CCM)
Safety Awarenes Training (SSAT)
Seafarers With Designated Duties(SDSD)

TRAVEL DOCUMENTS:

Type of document Number Place of issuance Date of issuance Date of expiry

PASSPORT B 1721907 Cilacap jawa tengah 5 november 2015 5 november 2020
SEAMAN BOOK E060606 Tanjung priok 16 februari 2016 15 februari 2019

FORMAL EDUCATION BACKGROUND:

School/Academy From To Qualification Attained

ELI hotel and torism school June 2013 June 2014

REFERENCES:Name, contact number of at least 2 (two) previous employers and the recommendation.

Employer’s name Address and contact number Recommendation

EMERGENCY CONTACT DETAILS:

No. Name Relationship Contact Number E-mail address

1 kuntalasari mother Home 081391294653
Mobile
2 Gurit tri watiningsih tante Home 082221518559

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 Number : FM-06B-REC
APPLICATION FORM / PERSONAL INFORMATION – HOTEL DEPARTMENT Rev. : 01
Date : 4 April 2014

Mobile

NEXT OF KIN:

No. Name Relationship Place / Date of Birth Signature

M. Fatoni HRD manager
Marjoko Hk Supervisor

Declaration:

I hereby declared that the above mentioned information is correct.

Place & Date :
Signature :

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