You are on page 1of 1

APPLICATION FORM

TO : CREW DEPARTEMENT
ATTN :
FORM : MAIL
Dear sir,
I send to appiay at your company for the position as engineer and I am ready to
planned on board with route of voyage determinate by the company
Date are as follow :
Name : BUDI AHMAD Rank : Engine
Place & Date of Birth : Sempitan, 25-05-1076 Religion : Moslem
Current Address : Dusun III Desa Tanjung Asri, Kec. Sei Dadap, Kab. Asahan
Contact Number : 081212099996
W/A : 081212099996
Email Address : kpskp23@gmail.com

II. TRAVELLING DOCUMENT


No Name of Document Number Date of issued Date of Expired Issuing Authority
1 SEAMAN BOOK C 022019 08 Nov 2016 12 Nov 2018 Tanjung Priok
2 PASSPORT B 109081 09 May 2017 09 May 2022 Palembang

III. SERTIFICATE OF COMPETENCY


No Document Number Place / Date of Issued
1 ATT-V 6200387293750214 Jakarta, 15 Oktober 2014
2 Endorsement ATT-V Operational 6200387293750214 Jakarta, 15 Oktober 2014
3 ATT-V Management 6200387293550218 Jakarta, 26 November 2018
4 Endorsement ATT-V Management 62003872935E0218 Jakarta, 05 Desember 2018

IV. CERITIFICATE OF COMPETENCY


No Type Of Certificate Certificate of 1Number Place / Date of Issued
1 RATINGS AS ABLE SEAFARER ENGINE 6200387293420218 JAKARTA, 05 OCTOBER 2018
2 BASIC SAFETY TRAINING REVALIDATION 6200387293041114 JAKARTA, 06 SEPTEMBER 2014
3 PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOATS 6200387293041114 JAKARTA, 09 SEPTEMBER 2014
4 ADVANCED FIRE FIGHTING 6200387293661114 JAKARTA, 03 JANUARI 2014
5 MEDICAL FIRST AID 6200387293071114 JAKARTA, 24 JANUARI 2014
6 SECURITY AWARNESS TRAINING 6200387293310214 JAKARTA, 28 NOVEMBER 2014
7 CROWD MANAGEMENT 620038729313218 JAKARTA, 04 OCTOBER 2018
8 CRISIS MANAGEMENT AND HUMAN BEHAVIOUR 6200384293170218 JAKARTA, 04 OCTOBER 2018
9 ENGINE ROOM RESOURCE MANAGEMENT 6200387293270218 JAKARTA, 10 AGUSTUS 2018
10 MEDICAL CARE ON BOARD SHIP 6200384293080218 JAKARTA, 21 AGUSTUS 2018
11 SEAFARERS WITH DESIGNATED SECURITY DUTIES 6200B87293320218 JAKARTA, 28 AGUSTUS 2018

V. SEA EXPERIENCES
No Vessel Company Flag Vessel HP Priode Rank
1 TB.KARYA FASIFIC PT. KARYA FASIFIC SH INDONESIA TB 2X837 01-09-2014 OILER
23 27-01-2015
2 TB.KARYA FASIFIC PT. KARYA FASIFIC SH INDONESIA TB 2X837 27-01-2015 MASINIS III
23 17-05-2015
3 TB.KARYA FASIFIC PT. KARYA FASIFIC SH INDONESIA TB 2X837 17-05-2015 MASINIS II
23 14-06-2015
4 TB.KARYA FASIFIC PT. KARYA FASIFIC SH INDONESIA TB 2X837 14-06-2015 MASINIS II
23 02-08-2018
If there any vacancy for me, please contact me.
Your Sincerely,

MAIL