Application Form OFC-007 (02-22)

Date of application: 06/02/2023 Please upload picture here

Name of manning agent:

General:
Last name: Scarlat First name: Sever-Stefan
Date of birth: 16.05.1997 Place of birth: Romania,Constanta
Address: Constanta , str. Vasile Lupu 34 City: Constanta
Country: Romania Nationality: Romanian
Telephone: 0737061711 Mobile:
E-mail: sever_scarlat@yahoo.com Skype ID: live:c3adf502abb1780b
Position applying for: DECK CADET
Available from: 06/02/2023

Sea history:
Vessel name Vessel Flag Rank DWT Maker, From Until Y/M/D Company
type model, (dd/mm/yyyy) (dd/mm/
BHP/KW yyyy)
Mediterranean Choose MARSHALL DECK 14774 01.02.2021 01.08.2021 SUNSHIP
Sea an ISLANDS CADET
item.
ISLE OF Choose CYPRUS STEWARD 3232 19.10.2022 08.12.2022 MATRIX
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 Application Form OFC-007 (02-22)

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Documents:
Document name: Country: Number: Place of issue: Date of issue: Expiry date:
Passport: ROMANIA 058000237 CONSTANTA 26.08.2019 26.08.2029
Seamans book: ROMANIA 39356CT CONSTANTA 30.12.2020 04.10.2027
Others:

National license / endorsement:

Country: Number: Place of issue: Date of issue: Expiry date:
ROMANIA 87357 CONSTANTA 30.12.2020 14.14.2025
Highest rank on endorsement:
Valid for chemical tankers: Choose an item.
Valid for oil tankers: Choose an item.

Other Flag State licenses:

Country: Number: Place of issue: Date of issue: Expiry date:

Medical examination:
Country: Date of issue: Expiry date:
ROMANIA 20.08.2022 20.08.2024

Vaccination Yellow Fever:

Date of issue: Expiry date:
22.01.2021

Vaccination COVID-19:
Vaccination Type Date of issue:
 Application Form OFC-007 (02-22)

PFIZER 14.12.2022

Maritime education:
Grade: School: Country: Date (from – to):
BACHELOR DEGREE UMC ROMANIA 2016-2020
MASTER DEGREE UMC ROMANIA 2020-2022

Others:
Weight: 57KG
Height: 1.68M
Marital Status: Single
Religion: Orthodox
Nearest international airport HENRI COANDA, BUCHAREST
Nearest domestic airport

Certifcates:
Date of issue: Expiry date:
Basic safety training, or:
Personal survival techniques 14.10.2020 14.10.2025
Fire prevention and fire fighting 14.10.2020 14.10.2025
Elementry First Aid 14.10.2020 14.10.2025
Personal Safety / Social Responsibility 14.10.2020 14.10.2025
Proficiency in survival craft / PSCRB
Advanced fire fighting
GMDSS
Medical care on board
Medical First aid
Radar navigator
Shiphandling (IMO model course 1.22)
Ship Security Officer
Designated Security Duties
ECDIS (generic – IMO model course 1.27, 40 hrs.)
ECDIS JRC type specific training
ECDIS FURUNO type specific training
ECDIS Sperry Marine type specific training
ECDIS Chart World type specific training
Tanker familiarization 23.09.2022 23.09.2027
Advanced chemical training
Advanced oil training
Ship Safety Officer
Ships Cook training certificate
Incident Investigation
Chemical Simulator
Risk Assessment
Framo Pump Course
 Application Form OFC-007 (02-22)

ME-B Course

Visa:
Date of issue: Expiry date:
US Visa (C1/D)
Schengen visa

Next of kin:SCARLAT PETRE Relationship:FATHER

Telephone:0727767910 Date of birth:14.07.1966
Address:CONSTANTA, STR VASILE LUPU 34

Next of kin:SCARLAT JENICA Relationship:MOTHER

Telephone:0723177035 Date of birth:24.01.1969
Address:CONSTANTA , VASILE LUPU 34

Next of kin:SCARLAT IULIU Relationship:BROTHER

Telephone:0721986684 Date of birth:07.04.1994
Address:CONSTANTA , VASILE LUPU 34

Tanker Information Sheet - (For applications of Deck Officers, Bosun, Pumpman and deck ratings)

