CMA SHIPS Singapore CREWING MANUAL SECTION 3

Ref: Crew/Form/01b Version:01/03/2014

TITLE: APPLICATION FORM FOR CADETS

CADET APPLICATION FORM ATTACH

RECENT
PHOTO
CMA Ships ROMANIA MANDATORY
13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail: cnz.application@cmaships.com
Personal data operator no.19478
Position applied for CMA CGM Vessel * :
Availabibity date:
* : For RTO, indicate the proposed vessel and, availability Date and planned duration

Are you applying upon personal or professional recommendation? YES/NO

If YES, please state who

Surname: First name:

Other names Known as Nationality:

Place of birth: Date of Birth: Age: Male Female

Passport
Number Place of issue Date of issue Date of expiry Issuing Authority

Visas
Type Number Place of issue Date of issue Date of expiry
C1/D (USA)
Australia Entry visa
MCV (Australia)
Schengen

Education Background
Nautical School / College / University From To Highest qualification attained

Personal details
Full address:

Postal code: Country:

E-mail:

Home tel number:

Mobile phone:

Domestic Airport International Airport

Marital status:

Full name of Next of Kin: Relationship

Address of Next of Kin if
different from above
Phone
if different from above

Dependents
Name Date of birth Age Gender Relationship

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CMA SHIPS Singapore CREWING MANUAL SECTION 3

Ref: Crew/Form/01b Version:01/03/2014

TITLE: APPLICATION FORM FOR CADETS

Person to contact in case of emergency

Name: Relationship

Address:

Phone number: Mobile number:

National Seaman's Book

Number Place of issue Date of issue Date of expiry Issuing Authority

National Cadet Diploma

Grade Issuing Authority Number Date of issue Date of expiry Place of Issue Date revalidated Date expiry

Medical Fitness Certificate

Type Date of issue Date of Expiry

Yellow Fever Vaccination

Date of Issue Date of Expiry

Foreign languages other than English

Language Level:
Beginner Intermediate Advanced

Personal details
Height: Weight: Colour of Hair:

Colour of eyes: Safety shoes size: Boiler suit size:

Uniform Shirt size: Uniform Trousers size:

Details of other Marine courses

IMO model
Type of Marine Course Reference- Regulation Number Date of issue Date of expiry
course
1.19 - 1.20 1.13 - STCW Reg.
Basic Training 1.21 A-VI/1-1 to A-VI/1-4
Personal Survival STCW Reg. A-VI/1-1
1.19
Techniques
BASIC TRAINING

STCW Reg A-VI/1-2

Basic Fire Fighting 1.20

STCW Reg A-VI/1-3

Elementary First Aid 1.13

Personal Safety & Social STCW Reg A-VI/1-4

Responsibilities (Human 1.21
Relationship)

STCW Reg A-VI/2 par 1.3

Proficiency in survival craft & Rescue Boats 1.23

STCW Reg A-VI/4-1

Medical First Aid 1.14

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CMA SHIPS Singapore CREWING MANUAL SECTION 3

Ref: Crew/Form/01b Version:01/03/2014

TITLE: APPLICATION FORM FOR CADETS

STCW Reg A-VI/4-2 par 2

Medical Care 1.15

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CMA SHIPS Singapore CREWING MANUAL SECTION 3

Ref: Crew/Form/01b Version:01/03/2014

TITLE: APPLICATION FORM FOR CADETS

Employment history
Vessel * Manning Agent Vessel type ** Flag Position Sign on date Sign off date Total mm/dd

* or industry sector if ashore

** Use abbreviation: PC = Pure container, GC = General Cargo, BC = Bulk Carrier, LNG = Tanker, LPG = Tanker, Chem = Chemical, RoRo = Roll on Roll off

*** Use abbreviation: MR = Medical Reason, VS = Vessel Sold, EOC = End of Contract

Regional Training Officer 's Selection Criteria

Level of English Writing : Speaking :

VOA / Pre Employment Test result :

Cadet details, Diploma and Certificates posting into MAP Yes No

Assessed potential of the Cadet :

Date Place Signature

Cadet's commitment to follow CMASHIPS training monitoring program

I, undersigned _________________ certified that I received detailed information to the CMASHIPS Cadet Training Monitoring Program

and I received a copy of the CMASHIPS Cadet Guide which was presented and fully explained.

