Application Form - PT Adicipta Bangun Mandiri

ABM Recruitment Online Faster Better

Please prepare required file to upload :

CV
Photo

Position To Apply For

First Name

Last Name

Date Of Birth

Place Of Birth

Primary Mobile Number

Secondary Phone/Mobile Number

ID CARD / KTP No

Address

Full address

City

Father Name

Mother Name

Marital Status

Weight (in Kg)

Height (in cm)

Shoe Size

Wearpack Size

Emergency Contact

Please fill with your family, friends, or who know you the most.

Full Name

Full Address

Relationship

Phone/Mobile

Passport Details

No Passport

Place issue passport

Issue Date Passport

Expire Date Passport

Seaman Book Details

No Seaman book

Place issue Seaman book

Issue Date Seaman book

Expire Date Seaman book

Covid-19 Vaccination Details

Vaccine Type

Dose

Yellow fever vaccine details

Date of Issue

Date of expire

VISA Details

Have you USA VISA - C1D ?

Yes

USA Visa No.

Issue Date USA VISA

Expired Date USA VISA

Mandatory Certificates

Certificate of Competency No

CoC - Issue Date

CoC Expired date Unlimited

CoC - Place Issue

CoC Endorse - No

CoC Endorse - Issue Date

CoC Endorse - Expire Date

CoC Endorse - Place issue

GMDSS CoC - No

GMDSS CoC - Issue Date

GMDSS CoC - Expire Date

GMDSS CoC - Place issue

ECDIS (generic) - No

ECDIS (generic) - Issue Date

ECDIS (generic) - Expire Date

ECDIS (generic) - Place issue

Arpa - No

Arpa - Issue Date

Arpa - Expire Date

Arpa - Place issue

BRM - No

BRM - Issue Date

BRM - Expire Date

BRM - Place issue

Radar - No

Radar - Issue Date

Radar - Expire Date

Radar - Place issue

ERM - No

ERM - Issue Date

ERM - Expire Date

ERM - Place issue

SSO - No

SSO - Issue Date

SSO Expired date Unlimited

SSO - Place Issue

MFA - No

MFA - Issue Date

MFA Expired date Unlimited

MFA - Place Issue

MC - No

MC - Issue Date

MC Expired date Unlimited

MC - Place Issue

Able Engine - No

Able Engine - Issue Date

Able Engine Expired date Unlimited

Able Engine - Place Issue

Able Deck - No

Able Deck - Issue Date

Able Deck Expired date Unlimited

Able Deck - Place Issue

Cook Certificate - No

Cook Certificate - Issue Date

Cook Certificate Expired date Unlimited

Cook Certificate - Place Issue

Steward Certificate - No

Steward Certificate - Issue Date

Cook Certificate Expired date Unlimited

Steward Certificate - Place Issue

SAT - No

SAT - Issue Date

SAT Expired date Unlimited

SAT - Place Issue

SDSD - No

SDSD - Issue Date

SDSD Expired date Unlimited

SDSD - Place Issue

BST - No

BST - Issue Date

BST - Expire Date

BST - Place Issue

AFF - No

AFF - Issue Date

AFF - Expire Date

AFF - Place Issue

SCRB - No

SCRB - Issue Date

SCRB - Expire Date

SCRB - Place Issue

Specific Vessel Certificates (optional)

BOCT - No

BOCT - Issue Date

BOCT - Expire Date

BOCT - Place Issue

BLGT - No

For Engineer, please fill engine type with full details

Vessel Name

Vessel Type

Engine Maker/Type

GRT / HP

Owner

Rank

Sign On

Sign Off

Reason of Sign off

Manning Agent Company Name 5

Contact Person - position 5

Phone/Mobile Agent 5

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Statement

All of the answer and information in this application are true and correct to the best of my knowledge and believe. I understand that supplying false information or misrepresenting or omitting any facts or information called for in this application for dismissal.