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PASAT d.o.o.

Adress: Petravieva 31, 21000 SPLIT


Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

Date of application: 01/09/2017


Last updated on:

EMPLOYMENT APPLICATION FORM


Position applied for: Engine Cadet Availability date: 30/09/2017
PERSONAL INFORMATION
Last name First name Middle name
FERJANI PAOLO
Date of birth (DOB) Place of birth
13/08/1992 CROATIA
Nationality Gender Marital status
Croatian M Single
Height (cm) Weight (kg) Shoe size Overall size
178 85 45 44
CONTACT INFORMATION
Address Phone 00385923489007
Street name + No HUMSKA Mobile
City PULA E-mail PAOLO.FERJANCIC@GMAIL.COM
Postal code 52100 Skype PAOLO.FERJANCIC
Country CROATIA Other
Nearest international airport Zagreb-Pleso
Nearest domestic airport

NEXT OF KIN
Surname, Name Relation

Address Phone
Street name + No Mobile
City E-mail
Postal code Skype
Country Other

CHILDREN
Surname Name DOB
1
2
3

BENEFICIARY IN CASE OF DEATH


Surname, Name Relation

Address Contact information


Street name + No humska Phone 00385922223531

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
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PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

City Pula Mobile


Postal code 52100 E-mail dfcajger6@gmail.com
Country HR|Croatia Other

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
Pg 2 of 13
PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

EDUCATION
Education:* University (4-5 years) Profession obtained:
*(select from dropdown list)

Foreign language* Spoken Written Comprehension


1 Add language here eng eng
2 Add language here ita ita
3 Add language here cro cro
*(Add language name in the cell and select level of knowledge from dropdown list)

GENERAL QUESTIONS
What wages do you expect per month? depends of ship and who will pay tasks
What contract duration you consider acceptable? 6 months
Would you consider joining in lower rank?
Why did you leave your last employer?
Last wage (inclusive of leave pay):
How did you learn about us? friends
Vessel type you are interested in (in order of priority): 1. Oil/Chemical Tanker
2. LPG/LNG Tanker
3. VLCC/ULCC
4.

MEDICAL HISTORY answer with YES or NO as applicable.


Have you ever been disembarked from ship for medical reasons? NO
Have you been hospitalized or consulted a doctor in the past 12 months? NO
Do you have any medical problem, disease or illness (eg. diabetes, high blood pressure, hernia, etc.)? NO
Have you ever tested positive on drug and alcohol test? NO
If you replied any questions with YES then please provide more details below (max 420 chars):

SERVICE HISTORY answer with YES or NO as applicable.


Have you ever been involved in maritime accident involving loss of live? NO
Have you ever been involved in maritime accident involving damage or loss of property? NO
Have you ever been involved in maritime incident involving oil pollution to environment?
If you replied any questions with YES then please provide more details below (max 420 chars):

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
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PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

SEA SERVICE please click here to complete

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
Pg 4 of 13
PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

REFERENCES
Company Contact Person Position Contact numbers (phone and mobile) and email

T: M: E:

T: M: E:

T: M: E:

Do you agree that we contact your previous employers for references? Please write YES or NO as applicable.

TRAVEL DOCUMENTS (national)


Document Number Date of issue Valid till Place of issue Remarks
Passport 31821261 19/06/2017 19/06/2027 PU/PULA
Seamans book 90387 18/08/2017 18/08/2027 RIJEKA
US visa C1/D
US visa B1 /B2
US B1 OCS visa
MCV Australian visa
Schengen visa
Other VISAs: (add below)

MEDICAL CERTIFICATES AND VACCINATIONS


Certificate Number Date of issue Valid till Place of issue
National Medical Certificate 63/2017 8/3/2017 8/3/2019 Rijeka
Yellow Fever Vaccination

FLAG STATE DOCUMENTS - please list any valid flag state Endorsements and Seamans' Books that you hold
Document Number Date of issue Valid till Place of issue

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
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PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

CERTIFICATES OF COMPETENCY AND PROFESSIONAL QUALIFICATIONS


Certificate Number Date of issue Valid till Place of issue
Master on a ship of 3000 GT or more STCW II/2

Chief mate on a ship of 3000 GT or more STCW II/2

Master on a ship up to 3000 GT STCW II/2

Chief mate on a ship up to 3000 GT STCW II/2


Master of a ship up to 500 GTt in navigational area 3
STCW II/3
Officer in charge of navigational watch on a ship of
500GT or more STCW II/1
General operators certificate for the GMDSS STCW
IV/2
Chief engineer officer on a ship powered by the
main propulsion machinery of 3000 KW propulsion
power or more STCW III/2

Second engineeer officer on a ship powered by the


main propulsion machinery of 3000 KW propulsion
power or more STCW III/2

Chief engineer officer on a ship powered by the


main propulsion machinery up to 3000 KW
propulsion power STCW III/3

Second engineeer officer on a ship powered by the


main propulsion machinery up to 3000 KW
propulsion power STCW III/3

Chief engineer officer on a ship powered by the


main propulsion machinery of less than 500 KW in
navigational area 5 STCW HR III/4

Officer in charge of an enerineering watch on a ship


powered by the main propulsion machinery of 750
KW propulsion power or more STCW III/1
Rating forming a part of the navigational watch
STCW III/4
Rating forming a part of a watch in a manned
engine-room STCW II/4
Able Seafarer Deck (STCW II/5)

Able Seafarer Engine (STCW III/5)

Electro-technical officer (ETO) STCW III/6

Ship's electrican STCW III/7

Ship's mechanic STCW HR III/1

Ships Cook STCW HR V/1

Yacht master category a (up to 100 gt)

Yacht master category b ( up to 500 gt)

PASAT Shipping Services Ltd.