I certify that I will comply to the Cadet training program under supervision of the Traing Officers on board and ashore.

Date Place Signature

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ACORDUL PERSOANEI CARE SOLICITA
SERVICIUL DE RECRUTARE SI PLASARE IN DOMENIUL NAVIGANT
cu privire la prelucrare si transmitere a datelor cu caracter personal

Subsemnatul:

Cod identificare (CNP/Pasaport):

CMA Ships ROMANIA
13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail:
cnz.application@cmaships.com Personal data operator no.19478

1. Îmi exprim în mod expres consimtamântul ca societatea comerciala CMA SHIPS

ROMANIA S.R.L (denumita in continuare CMA SHIPS ROMANIA) inregistrata ca operator de
date cu caracter personal nr. 19478 sa prelucreze informatiile indicate la punctul 2 de mai jos
inregistrate pe numele meu in evidentele proprii si sa transmita aceste date catre societati de
shipping si/ sau crewing, cum ar fi, dar fara a se limita la acestea, CMA SHIPS (persoana
juridica franceza cu sediul in 4, Quai d’Arenc 13002 Marseille, France).

Imi exprim, de asemenea, acordul ca CMA SHIPS ROMANIA sa solicite date cu privire la
persoana mea de la institutii/societati, precum si consultarii informatiilor înregistrate pe numele
meu în bazele de date ale acestora, ori de cate ori este necesar, in scopul initierii si/ sau derularii
procesului de analizare si/ sau aprobare a solicitarii mele in vederea recrutarii/ plasarii ca
personal navigant.

2. Informatii prelucrate:

a) date cu caracter personal având functie de identificare precum (nume, prenume, data si local
nasterii, cod numeric personal, domiciliul, sex, numar de telefon fix/ mobil/ fax, adresa de
email, starea civila, numar de copii, fotografia, inaltimea, greutatea, numele si adresa
angajatorului actual si/ sau a angajatorilor anteriori, data angajarii, ocupatia, pasaport, carnet de
marinar, vize)

b) informatii legate de educatia si pregatirea profesionala (studii, limbi straine cunoscute precum
si gradul de cunoastere a acestora, licente, certificate de capacitate, cursuri IMO)

c) informatii referitoare la activitatea anterioara (experienta pe functie si tipuri de nave,

calificativele obtinute , numele navelor, datele de imbarcare si debarcare, datele de contact ale
operatorilor navelor respective, nationalitatea celorlalti membrii de echipaj cu care a servit la
bordul navelor).
d) date referitoare la functia pentru care aplica, tipul/ tipurile de nave de care este interesat, data
de la care este disponibil, salariul minim acceptat.

Am luat la cunostinta faptul ca îmi pot exercita toate drepturile prevazute de Legea nr.
677/2001 pentru protectia persoanelor cu privire la prelucrarea datelor cu caracter
personal si libera circulatie a acestor date, publicata în Monitorul Oficial nr.
790/12.12.2001, în mod special urmatoarele drepturi:

(i) Dreptul de acces la date: dreptul de a obtine la cerere si în mod gratuit, pentru o solicitare
pe an, confirmarea faptului ca datele în legatura cu mine sunt sau nu prelucrate de catre un
anumit operator. In ceea ce priveste CMA SHIPS Romania., acest drept poate fi exercitat in
urmatoarele conditii: se adreseaza o cerere catre CMA SHIPS Romania, intocmita in forma
scrisa, datata si semnata in care se va mentiona adresa de domiciliu a persoanei care isi
exercita dreptul. Cererii i se va atasa o copie xerox, lizibila, dupa actul de identitate al
solicitantului;

(ii) Dreptul de interventie: dreptul de a obtine, la cerere si în mod gratuit, rectificarea,

actualizarea, blocarea, stergerea sau transformarea in date anonime a datelor a caror prelucrare
nu este conforma legii, în special a datelor incomplete sau inexacte. In ceea ce priveste CMA
SHIPS Romania acest drept poate fi exercitat in urmatoarele conditii: se adreseaza o cerere
catre institutia care a inscris datele la CMA SHIPS Romania intocmita in forma scrisa, datata si
semnata, in care se vor mentiona datele asupra carora se solicita interventia, motivul justificat
si modul de interventie. Cererii i se va atasa o copie xerox, lizibila, dupa actul de identitate al
solicitantului;