YES/NO Year* Rank** Yes/No Year* Rank**

Chemical Products Chemical Products
Aromatics: Perchlorethylene YES/NO Rank
Styrene YES/NO Rank Trichlorethylene YES/NO Rank
Toluene YES/NO Rank MDI/TDI YES/NO Rank
Benzene YES/NO Rank Ethylene/Methylene Dichloride YES/NO Rank
Xylene YES/NO Rank Styrene Monomer YES/NO Rank
Alcohols & Glykols YES/NO Rank MethylTert-Butyl Ether (MTBE) YES/NO Rank
Methanol YES/NO Rank Butyl Acetate YES/NO Rank
Ethanol YES/NO Rank Acetone YES/NO Rank
Iso-propyl Alcohol (IPA) YES/NO Rank Acrylonitrile YES/NO Rank
Butyl /Isobutyl Alcohol YES/NO Rank Caustic Soda YES/NO Rank
2-Ethylhexanol (Octanol) YES/NO Rank Chloroform YES/NO Rank
Mono Ethylene Glycol (MEG) YES/NO Rank Phenols YES/NO Rank
Molasses YES/NO Rank Propylene Oxide YES/NO Rank
Acids: Vinyl Acetate Monomer (VAM) YES/NO Rank
Phosphoric YES/NO Rank Urea Ammonia Nitrate YES/NO Rank
Sulphuric YES/NO Rank Dowanol YES/NO Rank
Acrylic YES/NO Rank YES/NO Rank
Acetic YES/NO Rank Clean Petroleum Products (CPP):
Paraffins: Gasoil /Diesel Oil YES/NO Rank
Slack Wax YES/NO Rank ULSD YES/NO Rank
Hexane YES/NO Rank Gasoline YES/NO Rank
Cyclohexane YES/NO Rank Naphta YES/NO Rank
 Application Form OFC-007 (02-22)

Vegoils: Fuel Oil YES/NO Rank

Such as Crude Palm Oil, YES/NO Rank Luboils YES/NO Rank
Rapeseed Oil, Soyabean Oil,
Sunflower Oil, etc.

*Year: enter year of latest experience **Rank: enter highest rank of experience

Parcel Trade Exp. (max. no during single voyage): STS transfer (Max No. for last 2 yrs including ops at buoys):

Cargo Pumps Experience Tank’s Coating Type Experience

Deepwell: YES/ Expoxy YES/NO
NO
Framo YES/ Zinc Silicate YES/NO
NO
Marflex (electrical driven) YES/ Marineline YES/NO
NO
Centrifugal YES/ Stainless Steel YES/NO
NO
Screw YES/ Tank’s Passivation Experience YES/NO
NO
Steam Turbine YES/ Wall Wash Experience YES/NO
NO

Vetting Inspections (indicate which)

CDI Inspection (indicate date of last inspection)
OCIMF Inspection (indicate date of last inspection)
USCG Inspection (indicate date of last inspection)
Dry Dock Experience (indicate shipyard)
Experience in Delivery of New Buildings
Trading Area (indicate areas)
Ice Navigation Experience (indicate areas)
Ship-to-Ship Experience (indicate areas)

Annex I – data consent

Hereby, I SCARLAT SEVER-STEFAN passport number 058000237 , give my consent that ASM Maritime INC. /
ASM Shipping LTD will hold and share with 3rd parties personal information as I provided for operational purposes
only which includes: flights, crew change formalities, immigration, port authorities and any other party supporting
the vessel’s operation. The personal information includes the following: Name, address, birth date, birth place, bank
account number, wage details, medical records, NOK, email, phone number, passport, STCW documents, national
documents, visas, flight records, sea service and PPE size.

I declare that the information given by me is correct to the best of my knowledge and I consent to disclosure of my
personal information under the terms of the General Data Protection Regulations. I am fully aware that my personal
information will be used by the Employer for operational reasons only.

Signature __________
 Application Form OFC-007 (02-22)

Annex II – Background Checks

I hereby declare that:

 I have no allegiances or involvement with terrorist organizations

 I have no criminal records

Signature_________________

For Manning Agent:

I hereby declare that:

 I confirm that crew declaration was verified and found true

Manning agent signature ________________