Officer Application Form Name

(for official use)

Laurentiu Nicusor
ver 008 / 12.2019

LOCATION YOU ARE APPLYING FROM: Romania

Country (please specify if other)

APPLICATION FOR POSITION AS: Second Officer

AVAILABILITY DATE : 01-Nov-2020

dd-mmm-yyyy

Name: Laurentiu Nicusor Popa

first name middle initials last name / surname

Nationality: ROMANIAN

Full address : Str. Dorobantilor, No 48, Bl A55, Ap 103, Braila City, Romania

Country : Romania Postal Code :

E-mail id : laurentiunicusorpopa@gmail.com

Home/ Alternate telephone no: Mobile phone : +40755075343

Domestic Airport : International Airport :

Bucharest Henri Coandă

Marital Status : Married

Full Name of Next of Kin : Popa Daniela Relationship : Wife

Str. Dorobantilor, No 48, Bl A55, Ap 103, Braila City, Romania

Address of Next of Kin :

Contact Number of Next of Kin : +400758555158 Email of Next of Kin : moca.daniela86@gmail.com

Person to Contact In Case Of Emergency or Accident

Name : Popa Daniela

Relationship with Person : Wife

Address :
Str. Dorobantilor, No 48, Bl A55, Ap 103, Braila City, Romania

Contact Number : +40758555158

Do you hold a passport with at least 1 year of validity? Yes No Issuing authority Braila

Do you hold a Seaman book with at least 1 year of validity? Yes No Issuing authority Constanta

Do you have Yellow Fever vaccination with at least 1 year of validity? Yes No

Do you hold all valid STCW certificates mandatory for the rank applied for?
Yes No

If select "No", please list down the STCW certificates that are lacking.

Certificate of Competency (COC)

Date of Issue Date of Expiry

Grade Issuing Authority Number Place of Issue
(dd-mmm-yyyy) (dd-mmm-yyyy)

Mate 1st Class ANR 81250 29-May-2018 18-May-2021 Constanta

Classification: Public_x000D_ Classification: Public

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 Officer Application Form Name
(for official use)
Laurentiu Nicusor

IMPORTANT - THIS PAGE WILL BE SHARED WITH TECHNICAL INTERVIEWER

Value-added Courses Done in Last 5 Years
Course Name

1.Ship Security Officer 6. Proficiency in survival craft and rescue boats, other than fast rescue boats

2.ECDIS Generic 7.Certificate of Proficiency Security Awarness

3. Basic Training 8. Medical Care

4. Advanced Fire-fighting 9. Radar Arpa, Bridge Teamwork and Search and Rescuce

5. Human Element, leadership and management 10. Genera; Operator for GMDSS (GOC)

Employment History (Please Start With Your Latest Sailing Experience On Top Row )
Type of Vessel
Please complete all fields
Voyage
From To Total Type
Company Name of Vessel (Foreign Rank Reefer
(dd-mmm-yyyy) (dd-mmm-yyyy) MM-DD Vessel TEU
Going / GRT TEU BHP UMS Main Engine
Coastal) Type (For E/E
only)

Foreign Second Bulk

Orion Intrepid 17-Jan-2020 16-Jul-2020 5 - 29 30046
Going Officer Carrier

Foreign Second Bulk

Orion Concordia 09-Mar-2019 10-Sep-2019 6-2 43069
Going Officer Carrier

Foreign Second Bulk

Orion Bellatrix 29-Jul-2018 11-Nov-2018 3 - 14 40424
Going Officer Carrier

Foreign Second Bulk

Orion Hero 12-Jul-2017 03-Feb-2018 6 - 23 91373
Going Officer Carrier

Foreign Third Bulk

Orion Rugia 09-Sep-2016 16-Feb-2017 5-8 91374
Going Officer Carrier

*In Case You Have More Sea Experience, Please Utilise The Additional Seatime Sheet

Date when Promoted to Current Rank : 12-Jul-2017

dd-mmm-yyyy

2 weeks
Notice Period

Upon shortlisting, may we contact your last employer for reference check? Yes No

By ticking the box or signing below, I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or
lead to my dismissal if hired. And I have read the Maersk Data Privacy Statement* and I accept it. I also accept that my internal data is shared with the responsible recruiter, interviewers and hiring manager.

Click here Maersk Data Privacy Statement

1/10/2020 Popa Laurentiu Nicusor

Date Signature
dd-mmm-yyyy

Classification: Public_x000D_ Classification: Public

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 Officer Application Form Name
(for official use)
Laurentiu Nicusor

Where did you find out about our recruitment exercise?

Please Tick Specify Details
Newspaper

Flyers

Friends / Family members already in this organization

Internet X

Maersk Website X

Others: Please specify

Classification: Public_x000D_ Classification: Public

# # Page 3 of 4
 Officer Application Form Name
(for official use)
0

IMPORTANT - THIS PAGE WILL BE SHARED WITH TECHNICAL INTERVIEWER

Employment History (Please Start With Your Latest Sailing Experience On Top Row )
Type of Vessel
Voyage Please complete all fields
From To Total Type
Company Name of Vessel (Foreign Rank Reefer
(dd-mmm-yyyy) (dd-mmm-yyyy) MM-DD Vessel TEU
Going / GRT TEU BHP UMS Main Engine
Coastal) Type (For E/E
only)

ver 005/ 01.2018_x000D_ Classification: Public

#