Application Form - Sea Staff

Responsibility Human Resources Department Form no. 3.4a

Last Issuing Date Edition 1 / 5 - January 2020 File no.
Page 1 of 2 APPLICABILITY OFFICE

POSITION APPLIED FOR: Engine Cadet FULL NAME: Deliu Dumitru Alexandru

NATIONALITY: Romanian DATE OF BIRTH: 14.05.1998 PLACE OF BIRTH: Huși/Vaslui/Romania

PERSONAL DETAILS
MARITAL STATUS: Unmarried RELIGION: Ortodox CNP: 1980514375206
ADDRESS: Strada Fundătura Ștefan Ionescu Nr.1/ Oraș Huși/Juteț Vaslui

PHONE: 0768040066 E-MAIL: deliu_alexandru@yahoo.com

NEXT OF KIN (NAME, RELATION TYPE AND PHONE): Deliu Arhonda Didina/ My Mother/0764818046

DATE
EDUCATION: FROM TO
Academia Navală "Mircea cel Bătrân"
(NAME OF INSTITUTION)
01.10.2017 -
DETAILS OF DOCUMENTS / LICENCES / CERTIFICATES
RANK USA VISA
CERTIFICATE NUMBER (WHERE ISSUED EXPIRES
APPLICABLE) No. _________________
PASSPORT 057796632 Vaslui 22.07.2019 22.07.2029
NATIONAL SEAMAN'S BOOK 38625CT Constanța 17.07.2019 04.07.2021 EXP. ________________
NATIONAL LICENCE (CoC)
FLAG DOCs
NATIONAL LICENCE (CoC) - SECOND SPECIALIZATION (IF APPLICABLE)
NATIONAL ENDORSEMENT
MARSHALL ISLANDS
NATIONAL ENDORSEMENT - SECOND SPECIALIZATION (IF APPLICABLE)
STCW COURSES
BASIC TRAINING No. _________________
ADVANCED FIRE FIGHTING
MEDICAL FIRST AID EXP. ________________
MEDICAL CARE
LIBERIA
PROFICIENCY IN SURVIVAL CRAFT & RESCUE BOATS
MARITIME ENGLISH LANGUAGE TRAINING PHRASE VOCABULARY
GENERAL OPERATOR FOR GMDSS (GOC) No. _________________
OPERATIONAL USE OF ECDIS
SPECIFIC ECDIS COURSE-IMTECH EXP. ________________
SPECIFIC ECDIS COURSE-SPERRY
SPECIFIC ECDIS COURSE-TRANSAS MALTA
SHIP SECURITY OFFICER
SECURITY AWARENESS 00007877 Constanța 07.06.2019
BRIDGE TEAM AND RESOURCE MANAGEMENT No. _________________
ENGINE TEAM MANAGEMENT
SHIP'S HANDLING AND MANEUVERING SIMULATOR EXP. ________________
ENGINE ROOM SIMULATOR
SHIP'S COOK ________________
HCCP - Hygiene Course for Catering Personnel
BASIC TANKER No. _________________
SPECIALIZED TRAINING FOR OIL TANKERS
SPECIALIZED TRAINING FOR CHEMICAL TANKERS EXP. ________________
HELM-HUMAN ELEMENT LEADERSHIP AND MANAGEMENT -------
STCW CERTIFICATES YELLOW FEVER
FOC CERTIFICATE
SOT CERTIFICATE EXP. ________________
SCT CERTIFICATE
SHIP SECURITY OFFICER
GMDSS CERTIFICATE

If printed, this document is regarded as “uncontrolled”

Application Form - Sea Staff

Responsibility Human Resources Department Form no. 3.4a

Last Issuing Date Edition 1 / 5 - January 2020 File no.
Page 2 of 2 APPLICABILITY OFFICE

DETAILS OF PREVIOUS SEA SERVICE

(LAST VESSEL ON TOP)
PERIOD OF SERVICE
NAME OF VESSEL TYPE FLAG DWT RANK CREWING AGENCY
FROM TO

HISTRIA SHIPMANAGEMENT SRL (numita in continuare HSM) prelucreaza datele cu caracter personal furnizate de Dumneavoastra prin acest document in
scopul angajarii Dumneavoastra pe nave apartinand armatorilor straini.
Prin prezenta confirm ca am citit si luat la cunostinta Politica cu privire la Prelucrarea datelor cu caracter personal de catre HSM referitoare la Regulamentul
(UE) 2016/679 al Parlamentului European si al consiliului din 27 aprilie 2016 în ceea ce privește prelucrarea datelor cu caracter personal și privind libera
circulație a acestor date. Declar, pe proprie raspundere, ca am inteles in ce scop sunt folosite aceste date cu caracter personal, care imi sunt drepturile si
care sunt consecintele in lipsa consimtamantului de preluare si prelucrare a acestora de catre HSM, in special daca acestea sunt folosite in scopul angajarii.
Prin urmare, semnand acest formular imi acord CONSIMTAMANTUL in ceea ce priveste preluarea, prelucrarea, stocarea si transferul datelor mele
cu caracter personal, inclusiv a datelor cu caracter special, de catre HSM in scopul prestarii activitatii de crewing si posibila mea angajare la
bordul navelor apartinand armatorilor straini.

Semnatura navigator ________________________

If printed, this document is regarded as “uncontrolled”

CREWING DEPARTMENT SIGNED DATE
CREWING DEPARTMENT SIGNED DATE

If printed, this document is regarded as “uncontrolled”