(Curriculum Vitae) : Application Form [PDF]

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APPLICATION FORM ( CURRICULUM VITAE ) Full Name Place & Date Of Birth Gender Religion Permanent Address Nationality Mobile Phone Email Addres



AGUS ZALI MOJOKERTO, 5 APRIL 1967 MALE MOESLEM JL. CICADAS NO. A7 RT/RW KECAMATAN KEPANJEN KIDUL KELURAHAN BENDO KOTA BLITAR KODE POS 66116 INDONESIAN +6282142005777 [email protected] CERTIFICATE OF COMPETENCY



No. 1. 2. 3.



Detail ENGGINER OFFICER CLASS IV ENGINEER OFFICER CLASS III ENDORSEMENT III



Number 6200098230T40303 6200098230S30116 6200098230SC0116



FURTHER DETAIL No. Detail 1. 2.



No.



PASPORT SEAMAN BOOK



Name of Certificate



Place Issued JAKARTA,09 JANUARY 2003 JAKARTA,07 OCTOBER 2016 JAKARTA,11 June 2014



Date Issued UNLIMITED UNLIMITED 31 December 2016



Number



Place Issued



Date Issued



Expire



T 064872726 E 143932



BLITAR SURABAYA



12 OCT 2016 16 JANUARY 2017



12 OCT 2021 16 JANUARY 2020



CERTIFICATE OF PROFIENCY Number



1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.



BASIC SAFETY TRANING PROFICIENCY ADVANCED FRE FIGHTING MEDICAL FIRST AID MEDICAL CARE AN BOARD SHIP BOCT ENDORSEMENT ATTESTING(MPA) ATT III MANAJEMEN SHIP SECURITY OFFICER SEAFERERS WITH DESIGNATED SECURITY DUTIES SECURITY AWARENESS TRAINING ENGINE ROOM RESOURCE MANAGEMENT



No. 1. 2. 3. 4. 5.



VESSEL NAME/FLAG MT. KENCANA 7 TB.CANTIKA 1 KM.MAJU 68 KM.PHILIPS SPOB. SEROJA VII



6200098230010309 6200098230040309 6200098230060309 6200098230080308 6200098230080309 6200098230390518 6200098230S30116 6200098230S30116 6200098230240315 6200098230320315 6200098230310315 6200098230270115



PERSONAL HISTORY VESSEL TYPE/TRADE AREA MT/API TUG BOAT/API/NVC CARGO CARGO OIL TANKER



GRT/BHP 759/2029 282/2000 1766/735 658/800 2384/1300



Place Issued 26 August 2015 26 August 2015 26 August 2015 26 August 2015 26 August 2015 10 January 2018 10 October 2016 07 October 2016 11 September 2015 14 September 2015 14 September 2015 26 Oktober 2015



RANK MASINIS - II CH/ENGINEER CH/ENGINEER CH/ENGINEER CH/ENGINEER



SIGN ON 06-05-2014 22-11-2014 06-10-2016 17-02-2017 09-04-2018



SIGN OFF 12-11-2014 04-08-2016 01-01-2017 10-06-2017 11-12-2018



*For further information of certificate’s availability, could be checked at official homepage //http: www.pelaut.dephub.go.id



Sincerely yours,



AGUS ZALI