RYAN SHIP MANAGEMENT LTD

SHIPPING CONNECTIONS / (MARITIME RECRUITMENT)

POSTAL ADDRESS:-RYANSHIP P O Box 1282 - SUNDERLAND TYNE and WEAR SR5 9HX UNITED KINGDOM Tel: +44 191 54 888 59 Fax: +44 191 54 88 425 Email : SHIPPINGCONNECT@aol.com www.shipping-connections.com

Application Form
Section 1
Position Applied for Lowest Position Acceptable Date of Availability

Deck & Engineering Officers

Position
Chief Officer /SDPO 1st Officer/SDPO 15 / 09 / 2013 MUST Enter a date and in dd/mm/yyyy

Section 2
Family name / Surname First Name / Given Name Date & Place of Birth Nationality Permanent Address Present Address PPE information Present Contact Number Mobile Number SKYPE ADDRESS Email Address Nearest Airport (and Distance)

Personal Details
Dumitru Gheorghe-Cristian Date 22-01-1975 Romanian Constanta-Romania Constanta-Romania SAFETY SHOES SIZE 43 COVERALL SIZE L Place-Constanta

george22lord@gmail.com Bucharest (240 km)

Section 3
Country of Issue Date Issued Place Issued Passport Number Passport Expires
Secondary passport or Dual nationality

Passport and VISA details

Romania Constanta Constanta USA Visa - Type B1/OCS USA VISA Expires USA Visa - Type C1/D USA VISA Expires Other Country Visa Visa Expiry

Section 4 ( hi-light as required )

Issuing Country & Place Number

Seaman book / Discharge book / Seaman Record Book / CDC Romania-Constanta 9540 ct
Dumitru Daniela/Wife Daughter 5 years old

Date Issued Expiry Date (if any)

06/07/2012 30/03/2014

Section 5
Full Name / Relationship
Any dependents / Children (incl age )

Next of Kin this is important information we require- Dont ignore it

WPIF M/01

12TH July 2011

Rev - 02

Address Contact Numbers

Same as applicant dana4george@gmail.com

Page 1 of 7 Section 6
Class / Grade/Capacity

STCW95

Highest Certificate of Competency / Licence Held ( also list Flag State Endorsements)
Certificate No.

Issuing Country

Date Issued

Expiry

Details of Limitations

Chief mate unlimited

Romania

26925

02/10/2007

19/01/2015

nil

ALSO ENTER ABOVE DETAILS OF ANY OTHER FLAG STATE CERTIFICATES HELD

Section 7

STCW95

Dangerous Cargo Endorsements

Date Issued Expires Details of Limitations/ Grade

Petroleum.
Liquefied Gas. Liquid Chemicals.

Certificate No.

Section 8

STCW95 related Courses Attended and Certificates Obtained

STCW Code

Name of Course / Certificate

Personal Survival Techniques Basic Sea Survival / Training Fire Prevention & Fire Fighting Elementary First Aid
Personal Safety & Social Responsibility Proficiency in Survival Craft & Rescue Boats

Place CERONAV

Issue Date 05/04/2012

Cert No 00017863

Expiry Date

A- VI/1-1 A-VI/1 A-VI/1-2 A-VI/1-3 A-VI/ 1-4 A-VI/ 2-1 A-VI/ 3 A-VI/ 4-1 A-VI/4-2 A-II/ 1-2 A-IV/ 2

05/04/2017

CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV CERONAV

19/01/2010 27/03/2012 22/01/2010 25/04/2012 13/04/2012 29/01/2010

0011076 00029839 0010759 00004922 00004131 0003749 4058 00558

19/01/2015 27/03/2017 22/01/2015 25/04/2017 13/04/2017 29/01/2015

Proficiency in RESCUE CRAFTS Advanced Fire Fighting Medical & First Aid Medical Care ( Ship Captains Medical Course ) Radar & ARPA Simulator TrgManagement level GMDSS + ENDORSEMENT SAFETY OFFICERS COURSE (SO) Ship Security Officers Course (SSO) Issued under STCW95 Medical Certificate / HEALTH Certificate Drug and Alcohal test certificate YELLOW FEVER Bridge Team Management Bridge Resources Management Electronic chart Display and Information System WPIF M/01 12TH July 2011 Rev - 02

A-VI/ 5

CERONAV

08/04/2009
28/02/2012

08/04/2014 28/02/2014

A-II/2 B-VIII/2

course ( ECDIS ) ISM Code TANKERS FAMILIARISATION Advanced Tanker Operations (Chem.) Advanced Tanker Operations (Oil) Advanced Tanker Operations (LPG) INERT GAS CRUDE OIL WASHING Tanker Safety ( petroleum ) Tanker Safety ( Chemical ) Tanker Safety ( GAS ) REFRESHER & UPDATING Prevention of Pollution of the Marine Enviroment A.1441 (18)

A-V/1 A-V/1-2 A-V/1 A-V/1

I/II & III/2 A-II/1,AII/2,AIII/1,AIII/2 A-II/1,AII/2,AIII/1,AIII/2 A-II/1,AII/2 CERONAV 01/03/2013 00001596 01/03/2018

Transport and handling of dangerous and harmful cargoes.

