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Application for Shipboard Employment for

Photo
Date of readiness: __11.11.2016____________
Position Applied
(STCW Reg) :
Family Name :
Given Name :

1.
Second Engineer
2.
Abdulachim
Emin

Date of birth:
Place of birth:

Middle Name :

City Address :

Phone, Mob, E-mail:

0723637326

11.07.1982
Age =/> 18 :
Constanta
Strada Unirii Nr.114 . Bl. U3 ,Sc. E
Ap 02

Provincial Address :

First Interview by Manning Agent :

on :
DOCUMENTS

Document

Passport No.
S/book No. (1st issue)
S/registration certificate
Flag State Service Record Book
Schengen Visa
US Visa
Other Joining Visa (Nation :
C.o.c
Grade :
Endorsement Grade :
Italian Endo. Grade :
Endorsement is valid for:

Number

Place of issue

Issued:

Expiry date:

Oil tanker

CERTIFICATES

Cert. NO.

Chemical tanker

Issued

Gas tanker

Expiry Date:

Registration:
(expiry date)

note

P.S.S.R.
Basic Firefighting
Personal Survival Tecn.
Elementary First Aid
Medical First Aid
Advanced Fire Fighting
H.E.L.M. Human Resources Elements
and Leadership Management
Proficiency In Survival Craft in Fast
Rescue Boats
Proficiency In Survival Craft & Rescue
Boats other than Fast Rescue Boats
Medical Care
Radar Basic
Radar ARPA
ARPA Bridge Team Search & Rescue
Bridge Team Management
Ship Security Officer
G.M.D.S.S./GOC
Manoeuvring & Ship Handling
Ecdis Basic
Ecdis Specific Systems
General Tanker Familiarization Course
Oil Tanker Specialized Training
Chemical Tanker Specialized Training
Inert Gas System
Crude Oil Washing
Engine Automation
Framo

*Revalidation:
(expiry date)

Endorseme
(expiry date

PMS Rina
CMS Rina
Maritime English
Medical Fitness Certificate
Yellow Fever

OTHER CERTIFICATES
Security Awareness training
Environmental Awareness

every 2 years
every 10 years

Cert. NO.

Issued

Expiry Date:

Registration:

*Revalidation:

*Endorsement

Seamans books and endorsements issued by other countries:


Type of the document

Issuing country

Pre-Sea Training / Nautical School / Institute / University /

Cert No

Qualification:

Evidences
(Please list personal impressions at the employment interview appraisals/assessments/references )

Issued:

Expiry date:

Passed:

* Revalidation : every 5 years

SEA SERVICE (starting from the last contract)


Name of vessel

Minimum Salary:

Year
built

Flag

Engine

USD

Previous employers :
Name of the Company:
( No.
Name of the Company:
( No.
Name of the Company:
( No.

BHP

Position

Marital status: married

Period of service
(dd.mm.yy)

single

Surname, Name

divorced
DOB

Ship manager / Crewing


Agency

widower

Address/Tel number:

Spouse
Children:
Next of kin

Personnel details:
Religion :
Height, cm:
Color of Hair:
Shoes size:

Type of vessel / DWT

Weight, kg:
Eyes:
Overall size:

Additional information:
Nearest Airport :
Nationalities you worked with:
Types of cargo you worked with:
Registry Certificate (for welders only) :
Knowledge of English : Fluent/Good/Poor

Yes

No

Issued by:
Marlins %

Salary

I enclose the authorization to treat my personal data according to the Romanian Law YES

NO

Signed _______________________

* Revalidation : every 5 years


CERTIFICATES

COC
P.S.S.R.
Basic Fire fighting
Personal Survival Tecn.
Elementary First Aid
Medical First Aid
Advanced Fire Fighting
Proficiency In Survival Craft & Rescue.
Medical Care

Cert No.

Issued

Expiry Date:

Registration :

Radar Basic
Radar ARPA
ARPA Bridge Team Search & Rescue
Bridge Team Management
Ship Security Officer
G.M.D.S.S. GOC
Manoeuvring & Ship Handling
Ecdis Basic
Ecdis Specific System
General Tanker Familiarization Course
Oil Tanker Specialized Training
Chemical Tanker Specialized Training
Inert Gas System
Crude Oil Washing
Engine Automation
Framo
PMS Rina
CMS Rina
Maritime English
Medical Fitness Certificate
Yellow Fever

*Revalidation :

Endorsement

every 2 years
every 10 years