SSM United - Ship Management Ltd.

Photo
Address: 114. Brigade 12, 21000 Split, Croatia
Telephone: ++385 (0)21 558 558
Fax: ++385 (0)21 558 555
E-mail: ssm-personnel@ssm.hr

PERSONAL INFORMATION
RANK APPLIED FOR: CIVIL STATUS:
AVAILABLE FROM: SCHOOL LEVEL EDUCATION:
NAME: NATIONAL STCW LICENSE REGULATION:
SURNAME: COVERALL SIZE:
DATE OF BIRTH SHOES SIZE:
PLACE OF BIRTH: WEIGHT(kg):
HOW DID YOU FIND OUT ABOUT US? HEIGHT(cm):
MOBILE: PREVIOUS EMPLOYER 1:
SKYPE: EMPLOYER'S EMAIL,TEL:
PHONE: PREVIOUS EMPLOYER 2:
FAX: EMPLOYER'S EMAIL,TEL:
E-MAIL: LAST WAGE (INCLUSIVE OF LEAVE PAY):
ADDRESS(CITY): LANGUAGES:
COUNTRY: SMOKER: (YES/NO)
NATIONALITY: TATTOO: (YES/NO) check last sheet
NEAREST AIRPORT: GDPR REGULATIONS check last sheet

NEXT OF KIN INFORMATION

NAME: SURNAME:
DATE OF BIRTH PLACE OF BIRTH:
ADDRESS(CITY): E-MAIL ADDRESS:
COUNTRY: FAX NO:
PHONE: RELATIONSHIP:
MOBILE NO:

RECORD OF SEA SERVICE (list from begining to present)

VESSEL NAME RANK VESSEL TYPE/GRT ENGINE TYPE/POWER(KW) CREW MANAGER/OWNER FROM - TO

ABB EXLANATION ABB EXPLANATION ABB EXPLANATION ABB EXPLANATION

CON Container FPSO Float.Prod.Storage LPG LPG Carrier O/O Ore/Oil Carrier
CHM Chem Carrier GCD General Cargo MLP Multi-Purpose OTH Other
CH3 Chem Carrier IMOIII HLV Heavy Lift Vessel MSV MultiService Vessel PAS Passenger Ship
DRG Dredger LSH Lash NVL Naval Ship RFG Reffer Vessel
DP Dynamic Position LIV Live Stock Carrier RIG Offshore Oil Rig R/R Ro/Ro Vessel
FSH Fishing Vessel LNG LNG Carrier OSV Offshore Supply Vessel PRR RoRo Passenger V
FSO Floating Storage LOG Log/Timber OBO Ore/Bulk/Oil Carrier SAL Sailing Vessel
SRV Survey Vessel SUL Self Unloader TUG Tug YAT Yacht
TNB Tanker(Bitumen) TNC Tanker(Crude) TNP Tanker Product TNS Tanker Storage
TNV Tanker VLCC/ULCC
Retaining period: 5 years Form FK-01
* Details to be insterted in capital letters
 SSM United - Ship Management Ltd.

NATIONAL DOCUMENTS
DOCUMENT NAME NUMBER PLACE DATE OF ISSUE DATE OF EXPIRY

Passport
U.S.A Visa
U.S.A Visa C1/D
Medical Fitness Certificate
Dental Certificate
Yellow Fever Vaccination
Cholera Vaccination
National Seaman's Book
National Certificate of Competence (License)
GMDSS Operator
Watchkeeping Certificate for Ratings
Basic Safety Training Certificate (OR)
1. Personal Survival Techniques
2. Fire Prevention and Fire Fighting
3. Elementary First Aid (IMO 1.13)
4. Personal Safety and Social Responsibility
Proficiency in Survival Craft and Rescue Boats
Proficiency in Fast Rescue Boats
Advanced Fire Fighting
Medical First Aid (IMO 1.14)
Ship Security Awareness - SSA
Proficiency in designated security duties - PDSD
Medical Care (IMO 1.15)
Radar Observer
A.R.P.A.
Hazardous Cargo Training Certificate (Hazmat)
Ship Security Officer
ECDIS
Bridge Team Management Training Certificate
Bridge Resources Management
Engine Room Team Mangement
Engine Room Resources Management
Ship Handling and Maneouvring
ISPS Familirization
ISM Code Familirisation
Tanker familirization course
Advance Oil Tanker training programme
Advance liquid gas tanker operations
Advance Chemical Tanker training programme
Liquid cargo operations simulator
Security training
LT (Leadership training)
EA (Environmental awareness)
For additional documents use page 4.
OBLIGATORY ANSWERS:
1. Have you ever been denied a foreign visa? YES NO
2. Have you ever been the subject of a court of anquiry or involved in a maritime incident?
If yes, please clarify! YES NO