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PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

Radar navigation,radar plotting and use of ARPA-


operational level
Radar, ARPA, bridge teamwork and search and
rescue-management level

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
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PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

ADDITIONAL STCW CERTIFICATES


Certificate Number Date of issue Valid till Place of issue

Basic Training STCW VI/1 400386530 7/12/2017 7/12/2022 Rijeka

Advanced training in fire fighting STCW VI/3 400386529 7/12/2017 7/12/2022 Rijeka

Proficiency in survival craft and rescue boats (other


than fast rescue boats) STCW VI/2-1 VI/2-1 205143 4/27/2015

Proficiency in fast rescue boats operations STCW V/2-


1 VI/2-1

Medical first aid VI/4-1

Advanced Medical care STCW VI/4-2

Crowd management, passenger safety and safety


training for personnel providing direct services to
passengers in passenger spaces STCW V/2, V/3

Proficiency in crisis management and human behavior


training including passenger safety,cargo safety and
hull integrity training for ro-ro ships STCW V/2, V/3

Dangerous hazardous and harmful cargoes for


seafarers STCW B-V/b, B-V/c

Ship security officer STCW VI/5

Security awareness training for all seafarers STCW


VI/6-1
Security training for seafarers with designated security
duties STCW VI/6-2 262619 in progres-5.9.2017 Rijeka

ECDIS - operational use of electronic chart display and


information system- STCW A - II/1, B-II/1

STCW FOR TANKER SHIPS


Certificate Number Date of issue Valid till Place of issue
Tanker familiarization oil and chemical STCW V/1-
40386695 7/18/2017 7/18/2022 Rijeka
1-1

Tanker familiarization liqudfied gas tanker STCW


in progres 9/11/2017 Rijeka
V/1-2-1

Specialized (advanced) training for oil tanker STCW


V/1-1-2

Specialized (advanced) training for liquefied gas


tanker STCW V/1-2-2

Specialized (advanced) training for chemical tankers


STCW V/1-1-3

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
Pg 8 of 13
PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

OFFSHORE INDUSTRY COURSES (mark if OPITO)


Certificate Number Date of issue Valid till Place of issue

FOET - Further Offshore Emergency Training

HLO - Helideck Emergency Response Team Leader

HDA - Helideck Assessments

CAA - Civil Aviation Authorities Helicopter

Offshore Crane Operator

OEHTM - Offshore emergency helideck team


member

HUET -Helicopter Underwater Escape Training

HLO - Helicopter Landing Officer

BOSIET - Basic Safety Induction & Emergency


Training

High voltage-operational level / management level


( mark in remarks)

Please enter below any other certificates held or


courses done for offshore:

1.

2.

3.

4.

DP CERTIFICATES/LOG BOOK
Certificate Number Date of issue Valid till Place of issue

DP Basic (induction)

DP Advanced

DP Limited

DP Unlimited

DP Log Book

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
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PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

OTHERS:
Certificate Number Date of issue Valid till Place of issue

Large Ship Handling Simulator Course

Manned Model Shiphandling Course

Energy Conservation

Incident Investigation & Analysis

Risk Assessment

Tank Inspection

Liquid Cargo Handling Simulator

Automatic External Defibrillator training

AMOS2

Volatile Organic Compound

MAN Electronic M/E training course

Free Fall Lifeboat training course

Ship to Ship

Shipboard Safety Officer ( Safety Officer)

Ship Simulator and Bridge Team Work (SSBT)

Shipboard Safety Officer Course

Bridge resource management

Engine room resource management

Human element, leadership and management at


the operational level (HELM)
Human element, leadership and management at
the management level (HELM)

Leader ship and team work

Marine Environmental Awareness

Ship simulator and bridge team work

Bridge Team Management

Port facility security officer

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
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PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

Seagull test ( CES 4.1 )

Marlins English test

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
Pg 11 of 13
PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

SEA SERVICE last contract on top


GT/TEU/ ME make/ Total Reason to sign
Rank Company Vessel name Type From To days
DWT power o/b off

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PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
Pg 12 of 13
PASAT d.o.o.
Adress: Petravieva 31, 21000 SPLIT
Tel: +385 21 48 56 12
Fax: +385 21 48 56 16
email: pasat.split@pasat.hr
web: www.pasat.hr
IBAN: HR7923600001102393181

PASAT Shipping Services Ltd.


Employment Application Form v.1 rev.0.
Pg 13 of 13