HUMAN RESOURCES - MANNING SERVICES

Head Office: CONSTANTA, No 19 MERCUR Street, 900699 ROMANIA Mobile Phones: +40 744 671 594 / 0726 090 925 Tel. +40 241 545 606 / 0341 439 686 Fax:+40 341 439 687 E-mail: office@simmitmanpower.com Website: www.simmitmanpower.com Personal Data Operator no.9980 (acc. RO Law no.677/2001)

EMPLOYMENT APPLICATION FORM No 1011005590006 SEA STAFF / PER-CM / 06 / GM

SURNAME ANTONIE NAME DORIN POSITION C/O OR MASTER

ID (CNP) 1590510131210
Available from 01-May-2013

PERSONAL DETAILS
PHOTO DATE OF BIRTH PLACE OF BIRTH MARITAL STATUS NATIONALITY NEAREST AIRPORT
10,05,1959 PATULELE MARRIED ROMANIAN HENRI COANDA, BUCHAREST

HEIGHT WEIGHT EYES COLOR HAIR COLOR LANGUAGES

170 80 HAZEL GREY ENGLISH

CM KG

ADDRESS STR. AURORA, NR.6, BL.PF1, SC.B, AP.22, CONSTANTA CONTACT PHONE +40241 581 074 MOBILE PHONE +40723 379 203 ; +40720 045 158 EMAIL ADDRESS antonie_dorin@yahoo.com

NEXT of KIN
SURNAME ANTONIE NAME ANCUTA ADDRESS STR. AURORA, NR.6, BL.PF1, SC.B, AP.22, CONSTANTA CONTACT PHONE +40241 581 074 MOBILE PHONE +40720 045 158

COLLEGES / INSTITUTES
NAME OF INSTITUTION
MIRCEA CEL BATRAN MAR. INSTITUTE

COURSE ATTENDED
NAVIGATION

DATES FROM TO
1978 1982

QUALIFICATION GAINED
DECK OFF

DETAILS of PERSONAL DOCUMENTS

DOCUMENT PASSPORT US VISA C1/D SEAMAN'S BOOK
LICENCE/CERTIFICATE OF COMPETENCE

NUMBER
050032192 20061232460004 11323CT 11561

PLACE OF ISSUE
CONSTANTA NASSAU CONSTANTA

DATE ISSUED EXPIRES

26.01.2010 24.05.2012 27.09.2007 22.11.1995 22.11.2007 03.06.2002 13.03.2009 23.05.2007 23.05.2007 26.01.2015 21.05.2017 29.12.2013 11.12.2014 22.11.2017 03.06.2012 13.03.2014 01.03.2010 11.12.2014

ISSUING AUTHORITY
CONSTANTA POLICE USA AMBASSY BICHAREST ROMANIAN NAVAL AUTHORITY ROMANIAN NAVAL AUTHORITY PORT HEALTH AUTHORITY NETHERLANDES SHIPP. INSPECTORATE VIRGINIA, USA DIRECTORATE GENERAL OF SEAFARERS
OFFICE OF THE MARITIME ADMINISTRATOR

GRADE
MASTER CONSTANTA ROTTERDAM VIRGINIA PANAMA
RESTON, VIRGINIA, USA

YELLOW FEVER
NETHERLANDES LIBERIA PANAMA MARSHAL ISLANDS FLAG STATE S.BOOK A209691 874729 CT844908 214440

RECORD of SEA SERVICE

(Please give a full record starting with the last vessel on which you served) SHIP PARTICULARS COMPANY
R & S NAPOLI, ITALY HISTRIA KON-QUEST SA LAMPEDUSA MAR. ENZIAM SHIPP. WELISTRO GROUP MOONLIGHT NAV. BETTY K AMDTS DILEK MAR. KARMAR SHIPP BOUNTY SHIPP.

DATES MAIN ENGINE TYPE POWER FROM

13.03.2012 12.03.2011 30.06.2010 14304 2450 24.04.2009 01,06,2008 20,12,2007 02,06,2007 03,01,2007 08,02,2006 08,05,2005 10,08,2004 21.08.2003 15.01.2003

RANK
C/O C/O C/O C/O

NAME
CDRY BLUE RM POWER HISTRIA DIAMOND NAMA
SAFMARINE ANGELA

TYPE FLAG
GC BC BC GC GC MP GC CONT MP MP CONT GC CONT SUI LBR ITALIAN M.Is.

