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APPLICATION FORM / PERSONAL INFORMATION  SHIP/HOTEL DEPARTMENT
Applied position Asistans Cook Nationality Indonesia
First Name Nafissah Home Airport Soekarno Hatta
Last Name Nafissah Home Address incl. post code 62371
Place & Date of Birth Tuban, July, 02, 1998 Telephone +6285606079587
Weight & Height 50 Kg & 152 cm Email address nafisaalwahad@gmail.com
RECORDS OF PREVIOUS EXPERIENCES (dimulai dari yg terahkir)
Ship, Hotel or Restaurant Name *
(Nama Kapal/Hotel/Restoran)
Facility & services
rated (4 or 5 star)*
Address of the hotel,
restaurant or agency
Position Salary in (IDR/USD/etc) Employment
start date
Employment
end date
Reason for
leaving or current
status
Start End
1 Aston Hotel Cirebon F & B Product Asistant Cook
Job
Description
a) Prepare Condiment for Breakfast
b) Handlle Breakfast
c) Handlle Alacarte
2
Job
Description
a)
b)
c)
3
Job
Description
a)
b)
c)
4
Job
Description
a)
b)
c)
5
Job
Description
a)
b)
c)
Page 1 of 3
PERSONAL DETAILS:
APPLICATION FORM / PERSONAL INFORMATION  SHIP/HOTEL DEPARTMENT
*Starts from the most recent workplace. Facility services rating for hotel and restaurant.
CERTIFICATES:
Course Institution Place Cert. Number Date of Issue
Basic Safety Training (BST) BST PIP Semarang 6211442508010314 29 September to October 2014
Diploma Schol Grand Wisata Hotel School Cook
High School SMK Pelayaran Tuban Nautic
TRAVEL DOCUMENTS:
Type of document Number Place of issuance Date of issuance Date of expiry
PASSPORT
SEAMAN BOOK
FORMAL EDUCATION BACKGROUND: (Latar belakang pendidikan formal)
School/Academy From (..Month/Date/ Year..) To (..Month/Date/ Year..) Qualification Attained
Diploma School
High School
REFERENCES: Name, contact number of at least 2 (two) previous employers and the recommendation (Rekomendasi dari dua employer/majikan terahkir nama dan telponnya)
Employers name Address and contact number Recommendation
Mr. Bayu Topandas Asistant Cook
EMERGENCY CONTACT DETAILS:
No. Name Relationship Contact Number E-mail address
1 Miftahul Hidayah Mother Mobile +6282261398340
2 Siti Rohmah Grand Mother Mobile +6285203169741
3 Wahyu Sadewo Brother Mobile +6285791678897
Page 2 of 3
APPLICATION FORM / PERSONAL INFORMATION  SHIP/HOTEL DEPARTMENT
NEXT OF KIN:(Saudara Sekandung)
No. Name Relationship Place / Date of Birth Signature
1 Daimatul Khasanah Siblings Tuban , November, 01, 2016 Nafissah
2 Ilham Syufi Dziqrullah Siblings Tuban , April , 30, 2013
Declaration:
I hereby declared that the above mentioned information is correct.
Place & Date : Tuban, July 02 1998
Signature : Nafissah
Page 3 of 3

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  • 1. APPLICATION FORM / PERSONAL INFORMATION SHIP/HOTEL DEPARTMENT Applied position Asistans Cook Nationality Indonesia First Name Nafissah Home Airport Soekarno Hatta Last Name Nafissah Home Address incl. post code 62371 Place & Date of Birth Tuban, July, 02, 1998 Telephone +6285606079587 Weight & Height 50 Kg & 152 cm Email address nafisaalwahad@gmail.com RECORDS OF PREVIOUS EXPERIENCES (dimulai dari yg terahkir) Ship, Hotel or Restaurant Name * (Nama Kapal/Hotel/Restoran) Facility & services rated (4 or 5 star)* Address of the hotel, restaurant or agency Position Salary in (IDR/USD/etc) Employment start date Employment end date Reason for leaving or current status Start End 1 Aston Hotel Cirebon F & B Product Asistant Cook Job Description a) Prepare Condiment for Breakfast b) Handlle Breakfast c) Handlle Alacarte 2 Job Description a) b) c) 3 Job Description a) b) c) 4 Job Description a) b) c) 5 Job Description a) b) c) Page 1 of 3 PERSONAL DETAILS:
  • 2. APPLICATION FORM / PERSONAL INFORMATION SHIP/HOTEL DEPARTMENT *Starts from the most recent workplace. Facility services rating for hotel and restaurant. CERTIFICATES: Course Institution Place Cert. Number Date of Issue Basic Safety Training (BST) BST PIP Semarang 6211442508010314 29 September to October 2014 Diploma Schol Grand Wisata Hotel School Cook High School SMK Pelayaran Tuban Nautic TRAVEL DOCUMENTS: Type of document Number Place of issuance Date of issuance Date of expiry PASSPORT SEAMAN BOOK FORMAL EDUCATION BACKGROUND: (Latar belakang pendidikan formal) School/Academy From (..Month/Date/ Year..) To (..Month/Date/ Year..) Qualification Attained Diploma School High School REFERENCES: Name, contact number of at least 2 (two) previous employers and the recommendation (Rekomendasi dari dua employer/majikan terahkir nama dan telponnya) Employers name Address and contact number Recommendation Mr. Bayu Topandas Asistant Cook EMERGENCY CONTACT DETAILS: No. Name Relationship Contact Number E-mail address 1 Miftahul Hidayah Mother Mobile +6282261398340 2 Siti Rohmah Grand Mother Mobile +6285203169741 3 Wahyu Sadewo Brother Mobile +6285791678897 Page 2 of 3
  • 3. APPLICATION FORM / PERSONAL INFORMATION SHIP/HOTEL DEPARTMENT NEXT OF KIN:(Saudara Sekandung) No. Name Relationship Place / Date of Birth Signature 1 Daimatul Khasanah Siblings Tuban , November, 01, 2016 Nafissah 2 Ilham Syufi Dziqrullah Siblings Tuban , April , 30, 2013 Declaration: I hereby declared that the above mentioned information is correct. Place & Date : Tuban, July 02 1998 Signature : Nafissah Page 3 of 3