The document is an application form for Adi Rajab Alang, an Indonesian citizen born in 1996, who is applying for a position. It includes personal details like name, date of birth, contact information. It also lists his education qualifications like passport, seafarer book, safety certificates, and sea service experience working on different vessels between 2015-2022 as a cadet, 3rd officer, 2nd officer, and chief officer. The form provides all relevant documentation details to support his application.
The document is an application form for Adi Rajab Alang, an Indonesian citizen born in 1996, who is applying for a position. It includes personal details like name, date of birth, contact information. It also lists his education qualifications like passport, seafarer book, safety certificates, and sea service experience working on different vessels between 2015-2022 as a cadet, 3rd officer, 2nd officer, and chief officer. The form provides all relevant documentation details to support his application.
The document is an application form for Adi Rajab Alang, an Indonesian citizen born in 1996, who is applying for a position. It includes personal details like name, date of birth, contact information. It also lists his education qualifications like passport, seafarer book, safety certificates, and sea service experience working on different vessels between 2015-2022 as a cadet, 3rd officer, 2nd officer, and chief officer. The form provides all relevant documentation details to support his application.
The document is an application form for Adi Rajab Alang, an Indonesian citizen born in 1996, who is applying for a position. It includes personal details like name, date of birth, contact information. It also lists his education qualifications like passport, seafarer book, safety certificates, and sea service experience working on different vessels between 2015-2022 as a cadet, 3rd officer, 2nd officer, and chief officer. The form provides all relevant documentation details to support his application.
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APPLICATION FORM
GENERAL INFORMATION First name Adi Rajab Date of birth March 12, 1996
Last name Alang Place of birth Palopo
Nationality Indonesia Email address adirajabalang@gmail.com
Mobile Phone +62 822 13816490 Home telephone
Coverall size L Safety shoes size 40
Next of kin Yuyun Mahmuda Alang Relationship Sister Mobile Phone +62 813 5559 1932
Jl. Swasembada Barat XXIII No.17 Rt.003/012 Kel. Kebun Bawang Kec. Tanjung Priok Jakarta Utara – Home Address Indonesian
Place Documents/Certificates Held Document No. Date Issued Expiry Date Issued
Passport B 5772888 Tanjung Priok Jun 13, 2017 Jun 13, 2027
Seaman’s book H 095249 Kota palopo nov 25, 2022 Nov 25, 2025
National License – deck Officer Class II 6211599924N20422 makassar Juli 18, 2022 Unlimited
National endorsement - management 6211599924NB0422 Jakarta Aug 05, 2022 Aug 05, 2027
Certificate of GMDSS radio operator 6211599924G10219 jakarta Des 23,2019 Unlimited
Endorsement GMDSS 6211599924GA0220 jakarta feb 03, 2020 feb 03, 2024
General operator certificate 79591/SOU/XII/2019 jakarta Des 16, 2019 Des 16, 2024
CERTIFICATES OF PROFICIENCY (COP) as per STCW 2010
Course Title Document No. Place Issued Date Issued Expiry Date
Basic Safety Training 6211599924010420 Makassar Des 11, 2020 Des 11, 2025
Proficiency in Survival Craft and Rescue Boat 6211599924040118 Jakarta Dec 26, 2018 Dec 26, 2023
Medical First Aid 6211599924070216 Makassar Unlimited Unlimited
Medical care On Board Ship 6211599924080218 Jakarta Dec 27, 2018 Dec 27, 2023
Advance fire fighting 6211599924060116 Makassar Unlimited Unlimited
Security Awareness Training 6211599924310116 Jakarta Oct 27, 2016 Oct 27, 2021 Seafarer with Designated Security Duties 6211599924320216 Jakarta Unlimited Unlimited
Ship security officer 6211599924240118 Jakarta Dec 14, 2018 Dec 14, 2023
Bridge Resource management 6211599924230219 Jakarta Jan 17, 2019 Jan 17, 2024
Operator Use OF ECDIS Training Program 6211599924280219 Jakarta Feb 11, 2019 Feb 11, 2024
Radar Simulator 6211599924030219 Jakarta Jan 23, 2019 Jan 23, 2024
ARPA Simulator 6211599924020219 Jakarta Feb 01, 2019 Feb 01, 2024
SEA SERVICE DATA
Vessel Type Period Company Flag Rank No Vessel’s Name GRT From To 1 MV. Oriental Jade Container 18000 22.03.15 12.11.15 Spill Indonesia Cadet 2 MV. Oriental Jade Container 18000 19.11.16 02.07.17 Spill Indonesia 3/O
MV. Martha Bulk Carrier 17018 15.10.17 28.04.18 Pelayaran Bahtera Bahamas 2/O 3 Baruna Adhiguna MV. Golden Maple Bulk Carrier 20138 01.08.18 22.03.19 Hangang Global Korea 3/O Shipping Co.,Ltd 5 MV. CTP Golden Container 11810 07.06.19 22.12.19 CTP Line Indonesia 2/O
6 Subaru7 Cargo 6178 19.03.20 10.01.21 Dalian Shipping Panama 2/O
