CRW13 – APPLICATION FOR EMPLOYMENT

Applied Company: Pacific Ocean Manning , INC.

Personal Data
First Name : Middle Name: Last Name / Surname
MELANDRO MANGANTI SANTOS
Nationality Date Of Birth Place of Birth
FILIPINO (24/03/83) STA RITA, PAMPANGA

Position Applied For Female Male Available date ANYTIME

Home Address Personal Documents Issued on Valid until

Passport (Country / Number) MARCH 21,2019 MARCH 20,2029
#37 GOMBURZA STREET STA P1138894B
CRUZ LUBAO PAMPANGA Seaman’s book FEB.27,2019 FEB.27,2029
C1444069
USA C1/D visa Seaman’s book
none
Telephone Schengen Visa
09076504977 none

E-Mail Medical Fitness Certificate

melandrosantos83@gmail.com

National Certificates of Competence Tanker Endorsements

country_____PHILIPPINES__________________ Management level Operation level
Grade Issued Expires Oil Chemical Gas
NCII JULY 7,2022 JULY 6, 2027

Valid Flag State Liberia , Panama , , Malta , Marshall Islands , UK , Singapore Norway (NIS) ,
Endorsements Italy Other (list flags)
GMDSS Flag State GMDSS Endorsements (list)
General /Restricted

Other valid certificates and training attended

Basic Safety Training Advanced Fighting Medical First Aid Medical Care ECDIS (Generic)
Ship Security Officer Bridge Team Management Ship Handling Liquid Cargo Handling
ER Management ECDIS (Type Specific) Other (specify) SDSD, CROWD ,CRISIS

Education History: Name of Institution / Level / Graduate Date: STI GUAGUA PAMPANGA/ CYPER PROGRAMMING/MARCH
2002
Please answer the following questions:
 Did you suffer, or presently suffer from, any disease likely to render you unfit for services at
sea or likely to endanger the health of other persons on board?
If yes, please provide details _______________________________________________ YES NO
______________________________________________________________________

 Did you suffer any accident, which rendered you temporary and/or partially disabled? YES NO
 Did you ever undergo psychiatric treatment YES NO
 Are you addicted to alcohol or drugs of any kind? YES NO
I hereby declare that the above facts and information are true and accurate. I further consent to the holding and processing by (i) the owners of any vessel on which I may
be assigned from time to time and (ii) the Managers and any direct or indirect parent or subsidiary or associated or affiliated company of the Managers (together referred to
as "the Companies") for the purposes of my employment, of personal data about me contained herein, or provided to any of the Companies at a later date, including with
respect to personal and pensions administration, employee management and as required to comply with any laws, regulations or contracts applicable to any of the
Companies or their businesses. I understand that this data will be stored in the Managers’ database for the purposes of my current or future employment arranged by the
Managers. Further, I confirm that the above may involve the transfer of my personal data within the Managers’ organization .

Place_______PAMPANGA____________________Date____JULY8,2022_________________Signature________________________

Page 1 of 3 CRW13 – Application Form

Revision Number: 6.1
 CRW13 – APPLICATION FOR EMPLOYMENT

For Office Use Only

Initial assessment of applicant for further recruitment
Comments
-
How much is your last salary? / How much salary you will accept? : $1170

- Nationality of Officers / Ratings you have experienced with? UKRANIAN- MASTER RUSSIAN – CHIEF MATE
 
- What trade you have experience with?
 
-What is your reason for leaving your previous company? LOOKING FOR BETTER OPPORTUNITIES
 
- Any benefits from your last company?
 
- Are your docs on hand and all valid? YES
 
- Do you have US VISA? What Type and Validity? NONE
 
- Are you willing for Background Inquiry? YES
 
- Present location and Availability? PAMPANGA, ANYTIME
 
- Covid Vaccination Status and Brand? YES, JANSSEN AND BOOSTER PFIZER
 
- Marital Status / Next of Kin / Cellphone Number / No. of Kids MARRIED, MILAGROS M. SANTOS,
09076504977, 1 SON
 
- Are you taking meds or any maintenance? (Please indicate) LOZARTAN 10MG
 
- Any documents for renewal or on process? YES, ON PROCESS PSCRB AND 3/5
 
- SSS # : 02-204-364-25
- PAGIBIG # : 121138934042
- PHILHEALTH # : 190257196506

Responsible person

Name / Signature _______________________________________________ Date ________________________________

Page 2 of 3 CRW13 – Application Form

Revision Number: 6.1
 CRW13 – APPLICATION FOR EMPLOYMENT

Sea Experience : (List the most recent experience first; use additional sheets as required)
Main Engine Date From Date To Reason for
Company Flag Vessel Name Type (1) GRT DWT (2) BHP Rank
(dd/mm/yy) (dd/mm/yy) S/off (3)
15636 MAN-B&W OCT. 5,2021 JUNE 10,2022 EOC
MATRACON LIBERIA MV NICKIE B CON 16839 WELDER
2267 4X MAK, 6M SEPT.9,2020 MAY 30,2021 EOC
ALFONS HAKANS CYPRUS THETIS OSV 453 AK WIPER
2350

(1)
Use only the following abbreviations for vsl types:
*Please use only following abbreviations for the vessel type: (2)
Engineers to give make/model of engines, e.g. “MAN 14V
GCD General Cargo MLP Multi-Purpose B/C Bulk Carrier CON Container O/O Ore Oil OBO Ore/Bulk/Oil 52/55A” or “SULZER 5RTA58”
(3)
TNC Tanker Crude TNP Tanker Product TNV VLCC/ULCC CHM Chemical Tanker LPG/LNG Gas Tanker FSO / FPSO Reason of Sing Off, e.g. “EOC – End of Contract”,
PAS Passenger Ship R/O Ro/Ro DRG Dredger NVL Naval Ship H/L Heavy Lift “MED – Medical Ground”, “OWN – Own request”
OSV Offshore Supply SRV Survey vessel LOG Log/Timber SSHL Semi-Submergible MOB Mobile Offshore Unit
Please provide details of two recent employers who we may contact for references
Name of Company
Name of person to contact
Address

Telephone/E-Mail

Page 3 of 3 CRW13 – Application Form

Revision Number: 6.1