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RYAN SHIP MANAGEMENT LTD SHIPPING CONNECTIONS / (MARITIME RECRUITMENT) POSTAL ADDRESS:-RYANSHIP P O Box – 1282
RYAN SHIP MANAGEMENT LTD
SHIPPING CONNECTIONS / (MARITIME RECRUITMENT)
POSTAL ADDRESS:-RYANSHIP P O Box – 1282 - SUNDERLAND
TYNE and WEAR
SR5 9HX
UNITED KINGDOM
Tel: +44 191 54 888 59
Fax: +44 191 54 88 425
Email : SHIPPINGCONNECT@aol.com
www.shipping-connections.com
Application Form
Deck & Engineering Officers
Section 1
Position
Position Applied for
Lowest Position Acceptable
Date of Availability
Chief Officer /SDPO
1 st Officer/SDPO
15
/
09
/ 2013
MUST Enter a date and in dd/mm/yyyy
Section 2
Personal Details
Family name / Surname
First Name / Given Name
Date & Place of Birth
Nationality
Permanent Address
Dumitru
Gheorghe-Cristian
Date – 22-01-1975
Romanian
Constanta-Romania
Place-Constanta
Present Address
Constanta-Romania
PPE information
SAFETY SHOES SIZE
43
COVERALL SIZE
L
Present Contact Number
Mobile Number
-
-
SKYPE ADDRESS
-
Email Address
Nearest Airport (and Distance)
george22lord@gmail.com
Bucharest (240 km)
Section 3
Passport and VISA details
Country of Issue
Date Issued
Place Issued
Passport Number
Passport –Expires
Romania
USA Visa - Type
USA VISA Expires
USA Visa - Type
USA VISA Expires
Other Country Visa
Visa Expiry
B1/OCS
Constanta
Constanta
C1/D
Secondary passport or Dual
nationality
Section 4 ( hi-light as required )
Seaman book / Discharge book / Seaman Record Book / CDC
Issuing Country & Place
Number
Romania-Constanta
9540 ct
Date Issued
Expiry Date (if any)
06/07/2012
30/03/2014
Section 5
Next of Kin – this is important information we require- Don’t ignore it
Full Name / Relationship
Any dependents / Children (incl age )
Dumitru Daniela/Wife
Daughter 5 years old
Address Contact Numbers Same as applicant dana4george@gmail.com Page 1 of 7 Section 6 STCW95 Highest Certificate
Address
Contact Numbers
Same as applicant
dana4george@gmail.com
Page 1 of 7
Section 6
STCW95
Highest Certificate of Competency / Licence Held ( also list Flag State Endorsements)
Class /
Issuing
Certificate No.
Date Issued
Expiry
Details of Limitations
Grade/Capacity
Country
Chief mate
Romania
26925
02/10/2007
19/01/2015
nil
unlimited
ALSO ENTER ABOVE DETAILS OF ANY OTHER FLAG STATE CERTIFICATES HELD
Section 7
STCW95
Dangerous Cargo Endorsements
Certificate No.
Date Issued
Expires
Details of Limitations/ Grade
Petroleum…………….
Liquefied Gas……….
Liquid Chemicals…….
Section 8
STCW95 related Courses Attended and Certificates Obtained
Name of Course / Certificate
STCW Code
Place
Issue Date
Cert No
Expiry Date
Personal Survival Techniques
Basic Sea Survival / Training
Fire Prevention & Fire Fighting
Elementary First Aid
A- VI/1-1
CERONAV
05/04/2012
00017863
05/04/2017
A-VI/1
A-VI/1-2
A-VI/1-3
Personal Safety & Social Responsibility
A-VI/
1-4
CERONAV
19/01/2010
0011076
19/01/2015
Proficiency in Survival Craft & Rescue
Boats
A-VI/ 2-1
CERONAV
27/03/2012
00029839
27/03/2017
Proficiency in RESCUE CRAFTS
Advanced Fire Fighting
Medical & First Aid
A-VI/ 3
CERONAV
22/01/2010
0010759
22/01/2015
A-VI/ 4-1
CERONAV
Medical Care
( Ship Captains Medical Course )
Radar & ARPA Simulator Trg-
Management level
GMDSS + ENDORSEMENT
A-VI/4-2
CERONAV
25/04/2012
00004922
25/04/2017
A-II/ 1-2
CERONAV
13/04/2012
00004131
13/04/2017
A-IV/ 2
CERONAV
29/01/2010
0003749
29/01/2015
4058
SAFETY OFFICERS COURSE (SO)
Ship Security Officers Course (SSO)
A-VI/ 5
CERONAV
08/04/2009
00558
08/04/2014
Issued under STCW95
Medical Certificate / HEALTH
Certificate
28/02/2012
28/02/2014
Drug and Alcohal test certificate
YELLOW FEVER
Bridge Team Management
Bridge Resources Management
A-II/2
B-VIII/2
Electronic chart Display and
Information System

course ( ECDIS )

