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crewdata.com

SEAFARER'S APPLICATION FORM http://crewdata.com

Position: DECK CADET

Readiness: 27.12.2018

Citizenship: Indonesia

Last name: Tono Marital status single

First name: Hartono Children:

Middle name: Sitabe rate Nationality: Indonesian

Birth date: 29.04.1998 Birth place: Indonesia

Home address: Jakarta, Jakarta Utara,

Indonesia, 92352

Phone mobile: 62-82-194******

Phone home:

Email: hartonodaengrate@g

mail.com

English level: Good

Salary Minimum: 300 Expected: 400 Last: $/month

Education

Educational institution Speciality Faculty Place Numb er

From Till

Merchant Marine polytechinc of

makassar

nautical

department

NAUTICAL

STUDIES

makassar/IDN ANT3 25.10.2016 20.04.2020

Passports, Licenses & Certificates

Title Class Number Place of issue Issued Valid

Passports & Visas

Seaman's book F103889 makassar, IDN 26.04.2018 26.04.2021 Travel passport B9354762 makassar, IDN 08.02.2018 08.02.2023 Certificates & Licenses

Advanced Fire Fighting (VI/3) 6211431710600418 makassar, IDN 02.03.2018 02.03.2023 Radar Observation and Plotting Simulator (A-II) 621************ makassar, IDN 03.03.2018 03.03.2023 Safety Officer Certificate (ISM Code) 020/ISM-

CODE/PIP-MKS-

04

makassar, IDN 12.01.2018 12.01.2023

Basic Safety Training (VI/1.1-4) 6211431471010614 makassar, IDN 16.10.2014 16.10.2019 Medical First Aid (VI/4.1) 621************ makassar, IDN 02.03.2018 02.03.2023 Automatic Radar Plotting Aids (ARPA) 621************ makassar, IDN 03.03.2018 03.03.2023 Security awareness training 621************ makassar, IDN 02.02.2015 02.02.2020 Basic oil and chemical tanker 621************ makassar, IDN 07.03.2018 07.03.2023 Basic liquid gas tanker 621************ makassar, IDN 07.03.2018 07.03.2023 SEAFERS designated security DUTIES 621************ makassar, IDN 18.03.2018 18.03.2023 Medical Certificates

Yellow Fever Vaccination makassar, IDN 02.02.2018 02.02.2021 General Physical State

Height (cm) Weight (kg) Shoes Clothes Hair color Eye color 168 68 42 L black brown

Additional information

2 Tono Hartono created by

crewdata.com

Date applied: 27.12.2018 Signature: