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APPLICATION FORM

Rank: 2nd engineer Expected Salary: 8,000.00 USD

Last Name: Roman First Name: Ivan

Middle Name: Aleksandrovych Ready From: 01.01.2024
Telephone No.: Mobile No.: +380939326989
E-mail: velmanvania@gmail.com Skype ID: saxara43
1. PERSONAL DETAILS

Date of Birth: 30/09/1992 Place of Birth: Ukraine Sex: ✔ Male Female

Nationality: Ukrainian Marital Status: married Country: Ukraine/Romania

Weight (kg): 82 Height (cm): 179 Nearest Int. Airport: Bucharest/ Otopeni

Eye Color: blue Hair Color: brown Overall / Shoes: 42

1.1 PERMANENT ADDRESS 1.2 MAILING ADDRESS (If different of permanent)

Street / No.: 28 June 235 Street / No.:

City/Post Code: Reni City/Post Code:

Province/Country: Odessa reg., Ukraine Province/Country:

2. FAMILY INFORMATION

2.1 NEXT OF KIN

Full Name: Roman Iryna Leonardovna Relation: wife

Telephone: +380930181833 Address / Str. #: Mihailovskaya 8 str, apt 61
City: Odessa Country: Ukraine

3. EDUCATION HISTORY (Please fill up starting from highest degree)

Name of the School/University: Odessa marine school of fishing industry From (Year): 2009
Qualification Degree / Speciality: To (Year): 2012
Name of the School/University: Odessa marine university From (Year): 2018
Qualification Degree / Speciality: Bachelor degree To (Year): 2022
Date of issuance of CoC (for cadets only): Seatime required for CoC (for cadets only):

4. ADDITIONAL QUALIFICATIONS / COURSES

Qualification / Course: When (Year): Place:

Qualification / Course: When (Year): Place:

Qualification / Course: When (Year): Place:

Qualification / Course: When (Year): Place:

Qualification / Course: When (Year): Place:

Qualification / Course: When (Year): Place:

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5. LANGUAGES SKILLS 6. COMPUTER SKILLS

NATIVE LANGUAGE 6.1 Computer Programs (Word, Excel, Level

Outlook, PowerPoint, etc.)
Language Speaking Reading Writing

English Advanced Advanced Advanced Word Advanced

German None None None Excel Advanced
French None None None Outlook Advanced
Spanish None None None
Italian None None None
Russian Mother Tongue Mother Tongue Mother Tongue

5.1 OTHER LANGUAGE (Please specify) 6.2 Specific Systems/ Software you are familiar with (BASSnet,
NS5, GL Manager, AMOS, ShipSure, Fidelio, IDEA, etc.))
Language Speaking Reading Writing

Danaos Advanced
Amos Advanced

5.2 ENGLISH LEVEL CERTIFICATE Score % Date

7. TRAVEL DOCUMENTS & VACCINATIONS Note: If no expiry date is applicable please leave the box blank

Documents Number Issue Date Expire Date Issued By / At

Travel passport FP673225 09/08/2018 09/08/2028 Odessa

Seaman`s book AB672302 24/12/2020 24/12/2025 Odessa
COVID-19 mRNA #1 FF2595 28/10/2021 Canada
COVID-19 mRNA #2 FF2595 25/11/2021 Canada

8. NATIONAL LICENSES (Certificates of Competence & Endorsement) Note: If no expiry date is applicable please leave the box blank

Grade Number Issue Date Expire Date Issued By / At

Certificate of Competency/2nd class engineer 00662/2021/08 26/02/2021 Odessa
Endorsement/2nd class engineer 00662/2021/08 26/02/2021 26/02/2026 Odessa

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9. FLAG STATE DOCUMENTS (Endorsement / Seaman’s Book / Others)

Type Seaman's book Type Endorsement Type

Country Issued Bahamas Country Issued Bahamas Country Issued

Type Seaman's book Type Endorsement Type

Country Issued Marshall Island Country Issued Bahamas Country Issued

Type Seaman's book Type Endorsement Type

Country Issued Singapore Country Issued Bahamas Country Issued

Type Type Type

Country Issued Country Issued Country Issued

Type Type Type

Country Issued Country Issued Country Issued

Type Type Type

Country Issued Country Issued Country Issued

Type Type Type

Country Issued Country Issued Country Issued

Type Type Type

Country Issued Country Issued Country Issued

Type Type Type

Country Issued Country Issued Country Issued

10. STCW & OTHER TRAININGS AND VERIFICATIONS Note: If no expiry date is applicable please leave the box blank

Courses & Certificates Number Issue Date Expiry Date Issued By / At

Advanced Fire Fighting 254415 01/02/2021 01/02/2026 Odessa

Basic Safety Training 254416 01/02/2021 01/02/2026 Odessa
Designated Security Duties 12391 21/11/2019 21/11/2024 Odessa
Engine Team and Resource Management 254417 01/02/2021 01/02/2026 Odessa
Medical First Aid 254414 01/02/2021 01/02/2026 Odessa
Proficiency in Survival Craft and Rescue Boats 254412 01/02/2021 01/02/2026 Odessa
Security-Related Training & Instruction For all Seafarers 254413 01/02/2021 01/02/2026 Odessa
Security Awareness Training 651 02/03/2017 Odessa