 

ISM Code

A.1441 (18)

 

TANKERS FAMILIARISATION

A-V/1

 

Advanced Tanker Operations (Chem.)

A-V/1-2

 

Advanced Tanker Operations (Oil)

A-V/1

 

Advanced Tanker Operations (LPG)

A-V/1

 

INERT GAS

 

CRUDE OIL WASHING

 

Tanker Safety ( petroleum )

 

Tanker Safety ( Chemical )

 

Tanker Safety ( GAS )

 

REFRESHER & UPDATING

I/II & III/2

 

Prevention of Pollution of the Marine

A-II/1,A-

CERONAV

01/03/2013

 
  • 00001596 01/03/2018

Enviroment

II/2,A-

III/1,A-

III/2

Transport and handling of dangerous

A-II/1,A-

CERONAV

12/02/2013

 
  • 00001461 12/02/2018

and harmful cargoes.

II/2,A-

III/1,A-

III/2

Maritime English

A-II/1,A-

CERONAV

05/03/2013

00000985

05/03/2018

II/2

Other ????

Other ????
Page 2 of 7 Section 9 OFFSHORE INDUSTRY COURSES L I Please enter below any other
Page 2 of 7
Section 9
OFFSHORE INDUSTRY COURSES
L
I
Please enter below any other certificates held or courses done, ie offshore, DP certs etc or Any other not already mentioned
Name of Course / Certificate
APPROVALS
Place
Issue Date
Cert No
Expiry
S
T
BOSIET
Abu Dhabi
20/12/2011
4826/11
19/12/2015
A
HUET
Abu Dhabi
20/12/2011
4826/11
19/12/2015
L
FOET
Abu Dhabi
20/12/2011
4826/11
19/12/2015
L
OFFSHORE MEDICALS
( UK, NORWAY or NETHERLAND )
O
Re-Breather training
T
H
E
Initial Standby vessel crews training ( ITSO )
CAA (Civil Aviation Authorities –
Helicopter)
R
Advanced Medical Aider ( AMA )
HLO
C
O
MARLIN’s English Test
Score:
%
U
IELTS-English TEST
http://www.ielts.org/test_centre_search/search_results.aspx
SCORE
R
S
PMS maintenance system – Confirm that you are Familiar with its use ( YES / NO )
E
S
DEEP WATER ANCHOR HANDLING EXPERIENCE
ENTER DEPTTH IN METERS
600
DP Maintenance Courses

DP Maintenance Courses

 

HIGH VOLTAGE COURSE

 
 

Dynamic Positioning Induction Course

Nautical

13/10/2006

Institute U.K.

Dynamic Positioning Simulator Course

 

Nautical

17/04/2008

 

Institute U.K.

Dynamic Positioning Operators

 

Nautical

26/02/2010

8758

 

Full

CERTIFICATE

Institute U.K.

Limited

26/02/2010

 

Full DP Cert

 

Dynamic Positioning Log book Details

Nautical

Institute U.K.

 

Section 10

Hours done with various DP system

 
 

SYSTEM DETAILS

Approx Hours as SDPO / Approx Days

Approx Hours as DPO / Approx Days

in case of Senior ETO / Senior Engineer

in case of Junior ETO / Junior Engineer

 

Kongsberg

2400

12000

Nautronics

1000

 
 
 
 
 
 

APPROXIMATE Total DP Hours in Various Operations

 

SAT DIVING

500

CABLE LAYING

 

-

AIR DIVING

300

SURVEY

 

-

ROV

500

PIPE LAYING

 

6000

WELL STIMULATION / INTERVENTION / ACTIVATION

400

DRILL SHIP / SEMI SUB

-

AHTS

400

PSV

8000

FPSO

-

SHUTTLE TANKER

 

-

CONSTRUCTION

400

ROCK DUMPING / MATTRESSING

-

CORING

-

TRENCHING

 

-

HEAVY LIFT

300

ACCOMMODATION / GANGWAY

-

 
DP Maintenance Courses HIGH VOLTAGE COURSE Dynamic Positioning Induction Course Nautical 13/10/2006 Institute U.K. Dynamic Positioning

Page 3 of 7

Section 11

Medical History

Section 11 Medical History
 
 

YES

NO

Have you ever signed off a ship due medical reason

?

x

Have you undergone any medical operations in past ?

