Agentia autorizata ANR de selectie si plasare Personal Maritim Navigant

Address:Tomis 20-26 (Hotel Tineretului Room 227) Contact: Tel/Fax: +40 241514520, 0732078831, 0732078829 E-mail: seakings96@yahoo.com Web: www.seaking.ro

SEA KING

APPLICATION FORM

Desired type of vessel

Desired length of contract

Minimum accepted wage / month

Rank:

PHOTO
Surname PERSONAL DATA
Date / Place of birth Fathers name Mothers name Address / Phones no. (fix & mobile) / E-mail Marital status Wifes name Children (number of)

Given name (s)

NATIONALITY

NEXT OF KIN (name / address / phone no

DOCUMENTS
DOCUMENT PASSPORT USA VISA National SEAMANS BOOK MEDICAL EXAMINATION PANAMA S/BOOK MALTA S/BOOK OTHERS LICENSES DOCUMENT NATIONAL LICENCE NATIONAL ENDORSEMENT TANKER ENDORSEMENT OIL TANK ENDORSEMENT CH TANK ENDORSEMENT LPG ENDORSEMENT NUMBER PLACE / DATE OF ISSUE EXPIRES

NUMBER

STCW 95 rule

ISSUE

EXPIRES

ENGLISH Excellent Good

Communication

ITALIAN Excellent Good

Communication

FRENCH Excellent

Good

Communication

GREEK Excellent Good

Communication

SPANISH Excellent Good

Communication

OTHERS Excellent Good

Communication

I.M.O. CERTIFICATE General Operators Certificate for GMDSS (GOC) Radar ARPA, Bridge Teamwork, Search and Rescue:()operation; ()management

STCW 95 COURSE A-IV/2

MODEL COURSE 1.25 ()1.07 ; () 1 . 0 8 1.19 1.20 1.14 1.21 1.23 1.24 2.03 1.15 1.11,

NUMBER

ISSUED ON

VALID TILL

A-I/12, II/1 2

Personal Survival Techniques Basic Fire-Fighting Elementary First Aid Personal Safety and Social Responsibilities on Board Ships Proficiency in Survival Craft and Rescue Boats, other than Fast Rescue Boats Proficiency in Fast Rescue Boat Advanced Fire-Fighting Medical First Aid & Care Bridge Team Management Prevention of Pollution of the Marine Environment MARPOL 73/78

A-VI/1-1 A-VI/1-2 A-VI/1-3 A-VI/1-4 A-VI/2-1 A-VI/2-2 A-VI/3 A-VI/4-1/2 B-I/12, VIII/2 AII/1,2,3;AIII/1 B-V/5 par5,9, 18

1 . 1 2

Transport and Handling of Dangerous, Hazardous and Harmful Cargoes

3.17; Maritime English and Problems of Communication in Human Relationships A-II/1-4 Chapter XI2,ISPS A-V/1;1-7

5 . 0 4

Ship Security Officer Tankers Familiarization Oil Tanker Specialization Chemical Tanker Specialization LPG Specialization Ro/Ro Passenger Ships / Passenger Ships other than Ro/Ro Passenger Ships

1.01

1.28, A-V/2, A-V/3 1 . 2 9

SEA SERVICE (last one first)

Owners name (contact phones) Ranks Ship (type / name/ flag) DWT ENGINE (type / HP) From TO RESON OF S/OFF