3. Are you banned temporarly or permanently from entering any country in the world?
YES NO
Retaining period: 5 years Form FK-01
* Details to be insterted in capital letters
 SSM United - Ship Management Ltd

CV
PLEASE WRITE HERE ANY ADDITIONAL INFORMATION ABOUT YOURSELF THAT YOU FIND NOTEWORTHY

REFERENCE NOTES:
Name of company: Name of contact person: Telephone number: E-mail address:

Retaining period: 5 years Form FK-01

* Details to be insterted in capital letters
 SSM - Ship Management Ltd

FOREIGN FLAG STATE DOCUMENTS

Document Grade Number Place of Issue Date of Issue Date of Expiry

BERMUDA:

Seafarer's Book

Endorsement of the CoC

Certificate for watchkeeper

CYPRUS :

Seafarer's ID/Sea Ser.Record Book

Cert.Of Recognition of National CoC

Cert.Of Rec.of National GMDSS GOC

LIBERIA :

Seaman's ID and Record Book

Endorsement of the CoC

Endorsement of the GMDSS GOC

MARSHALL ISLANDS :

Seafarer's ID/Record Book

Endorsement of the CoC

Endorsement of the GMDSS GOC

BAHAMA:

Endorsement of the CoC

Seaman's ID/Record Book

UNITED KINGDOM:

Endorsement of the CoC

Seaman's ID and Record Book

PANAMA:

Endorsement of the CoC

Endorsement of the GMDSS GOC

Seaman's Identification and Record Book

OTHER ( pls specify MALTA OR ST.VINCENT OR ANTIGUA&BARBUDA ETC):

REMARKS

Retaining period: 5 years Form FK-01

* Details to be insterted in capital letters
 SSM United - Ship Management Ltd

GDPR REGULATIONS

Consent to Use Job Application Data (GDPR)

The General Data Protection Regulation (GDPR) is a Regulation of the European Union and, from 25 May 2018, it
applies to all organisations that collect and process the personal data of EU citizens. As a responsible, forward-looking
business, SSM United recognises at senior levels the need to comply with the GDPR and ensure that effective
measures are in place to protect the personal data of our customers, employees and other stakeholders.

As part
of any recruitment process, SSM United collects and processes personal data relating to job applicants and training
aplicants. The company is committed to being transparent about how it collects and uses that data and to meet its data
protection obligations as per GDPR regulation. This Statement aims at informing you of how SSM United is going to
use the information you submit when applying for a job or a training course in our training centre.

Data will be stored in a range of different secured places, including on your application record, in HR management
systems, in Training Centre systems and on other IT systems (including email).

We need to process data to take steps at your request prior the employers to entering into a contract with you. We may
also need to process your data for the employers to enter into a contract with you. In some cases, we need to process
data to ensure that we are complying with its legal obligations. We need to process data to applay seafarers to Croation
Ministry of Sea, Transport and infrastructure, and to issue the certificates. Data proccesed are: name and surname,
OIB, passport number, address, phone number, seamans book number, nationality, date and place of birth, rank, e-
mail, certificate of competency number.

SSM United has a legitimate interest in processing personal data during the recruitment process and for keeping
records of the process. Processing data from job applicants allows us to manage the recruitment process, assess and
confirm a candidate's suitability for employment and decide to whom to offer a job.

If your application is unsuccessful, SSM United may keep your personal data on file in case there are future
employment opportunities for which you may be suited. You are free to withdraw your consent at any time. If your
application for employment is successful, personal data gathered during the recruitment process will be transferred to
your Employer and retained during your employment.

Providing your Job Application data is voluntary. However, if you choose not to provide all of the data that is
requested for your application, our ability to consider you as a candidate may be limited.

The Job Application data you provide will be used to assess your application for employment, to verify your
information and conduct reference checks, and to communicate with you and inform you of further career
opportunities. If employment you accept employment with our clients, the information collected will become part of
your employment record and will be used for employment purposes.

By submitting your Job Application data and clicking on button below you are granting your consent to the processing
of that information, including to the transfer of your Job Application data in accordance with this Statement.

By clicking this button I allow processing of information mentioned in this application

Retaining period: 5 years Form FK-01

* Details to be insterted in capital letters