 

x

Have you consulted a doctor during the past 12 months for an illness / Accident

 

x

Do you have any health or disability problem now ??

 

x

 

If answer to any of above is YES then give further details below or on a separate sheet

 
 
NOTE : All our clients have STRICT Alcohol and Drug Policy, Which means ZERO TOLERENCE for
NOTE : All our clients have STRICT Alcohol and Drug Policy, Which
means ZERO TOLERENCE for alcohol and drugs
Section 12
General
Yes
No
Have you ever been the subject of a court of enquiry or involved in a maritime accident
Have you ever had a professional licence suspended or revoked
Have you ever been convicted of any criminal offence?
Have you ever been dismissed
x
x
x
x
If yes to any of above then please full details below or on separate sheet of paper
Section 13
References
(Last Two Recent Employers)
Name of company
Name Person to be contacted
MSH
Andre van Torren
Address
fp@mshshipmanagement.com
Tel No
+971554033914
Fax
Email
fp@mshshipmanagement.com
Name of company
Name Person to be contacted
Address
Kito Enterprises LLC
Andre van Torren
Tel No
+971554033914
Fax
Email
n/a
Section 14
Any other information, you wish to add in support of your application
Am an experienced mate ,well motivated having many hours in backgroung working on PSV
,AHTS,PIPE LAYER vessels from DP class 1 up to Class 3.
Section
15
Declaration
I hereby declare that the above particulars are true and I authorize you to contact the referees listed above
And confirm that All my certificates / Licences are Authentic / SEASERVICE RECORD is ACCURATE / And I
confirm accepting Companies DRUG & ALCOHOL Policy
Signed …Dumitru Gheorghe-Cristian …
Date…22/06/13…
Page 4 of 7

Section 16

Record of Sea Service

 

(All Dates to be entered as dd/mm/yy)

 
 

Please give full record of sea service

STARTING FROM LAST VESSEL FIRST

 

VESSEL

COMPANY

Type of Vessel

GRT

Type of Engines

BHP

RANK

 

Sign on

   

Sign off

 

And Type of operation in case

Or DP System

DATE

DATE

of DP vessels

   
 

dd /

mm

/

yy

dd /

mm

/

yy

C-Master

MSH

(formerly Kito

Pipe Layer

 

Kongsberg SDP

  • 10000 21+11 DP

 

Chief Officer

/SDPO

6

weeks on/off

since Jan.2013

6

weeks on/off

since Jan.2013

Enterprises)

Class 3

   

Pipe Layer

 

Kongsberg SDP

   

6

weeks on/off

6

weeks on/off

C-Master

Kito Enterprises

  • 10000 21+11 DP

First Mate/SDPO

since

since

 

Class 3

OCT.2012

 

OCT.2012

 
   

Pipe Layer

 

Kongsberg SDP

       

C-Master

Kito Enterprises

  • 10000 21+11 DP

Class 3

DPO

6

weeks on/off

sinceJuly 2010

6

weeks on/off

sinceJuly 2010

Dalfrey Tide

Tidewater

PSV

2000

Kongsberg DP

 

SDPO/ChiefMate

 

12/02/10

   

15/05/10

 

Class 1

Ken C. Tamblin

Tidewater

PSV

3100

Kongsberg DP

 

SDPO/ChiefMate

 

11/09

 

Class 2

   

17/12/09

 
       

Kongsberg K-

     

09/09/09

   

Desoto Tide

Tidewater

PSV

2800

POS DP Class

SDPO/ChiefMate

 

11/2009

 

2

   

Sea Hero

Tidewater

PSV

1600

Kongsberg DP

 

SDPO/ChiefMate

 

14/04/09

   

10/07/09

 