(iii) Dreptul de opozitie: de a ma opune în orice moment, din motive întemeiate si legitime
legate de situatia mea particulara, ca datele care ma vizeaza sa faca obiectul unei prelucrari, cu
exceptia cazurilor in care exista dispozitii legale contrare. In ceea ce priveste CMA SHIPS
ROMANIA. acest drept poate fi exercitat in urmatoarele conditii: se adreseaza o cerere catre
CMA SHIPS ROMANIA, intocmita in forma scrisa, datata si semnata, in care se vor mentiona
datele asupra carora se solicita opozitia si motivul intemeiat si legitim legat de situatia
particulara a persoanei. Cererii i se va atasa o copie xerox, lizibila, dupa actul de identitate al
solicitantului.
AGREEMENT OF THE PERSON WHO APPLIES
SEA-GOING RECRUITMENT AND CREWING SERVICE
In relation to personal data processing and submission

I, the undersigned:

Identification Code (Personal Number/Passport):

CMA Ships ROMANIA
13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail:
cnz.application@cmaships.com Personal data operator no.19478

1. I express expressly my consent that the trading company CMA SHIPS ROMANIA S.R.L
(hereinafter CMA SHIPS ROMANIA) registered as personal data operator no. 19478 to process
the information indicated in paragraph 2 below registered in my name in its own records and
submit these data to other shipping and/ or crewing companies, such as, but not limited to, CMA
SHIPS (French legal person with the registered office in 4, Quai d’Arenc 13002 Marseille,
France).

I also express my consent for CMA SHIPS ROMANIA to inquire data about me from
institutions/companies, as well as to consult the information recorded on my name in their
databases, whenever necessary, on purpose to initiate and/ or develop the review and/ or
approval process for my application for the recruitment/ crewing as sea-going personnel.

2. Processed information:

a) personal data with identification function such as (surname, name, date and place of birth,
personal number, domicile, sex, fixed/ mobile/ fax number, email address, civil status, number
of children, photograph, height, weight, name and address of present employer and/ or previous
employers, date of employment, occupation, passport, seaman book, visas)

b) information related to professional education and training (studies, foreign languages known,
as well as their degree of knowledge, licenses, ability certificates, IMO courses)

c) information related to previous activity (experience on positions and types of ships, ratings
obtained, names of ships, embarking and debarking dates, contact data of those ship operators,
nationality of the other crew members with whom he served on board the ships).

d) data related to the position for which he applies, type/ types of ships he is interested in, date
from which he is available, minimum wages accepted.

I took note of the fact that I may exercise all the rights provided by Law no. 677/2001 on
persons’ protection in relation to personal data processing and free circulation of these
data, published in the Official Gazette no. 790/12.12.2001, especially the following rights:

(i) Right of access to data: the right to obtain upon request and free of charge, for one
application per year, the confirmation of the fact that the data related to me are processed or not
by a specific operator. In relation to CMA SHIPS Romania., this right may be exercised under
the following conditions: an application is submitted to CMA SHIPS Romania, drawn up in
written form, dated and signed in which the domicile of the person who exercises his right shall
be mentioned. A Xerox, legible copy of the applicant’s identity document shall be attached to the
application;

(ii) Intervention right: right to obtain, upon request and free of charge, the rectification,
updating, blocking, deletion or transformation in anonymous data of the data whose processing
does not comply with the law, especially incomplete or inaccurate data. In relation to CMA
SHIPS Romania, this right may be exercised under the following conditions: an application is
submitted to the institution which recorded the data at CMA SHIPS Romania drawn up in
written form, dated and signed, in which the data on which the intervention is required, the
justified reason and the intervention manner shall be mentioned. A Xerox, legible copy of the
applicant’s identity document shall be attached to the application;

(iii) Opposition right: to oppose in any moment, for any justified and legitimate reason related
to my particular situation, to the processing of the data that regard me, except for the cases in
which there are contrary legal provisions. In relation to CMA SHIPS ROMANIA. this right may
be exercised under the following conditions: an application is submitted to CMA SHIPS
ROMANIA, drawn up in written form, dated and signed, in which the data on which the
opposition and the justified and legitimate reason related to the person’s particular situation
shall be mentioned. A Xerox, legible copy of the applicant’s identity document shall be attached
to the application.