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FORMULIR BIODATA TARUNA POLITEKNIK PELAYARAN SURABAYA 2022
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Email
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Nama
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(sesuai dengan ijazah)
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No Formulir/Nomor Seleksi SIPNCATAR Kemenhub
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Jalur Seleksi (Saat Diterima)
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Reguler Pola Pembibitan (POLBIT)
Reguler Non Pola Pembibitan (REGULER)
Non Reguler (MANDIRI)
Program Studi
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D3 NAUTIKA
D3 TEKNIKA
D3 ELEKTRO PELAYARAN
D4 TEKNOLOGI REKAYASA OPERASI KAPAL (TROK)
D4 TEKNOLOGI REKAYASA PERMESINAN KAPAL (TRPK)
D4 TEKNOLOGI REKAYASA KELISTRIKAN KAPAL (TRKK)
D4 TRANSPORTASI LAUT
Nama Ibu Kandung
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Tempat Lahir
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Tanggal Lahir
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MM
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DD
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YYYY
Jenis Kelamin
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Laki-Laki
Perempuan
Agama
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Choose
Islam
Kristen
Katholik
Budha
Hindu
Konghucu
Lainnya
NIK
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(Nomor KTP tanpa tanda baca, Isikan Nomor Paspor untuk Warga Negara Asing)
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NISN
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NPWP
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Kewarganegaraan
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Jalan
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Dusun
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RT
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RW
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Kelurahan
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Kode Pos
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Kecamatan
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Kabupaten
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Provinsi
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Telepon Rumah
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Nomor Telepon Orang Tua
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Nomor HP (WA) Taruna/i
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