CERONAV

12/02/2013

00001461

12/02/2018

Maritime English Other ????

CERONAV

05/03/2013

00000985

05/03/2018

Page 2 of 7
L I S T A L L O T H E R C O U R S E S

Section 9
Name of Course / Certificate
BOSIET HUET FOET OFFSHORE MEDICALS ( UK, NORWAY or NETHERLAND )

OFFSHORE INDUSTRY COURSES

APPROVALS Place Abu Dhabi Abu Dhabi Abu Dhabi Issue Date 20/12/2011 20/12/2011 20/12/2011 Cert No 4826/11 4826/11 4826/11 Expiry 19/12/2015 19/12/2015 19/12/2015

Please enter below any other certificates held or courses done, ie offshore, DP certs etc or Any other not already mentioned

Re-Breather training
Initial Standby vessel crews training ( ITSO ) CAA (Civil Aviation Authorities Helicopter)

Advanced Medical Aider ( AMA ) HLO MARLINs English Test IELTS-English TEST

Score:

% SCORE

http://www.ielts.org/test_centre_search/search_results.aspx

PMS maintenance system Confirm that you are Familiar with its use ( YES / NO )

DEEP WATER ANCHOR HANDLING EXPERIENCE DP Maintenance Courses

ENTER DEPTTH IN METERS 600

WPIF M/01

12TH July 2011

Rev - 02

DP Maintenance Courses HIGH VOLTAGE COURSE Dynamic Positioning Induction Course Dynamic Positioning Simulator Course Dynamic Positioning Operators CERTIFICATE Dynamic Positioning Log book Details Nautical Institute U.K.

13/10/2006 17/04/2008
26/02/2010 Limited 26/02/2010 Full DP Cert

Nautical Institute U.K.

Nautical Institute U.K.

8758

Full

Nautical Institute U.K.

Section 10
SYSTEM DETAILS

Hours done with various DP system

Approx Hours as SDPO / Approx Days in case of Senior ETO / Senior Engineer Approx Hours as DPO / Approx Days in case of Junior ETO / Junior Engineer

Kongsberg Nautronics

2400

12000 1000

APPROXIMATE Total DP Hours in Various Operations

SAT DIVING AIR DIVING ROV
WELL STIMULATION / INTERVENTION / ACTIVATION

500 300 500 400 400 400 300

CABLE LAYING SURVEY PIPE LAYING DRILL SHIP / SEMI SUB PSV SHUTTLE TANKER
ROCK DUMPING / MATTRESSING

6000 8000 -

AHTS FPSO CONSTRUCTION CORING HEAVY LIFT

TRENCHING
ACCOMMODATION / GANGWAY

Page 3 of 7 Section 11 Medical History

YES Have you ever signed off a ship due medical reason ? Have you undergone any medical operations in past ? Have you consulted a doctor during the past 12 months for an illness / Accident Do you have any health or disability problem now ?? If answer to any of above is YES then give further details below or on a separate sheet NO
x x x x

WPIF M/01

12TH July 2011

Rev - 02

NOTE : All our clients have STRICT Alcohol and Drug Policy, Which means ZERO TOLERENCE for alcohol and drugs
Section 12 General
Yes
Have you ever been the subject of a court of enquiry or involved in a maritime accident Have you ever had a professional licence suspended or revoked Have you ever been convicted of any criminal offence? Have you ever been dismissed If yes to any of above then please full details below or on separate sheet of paper
x x x x

No

Section 13
Name of company

References

(Last Two Recent Employers)

MSH Andre van Torren Fax

Name Person to be contacted Address Tel No Email +971554033914

fp@mshshipmanagement.com fp@mshshipmanagement.com Kito Enterprises LLC Andre van Torren Fax

Name of company Name Person to be contacted Address Tel No Email +971554033914 n/a

Section 14

Any other information, you wish to add in support of your application

Am an experienced mate ,well motivated having many hours in backgroung working on PSV ,AHTS,PIPE LAYER vessels from DP class 1 up to Class 3.

Section 15

Declaration

I hereby declare that the above particulars are true and I authorize you to contact the referees listed above And confirm that All my certificates / Licences are Authentic / SEASERVICE RECORD is ACCURATE / And I confirm accepting Companies DRUG & ALCOHOL Policy

Signed Dumitru Gheorghe-Cristian

Date22/06/13 Page 4 of 7

WPIF M/01

12TH July 2011

Rev - 02

Section 16 VESSEL

Record of Sea Service

Please give full record of sea service

(All Dates to be entered as dd/mm/yy)

STARTING FROM LAST VESSEL FIRST

Type of Engines Or DP System

COMPANY

Type of Vessel
And Type of operation in case of DP vessels Pipe Layer Pipe Layer Pipe Layer

GRT

BHP

RANK

Sign on DATE dd / mm / yy

Sign off DATE dd / mm / yy

6 weeks on/off since Jan.2013 6 weeks on/off since OCT.2012 6 weeks on/off sinceJuly 2010 15/05/10