GRT
5629 30661 52000 8203 2592 9990 9000 4800 6000 14000 6036 3000 4800

TO
04.05.2012 31.10.2011 18.10.2010 18.09.2009 20,12,2008 14,05,2008 05,09,2007 05,05,2007 23,07,2006 28,10,2005 25,11,2004 01.03.2004 17.07.2003

WEM LINES, CREECE C/O

MASTER HISTRIA ONYX MASTER PROSPERITAS MASTER MOONLIGHT MASTER BETTY K VII MASTER STATIA RESPONDER MASTER VEGA MASTER FATE MASTER MOONLIGHT

SUMMARY of SEA SERVICE (in months)

RANK TANKER CONT. RO-RO PASS. B.C. G.C. TUG OTHERS TOTAL
0

IMO COURSES
NAME of COURSE
RADAR ARPA, BRIDGE TEAMWORK, SAR GENERAL OPERATOR'S CERTIFICATE FOR GMDSS G.O.C. MARITIME MOBILE SERV GMDSS (BLUE ONE) PERSONAL SURVIVAL TECHNIQUES SHIP HANDLING AND MANOEUVERING SIMULATION MEDICAL FIRST AID (ELEMENTARY) P.S.S.R. (PERS. SAFETY SOC. RESP.) ADVANCED FIRE FIGHTING PROFICIENCY IN SURVIVAL CRAFT & RESCUE BOATS MEDICAL CARE PREVENTION OF POLLUTION OF MARINE ENVIROMENT TRANSPORT & HANDLING OF DANGEROUS CARGO MARITIME ENGLISH BRIDGE TEAM & RESOURCE MANAGEMENT Ro-Ro PAX/ PAX SHIPS OTHER THAN Ro-Ro SHIPS SHIP SECURITY OFFICER SHIP SAFETY OFFICER ELECTRONIC CHART DISPLAY & INFO SYSTEM TANKER FAMILIARISATION., Sec.A-V/1, par.1-7 SPEC.TRAIN. for OIL TANKER. Sec.A-V/1, par.8-14 SPEC.TRAIN. for CHEM. TANKER. Sec.A-V/1,par.15-21 SPEC.TRAIN. LIQ. GAS TANKER Sec.A-V/1, par.22-34 STCW Endorsement (ATESTAT) LICENCE STCW Endorsement, TANKERS, par.1-7 STCW Endorsement, OIL TANKER, par.8-14 STCW Endorsement, CHEM. TANKER, par.15-21 STCW Endorsement, LIQ. GAS TANKER, par.22-34 The undersigned, I agree herewith as my personal private details delivered herein to SIMMIT MANPOWER Co. Ltd. data operator no.9980) to be sent to the third parties, either Foreigner or Romanian. I have acknowledged my legal rights regarding the information and the access to the data base of this operator as per Art.12 - 18 from Romanian Law no.677/2001. 26546 CONSTANTA 11.12.2009 03.11.2014
ROMANIAN NAVAL AUTH

CERTIFICATE DETAILS
NUMBER 0002253 0003650 1051 0010213 00011388 0010699 0010327 0017630 0002763 0008284 0008709 0004504 00003942 0001445 00000789 00003721 PLACE of ISSUE CONSTANTA CONSTANTA BUCHAREST CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA CONSTANTA DATE 20.11.2009 04.12.2009 04.12.2009 23.11.2009 18.05.2012 10.11.2009 13.11.2009 25.11.2009 06.11.2009 03.11.2009 17.11.2009 27.11.2009 25.05.2012 03.03.2009 01.07.2012 08.06.2012 EXPIRES 20.11.2014 04.12.2014 04.12.2014 23.11.2014 18.05.2017 10.11.2014 13.11.2014 25.11.2014 06.11.2014 03.11.2014 17.11.2014 27.11.2014 25.05.2017 03.03.2014 01.06.2017 08.06.2017 ISSUED BY CERONAV CERONAV IGCTI CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV

WAGE EXPECTATION
4800 EUR

DESIRED LENGTH of CONTRACT 4 - 6 LUNI

DATE
30.04.2013

PLACE
CONSTANTA

PREFERRED TYPE OF SHIPS:

SIGNATURE ANTONIE DORIN