Professional Documents
Culture Documents
HRM: 03-03A-02
SEAFARERS RECORD Applicants Surname: Cernisencu Rank: 3engineer Applicants First Name: Age: 26
Date of birth:30.03.1986
Place of birth:
Home address:
blv 1 decembrie 1918 bl. C1 sc.b ap.5 constanta Next of kin: Cernisencu alexandra Telephone: 0755896808
Marit Singl Marrie X al e d Statu s: DOCUMENTS Passport Seamans book National License/Diploma STCW Endorsement/COC Flag Endorsement Medical Fitness Certificate
NUMBER
14685204 22591 CT 31721
ISSUING AUTHORITY
Date Issued
29.06.09 31.07.07 02.07.09
Expiry Date
29.06.14 17.03.13 26.06.14
A&B,ROTTERDAM
TRAINING CERTIFICATES
YES NO
ISSUING AUTHORITY
Date Iss ue d
Expiry Date
LIFE-SAVING & FIRE FIGHTING VI / 1-1, 1-2, 1-3, 14 PERSONAL SURVIVAL TECHNIQUES A-VI/1 PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES A-VI/1 SURVIVAL CRAFT & RESCUE BOATS ADVANCED FIRE FIGHTING MEDICAL FIRST AID MEDICAL CARE RADAR, ARPA, BRIDGE TEAMWORK A-I/12 A-I I/2 WATCHKEEPING GMDSS (GO) PREVENTION OF POLLUTION A-II/1 A-II/2 HANDLING OF DANGEROUS CARGOES A-II/1 A-II/2 MARITIME ENGLISH A-II/1 A-II/2 TANKER FAMILIARIZATION SPECIALIZED CHEMICAL TANKER FAMILIARIZATION ECDIS TRAINING A-II/1 A-II/2 V/1, 1-7 SPECIALIZED TANKER FAMILIARIZATION V/1 8-14 V/1 15-21 II/III IV/2 VI/ 2-1 VI/ 3-1 VI/ 4-1 VI/ 4-2
x x x x x
18.02.11
18.02.16
Page 1 of 3
HRM: 03-03A-02
SEAFARERS RECORD
SHIP SECURITY OFFICER TRAINING BRIDGE/ENGINE TEAM AND RESOURCE MANAGEMENT SHIP HANDLING AND MANEUVERING SIMULATION A-II/1 A-II/2 ICE NAVIGATION TRAINING TANKER MANAGEMENT AND SELF-ASSESSMENT RISK ASSESSMENT AND INCIDENT INVESTIGATION SAFETY OFFICER TRAINING OTHERS: x
APPLICATION FORM
03.07.09 03.07.14
VG
20082691790004
Page 2 of 3
Capital Ship Management Corp. SEAFARERS RECORD PREVIOUS SEA SERVICE - MINIMUM LAST FIVE YEARS COMPANY LOWLAND AB CREW AB CREW STATUS STATUS MARLOW FAIR PLAY VESSEL MARLENE GREEN NYK VEGA NYK LYRA NAFTOCEMENT8 ANDREEAS A AHTS MAGNUS BW BAUHINIA RANK 3E 3E 3E 3E 3E EC EC TYPE CONT CONT CONT CEMC CONT AHTS VLCC FLAG ROTTERD AM PANAMA PANAMA PANAMA PANAMA A&B HONG KONG DWT 11890 97825 75201 3998 5967 1767 301019 ENGINE TYPE VARTSILA MAN B@W MAN B&W MAN DEUTS MAN MAN B&W FROM 07.08.1 2 19.01.1 2 16.04.1 1 04.11.1 0 01.04.1 0 20.07.0 9 4.11.07 TO 19.09.1 2 23.05.1 2 28.09.1 1 23.01.1 1 06.08.1 0 16.09.0 9 31.03.0 8
APPLICANTS SIGNATURE:
FOR CAPITAL SHIP MANAGEMENT CORP. CREW DEPT USE ONLY PROPOSED BY MANNING OFFICE/AGENT: DATE REVIEWED & APPROVED FOR INITIAL PROCESSING:
Page 3 of 3