C-Master C-Master C-Master Dalfrey Tide Ken C. Tamblin Desoto Tide Sea Hero Bourgeois Tide Bourgeois Tide Bourgeois Tide Sea Bear

MSH (formerly Kito Enterprises) Kito Enterprises Kito Enterprises Tidewater Tidewater Tidewater Tidewater Tidewater Tidewater Tidewater Tidewater

10000 10000 10000 2000 3100 2800 1600 1700 1700 1700 2590

Kongsberg SDP 21+11 DP Class 3 Kongsberg SDP 21+11 DP Class 3 Kongsberg SDP 21+11 DP Class 3 Kongsberg DP Class 1 Kongsberg DP Class 2 Kongsberg KPOS DP Class 2 Kongsberg DP Class 1 Kongsberg DP Class 1 Kongsberg DP Class 1 Kongsberg DP Class 1 N/A

Chief Officer /SDPO First Mate/SDPO DPO SDPO/ChiefMate SDPO/ChiefMate SDPO/ChiefMate SDPO/ChiefMate DPO/ChiefMate DPO/ChiefMate DPO/ChiefMate 2nd Mate

6 weeks on/off since Jan.2013 6 weeks on/off since OCT.2012 6 weeks on/off sinceJuly 2010 12/02/10 11/09

PSV PSV PSV PSV PSV-zDrive PSV-zDrive PSV-zDrive AHTS

17/12/09 09/09/09 11/2009 10/07/09 07/01/09 14/09/08 21/01/08 16/06/07

14/04/09 14/10/08 29/05/08 18/10/07 15/03/07

WPIF M/01

12TH July 2011

Rev - 02

J.Hugh Roff JR. Stipe Tide Wilbert Tide Art Carlson Oil Traveller McNee Tide

Tidewater Tidewater Tidewater Tidewater Tidewater Tidewater

AHTS AHTS AHTS PSV-zDrive PSV-zDrive AHTS

2223 1720 1598 3183 1919 2590

Nautronics 1 Kongsberg DP Class 1 Kongsberg DP Class 2 Kongsberg DP Class 2 Kongsberg DP Class 1 N/A

2nd Mate 2nd Mate 2nd Mate 2nd Mate 2nd Mate 2nd Mate

29/11/06 18/10/06 07/07/06 11/05/06 22/11/05 12/06/05

17/01/07 29/11/06 27/07/06 07/07/06 26/02/06 22/10/05

WPIF M/01

12TH July 2011

Rev - 02

Type of Engines :: for engineers only, DPOs to Mark DP System

BHP : for Engineers and AHTS / TUG Masters & Officers

Page 5 + 6 of 7

WPIF M/01

12TH July 2011

Rev - 02

ADDITIONAL INFORMATION SHEET VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority)
1.Pipe lay 2. Cable lay 3. Survey 4. PSV 5. AHTS

MAXIMUM ACCEPTABLE CONTRACT PERIOD (Please indicate below)

2 months on/off rotation

Please Quote Consolidated MINIMUM MONTHLY SALARY ( no leave pay ) payable for time onboard only or Working DAY RATE EXPECTATION ( no leave pay) ( please quote below in US$ -preferred or Euro or GBP ) DAY RATE EXPECTATION-600 Euro Languages Spoken / Written / Understood (1-poor Spoken 5 ENGLISH 5-Fluent) Written
5 5

Understood

DRUG & ALCOHOL POLICY

ALL Our Clients have very strict NO DRUG and ALCOHOL POLICY, Which is required to be complied with at all times, which means ZERO TOLERENCE on ALCOHOL & DRUG Your body must NOT have any ALCOHOL or DRUG substances from the time you board your flight or commence your travel to join vessel, and Must remain so Until you have completed full contract and returned to your home Airport / Town If during the said period you are found under the influence of DRUG or ALCOHOL then ALL EXPENCES incurred which will include all your travel and recruiting costs, And your reliefs Travel and recruiting costs, And Any other costs whatsoever incurred due to your NONCOMPLIANCE will be deducted from your salary, Which will include but not limited to damage to vessel her equipments and machineries, loss of charter, and any other costs Directly or indirectly connected with your NON-COMPLIANCE Sign & CONFIRM ACCEPTANCE OF ABOVE POLICYDumitru Gheorghe-Cristian
FOLLOWING DOCUMENTS COPIES MUST BE SENT TO US- send to us In separate Email Licence or Certificate of competency, Any tanker endorsements, GMDSS showing expiry date in case of Deck Officers, Medical Fitness / Examination Certificate, Passport Main page, Seaman book or Discharge book Main pages, In case of DPO DPO Cert, DP LOG Pages
FOLLOWING ADDITIONAL DOCUMENTS will ALSO BE REQUIRED Send to us in separate email

All short courses certificates ( STCW95 ), SSO certificate, Last 3-5 years ships entries in Discharge book or Seaman book, Certificate of Equivelant Competency from other flag states

PAGE 7 of 7

WPIF M/01

12TH July 2011

Rev - 02