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Please fill in and send to nlashiprushrd@maersk.

com

DECK CADET
CONTAINER VESSEL
8TH JANUARY 2017

Position applied for:


Type of vessel
Availability date:

Are you responding to a media


advertisement?
If YES, please state which publication

Yes
Internet

Surname: TIPIAN SOSA

First Name: RENZO ALESSANDRO

Nationality: PERUVIAN

Date of Birth:
01/10/1993

Place of Birth: LIMA

Age:

22

Passport
Number

Place of Issue

Peru

3251414

Date of Issue

Date of Expiry

11/10/2015

11/10/2020

Issuing Authority

IMMIGRATIONS PERU

Seamans Book
Number

Place of
Issue
Peruvian

Date of Issue
11/10/2015

G45L1

Issuing
Authority
COAST
GUARD AND
HARBOUR

Date of
Expiry
11/10/2020

Remark

U.S. Visa
Type

Date of Issue

Date of Expiry

Place of Issue

B1/B2

11/09/2015

11/09/2019

LIMA-PERU

Remark

Education Background
School / College

From

I.E 6048JORGE
BASADRE

NATIONAL SCHOOL
MERCHANT MARINE

To

Highest Qualification Attained

2005

2010

COLLEGE CERTIFICATE

2013

2017

BACHELORS MARINES SCIENCE

Personal details
Full address
Str. 2 gpo 24 mz L lte 14
Postal Code:

051

Country:Peru
E-mail:
(required)* renzotipian@gmail.com

Home telephone no: 015701524


Contact/Mobile phone: +511 930484656
Domestic Airport:

International Airport: JORGE CHAVEZ


INTERNATIONAL
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Marital Status: SINGLE


Full Name of Next of Kin: GIOVANNA SOSA MURGA

Relationship: MOTHER

C/Eng

GMDSS
Issuing Authority

Number

Date of Issue

Date of Expiry

Place of Issue

Dangerous Cargo Endorsements (DCE)


Type of
Endorsement

Grade / Level
I / II

Issuing
Authority

Number

Date of Issue

Date of Expiry

Chemical
Oil
Gas

Details of other marine courses / STCW short course certificate


Type of Marine Course
Tanker Familiarization
Adv. Tank. Ops. (inc.COW
&IGS)
Radar Observer

Place of Issue

Number

LIMA-PERU

HG57H658

LIMA-PERU

LIMA-PERU
LIMA-PERU
LIMA-PERU

JG686HJ8
H77907J
HU89535

First Aid
Medical & First Aid

LIMA-PERU

H798KIBP

Ship Master Medical Guide


Personal Survival

LIMA-PERU

JU786J8J7

LIMA-PERU

HU786HHO

LIMA-PERU
LIMA-PERU

KI87KJ780

Proficiency In Survival Craft


Advance Fire Fighting
Chem. Tanker Familiarization
Chem. Tanker Advanced

Date of Expiry

JHY697H7

ARPA
Radar Simulator

Basic Fire Fighting


Human Relationship-PSSR

Date of
Issue

KJ685GR

Ship Security Officer (SSO)


ECIDS( DECK OFF)

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Employment History
*

Vessel

E
x
p
e
i
e
n
c
e
d

Company

Vessel
Type

Flag

DWT/
TEU*

Year
Built

Main Engine
Make

Type

on container vessels please fill in TEU


**
Required for engineer applicants only
**

Required for engineer applicants only,

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B.H.P.
**

Rank

Sign on
date

Sign off
date

Total
mm/dd

Reason for
leaving
r

Date when promoted to Current Rank :

Other Personal Details


Height : 173

Weight: 72

Color of Hair: black

Color of Eyes : dark brown

Safety shoes: 42

Boiler suit: 32

Distinguishing Marks :
A beauty mark on my left side of my cheek

References
Do you have any objection if we will contact your last employers for reference
Reference?
If NO please specify below:

Yes

Please give the name and address of your current or immediate past employer
Name of company
Name of person to contact
Address
No.

Please list two contactable referees or past employers


Name of company
Name of person to contact
Address
No.

Banks Name:
Banks Address:

Banks Name:

Type :

Current / Savings

Bank Swift Code:


Intermediary Bank Details (If Applicable):
* Please be informed that the bank account provided must be in your name as shown in your passport.

Person to Contact In Case Of Emergency or Accident


Name: GIOVANNA SOSA MURGA
Address: STR 2 GPO 24 ML Lte 14

Residential Contact: +511 991767841

Mobile Contact: +511 959202483

Medical Fitness Certificate


Date of Issue

Date of Expiry

22/11/2016

07/11/2017
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Yellow Fever Vaccination


Date of Issue

Date of Expiry

22/11/2016

05/11/2017

Medical History
Have you ever signed off from a ship due to Medical reasons?
(If Yes give details)

No

Name of Vessel

Date of Occurrence

Brief Description of Illness / Injury / Accident

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge
and belief; further, that no Certificate of competency or License issued to me has ever been Revoked or Suspended. I
also certify that my medical history contained above is true and any false statement or undisclosed Material information
about past illness or injury will disqualify me from any employment benefits and claims.

Date _11.10.2007__________
_______________________

Signature

*The company may contact my previous employer for references.

Comments (for company use only)

APM id no:

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