Class 1

Bourgeois Tide

Tidewater

PSV-zDrive

1700

Kongsberg DP

 

DPO/ChiefMate

 

14/10/08

   

07/01/09

 

Class 1

Bourgeois Tide

Tidewater

PSV-zDrive

1700

Kongsberg DP

 

DPO/ChiefMate

 

29/05/08

   

14/09/08

 

Class 1

Bourgeois Tide

Tidewater

PSV-zDrive

1700

Kongsberg DP

 

DPO/ChiefMate

 

18/10/07

   

21/01/08

 

Class 1

Sea Bear

Tidewater

AHTS

2590

N/A

 

2 nd Mate

 

15/03/07

   

16/06/07

 
J.Hugh Roff JR. Tidewater AHTS 2223 Nautronics 1 2 nd Mate 29/11/06 17/01/07 Kongsberg DP Stipe
J.Hugh Roff JR.
Tidewater
AHTS
2223
Nautronics 1
2 nd Mate
29/11/06
17/01/07
Kongsberg DP
Stipe Tide
Tidewater
AHTS
1720
2 nd Mate
18/10/06
29/11/06
Class 1
Kongsberg DP
Wilbert Tide
Tidewater
AHTS
1598
2 nd Mate
07/07/06
27/07/06
Class 2
Kongsberg DP
Art Carlson
Tidewater
PSV-zDrive
3183
2 nd Mate
11/05/06
07/07/06
Class 2
Kongsberg DP
Oil Traveller
Tidewater
PSV-zDrive
1919
2 nd Mate
22/11/05
26/02/06
Class 1
McNee Tide
Tidewater
AHTS
2590
N/A
2 nd Mate
12/06/05
22/10/05
Type of Engines :: for engineers only, DPOs to Mark DP System BHP : for Engineers
Type of Engines :: for engineers only, DPOs to Mark DP System
BHP : for Engineers and AHTS / TUG Masters & Officers
Page 5 + 6
of 7
ADDITIONAL INFORMATION SHEET VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority) 1.Pipe
ADDITIONAL INFORMATION SHEET
VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority)
1.Pipe lay
2.
Cable lay
3.
Survey
4.
PSV
5.
AHTS
MAXIMUM ACCEPTABLE CONTRACT PERIOD
(Please indicate below)
2 months on/off rotation
Please Quote –Consolidated MINIMUM MONTHLY SALARY ( no leave pay ) payable for
time onboard only or Working DAY RATE EXPECTATION ( no leave pay)
( please quote below in US$ -preferred or Euro or GBP£ )
DAY RATE EXPECTATION-600 Euro
Languages Spoken / Written / Understood
(1-poor
5-Fluent)
Spoken
Written
Understood
ENGLISH
5
5
5
DRUG & ALCOHOL POLICY
ALL Our Clients have very strict NO DRUG and ALCOHOL POLICY, Which is required to be
complied with at all times, which means “””ZERO TOLERENCE on ALCOHOL & DRUG”””
Your body must NOT have any ALCOHOL or DRUG substances from the time you board your flight
or commence your travel to join vessel, and Must remain so Until you have completed full contract
and returned to your home Airport / Town
If during the said period you are found under the influence of DRUG or ALCOHOL then ALL
EXPENCES incurred which will include all your travel and recruiting costs, And your relief’s
Travel and recruiting costs, And Any other costs whatsoever incurred due to your NON-
COMPLIANCE will be deducted from your salary, Which will include but not limited to “damage to
vessel her equipments and machineries, loss of charter, and any other costs Directly or indirectly
connected with your NON-COMPLIANCE
Sign & CONFIRM ACCEPTANCE OF ABOVE POLICY…Dumitru Gheorghe-Cristian…
FOLLOWING DOCUMENTS COPIES MUST BE SENT TO US- send to us In separate Email
Licence or Certificate of competency, Any tanker endorsements, GMDSS showing expiry date in case of
Deck Officers, Medical Fitness / Examination Certificate, Passport Main page, Seaman book or Discharge
book Main pages, In case of DPO – DPO Cert, DP LOG Pages
FOLLOWING ADDITIONAL DOCUMENTS will ALSO BE REQUIRED – Send to us in separate email
All short courses certificates ( STCW95 ), SSO certificate, Last 3-5 years ships entries in Discharge book or
Seaman book, Certificate of Equivelant Competency from other flag states
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