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11. OTHER CERTIFICATES concerning Deck & Engine Crew Note: If no expiry date is applicable please leave the box blank

Courses & Certificates Number Issued Date Expiry Date Issued By / At

11.1 ECDIS Type Specific Certificates Note: If no expiry date is applicable please leave the box blank

Courses & Certificates Number Issued Date Expiry Date Issued By / At

11.2 ME Main Engine Certificate (MAN B&W, Wartsila, etc.) Note: If no expiry date is applicable please leave the box blank

Courses & Certificates Number Issued Date Expiry Date Issued By / At

12. ADDITIONAL DOCUMENTS / Certificates/Courses (DP, BOSIET, HUET, FOET,H2S,MIST,IOSH,OERTM,etc.)

Courses & Certificates Number Issued Date Expiry Date Issued By / At

12.1 Other Visas (Australian (MCV 988), Australian (651 / 771) Chinese, etc.) Note: If no expiry date is applicable please leave the box blank

Courses & Certificates Number Issued Date Expiry Date Issued By / At

US C1/D Visa 04/04/2021 04/04/2031

Schengen Visa 09/08/2028

13. MEDICAL HISTORY

Illness or Injury Describe the Nature of Illness or Injury Time Frame Current Status

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 14. SEA EXPERIENCE (Starting from last contract)

Name of the Name of the Vessel Type Flag Year of GT TEU’s Engine KW RANK Sign On Sign Off Reason for
Ship Owner/ Built Type Sign Off
Manager

Gestmar JUPITER Bulk Bahamas 2006 40017 MAN-B& 7928 2nd eng 23/05/23 13/10/23 End of
Tehnika W contract

Target GLORY Bulk Marshall 2005 39964 MAN-B& 8830 2nd eng 10/08/22 27/03/23 End of
Marine W contract

Swire KAYING Bulk Singapor 2021 22360 MAN-B& 5670 3rd eng 05/05/21 19/02/22 End of
e W ME contract

Portline SABRINA 1 Bulk Panama 2005 30064 MAN-B& 7800 3rd eng 07/12/19 03/11/20 End of
W contract

Johan M.K. ANNA BARBARA Bulk Liberia 2008 28750 MAN-B& 8200 3rd eng 11/04/19 23/10/19 End of
Blumenthal W contract

Atlantska AP REVELIN Bulk Marshall 2015 25494 MAN-B& 6216 3rd eng 28/12/18 12/02/19 End of
plovidba W ME contract

Atlantska AP REVELING Bulk Marshall 2015 25494 MAN-B& 6216 4th eng 21/07/18 27/12/18 Promotio
plovidba W ME n

Atlantska MAPLE GLORY Bulk Marshall 2011 20867 MAN-B& 6480 4th eng 30/10/17 31/05/18 End of
plovidba W contract

Stam CASSIOPEIA STAR Bulk Malta 2005 20283 MAN-B& 8704 4th eng 08/03/17 07/07/17 End of
Shipping W contract

Eurobulk EM ATHENS Cont Marshall 2000 25294 2500 SULZER 20954 4th eng 26/02/16 16/08/16 End of
contract

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 15. REFERENCES FROM PREVIOUS EMPLOYERS

Reference No. 1 Reference No. 2 Reference No. 3

Company Name Gestmar Tehnika Target marine
Name of the Person to contact Elisa Evina
Position of the Person to contact Crew manager Crew operator
Phone No. +33 6 43 91 87 65 +306956035341
Email address

Website of the Company

16. ADDITIONAL

Additional Qualifications

Remarks
Good day, Pls see my CV for 2nd engineer position on bulk/container fleet. I've been working on general cargo/bulk carriers/containers ships during last 9 years. Got
experience of Chinese Drydock in position of 2nd engineer from 21.02.2023 till 27.03.2023 Marlins test 98%, CES 87%. Advanced English. I can provide certificates
and references upon request. Ready for joining from December 2023/January 2024.I am in Romania at present moment. Thank you for your attention.

Have a nice day ahead.

THE APPLICANT ACKNOWLEDGES THAT OLDENDORFF CARRIERS GMBH HAS THE RIGHT TO COLLECT, STORE AND PROCESS THE DATA INCLUDED IN THIS DOCUMENT, FOR THE
PURPOSE OF POTENTIAL EMPLOYMENT ONLY. IT IS ALSO ACKNOWLEDGED THAT OLDENDORFF CARRIERS GMBH HAS THE RIGHT TO TRANSFER THE DATA INCLUDED TO CREW
AGENCIES IN OR CLOSE TO THE PLACE OF THE APPLICANT´S RESIDENCY FOR THE SAME PURPOSE ONLY.

___________________________________
Seafarer’s Signature

DECLARATION: I hereby declare that the above particulars are true and authorized you to contact the referees listed above.

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