This 3-page document is an application form containing personal and employment details of Nafissah Nafissah, who is applying for an assistant cook position. It includes her personal information like name, date of birth, contact details, education history and certificates. It also lists her previous work experiences at hotels and restaurants over the past few years along with job responsibilities and references. Emergency contact details of her family members are also provided. She declares that all information given is correct.

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)
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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)
Employer’s 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
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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
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