SEAFARER EMPLOYMENT APPLICATION FORM

Name : IRWAN KUSNANTO

Place & Date Birth : Malang, 16 Mei 1976
Address : Perum Taman Delta Blok S No. 03,
Candi-Sidoarjo, East Java-Indonesia, Postal Code 61271
Contact Number : +62 813 307 179 50 / 081 255 331 048
Email : Irwan_kusnanto@yahoo.com
Gender : Male
Religion : Moslem
Nationality : Indonesia
Marital Status : Married
Certificated Of Compatency Number Place issued Date issued Expire date
ANT V 6200515603N0506 JAKARTA 28 September 2006 -
ENDORSMENT ANT V 6200515603NE0506 JAKARTA 18 Februari 2008 -
ANT IV 6200515603N40513 JAKARTA 7 Oktober 2013 -
ENDORSMENT ANT IV 6200515603ND0513 JAKARTA 21 Oktober 2013 -
ANT IV MANAJEMEN 6200515603M40516 JAKARTA 12 Mei 2016 -
Endorsement ANT IV MANAJEMEN 6200515603MD0516 JAKARTA 19 Mei 2016 -

Document Number Place issued Date issued Expire date

PASSPORT U 141598 SURABAYA 20 Oktober 2009 20 Oktober 2014
SEAMAN’S BOOK B 064659 SURABAYA 24 Mei 2013 24 Mei 2018

Type of Certificate Number Place issued Date issued

BASIC SAFETY TRAINING 6200515603010505 SURABAYA 18 Juni 2013
ADVANCED FIRE FIGHTING – Revalidation 6200515603060516 SURABAYA 06 Januari 2016
PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOATS 6200515603040507 SURABAYA 24 Mei 2013
MEDICAL FIRST AID 6200515603080509 SURABAYA 24 Mei 2013
BASIC TRAINING FOR OIL AND CHEMICAL TANKER
CARGO OPERATIONS 6200515603390515 SURABAYA 18 Desember 2015
MEDICAL CARE ON BOARD SHIP - Revalidation 6200515603080515 SURABAYA 25 November 2015
INTERNATIONAL SAFETY MANAGEMENT CODE 1927.09.2012 SURABAYA 24 September 2012
RADAR SIMULATOR 6200515603030513 SURABAYA 22 Mei 2013
ARPA SIMULATOR 6200515603020513 SURABAYA 27 Mei 2013
GMDSS 6200515603210514 SURABAYA Februari 2014
ORU/GOC G 038533 SEMARANG Maret 2014
BRIDGE RESOURCE MANAGEMENT 6200515603230515 SURABAYA 05 November 2015
SHIP SECURITY OFFICIER 6200515603240515 SURABAYA 04 Desember 2015
SECURITY AWARENESS TRAINING 6200515603310516 SURABAYA 04 Januari 2016

DETAILS OF SEA SERVICE

Vessel Name GRT/HP Rank Company Periode
PT. KARTIKA JASA KARYA. 01-03-1995 s/d
TB. ANGGADA 168/800 AB SURABAYA INDONESIA 27-06-2005
PT. KARTIKA JASA KARYA. 16-12-2006 s/d
TB. ASAHAN 175/900 2nd Office SURABAYA INDONESIA 26-08-2008
PT. KARTIKA JASA KARYA. 26-08-2008 s/d
TB. GADING JAYA 124/750 CHIEF MATE SURABAYA INDONESIA 30-10-2009
PT. RENJANI MARITIM TRANSPOTASI 13-11-2009 s/d
TB. RAVA 203/2000 CHIEF MATE JAKARTA INDONESIA 12-04-2012
PT. RENJANI MARITIM TRANSPOTASI 12-04-2012 s/d
TB. RAVA I 203/2000 NAKHODA JAKARTA INDONESIA 13-11-2012
PT. PELAYARAN LESTARI PAPUA 03-06-2013 s/d
TB. PUTRA RUPAT 9 146/1600 NAKHODA BAHARI. SAMARINDA INDONESIA 01-11-2013
PT. PETRO SAMUDRA. BATAM 21-11-2013 s/d
MT L. POWER 758 CHIEF MATE INDONESIA 01-01-2015
PT. SOWOHI KENTITI JAYA 01-02-2015 s/d
TB. MARINO 168 242/2400 CHIEF MATE .SURABAYA. INDONESIA 01-05-2015
PT. SOWOHI KENTITI JAYA 01-05-2015 s/d
TB. MARINO 168 242/2400 NAKHODA .SURABAYA. INDONESIA 01-11-2015
26-12-2015 s/d
KM. EXPRES BAHARI 1C 216/3450 NAKHODA PT. SAKTI INTI MAKMUR
30-08-2016
09-09-16 s/d
TB.MARUTA III 220/1650 CHIEF MATE PT. BEPI SURABAYA
19-12-2016
PT. PELAYARAN KARYA LENTARI 22-12-2016 /
TB. PSL BALDWIN 172/2000 NAKHODA PERDANA, BALIKPAPAN MUTASI
PT. PELAYARAN KARYA LENTARI 10-05-2017 s/d
TB. PSL FRANK 146/1300 NAKHODA PERDANA, BALIKPAPAN 10-10-2017
PT.ENERGY MARINE OPERASIONAL 17-10-2017 s/d
PT.ENERGY MARINE INDONESIA
INDONESIA STAFF SEKARANG