Quality Management System

Issue 2 Revision 0
Date: Dec 2009
EMPLOYMENT APPLICATION FORM
CRW 2.
Pa!e o" #
EMPLOYMENT APPLICATION FORM
Position applied for
ATTAC$
P$OTO
Second choice
Date of availability
Surname
Name / s
Date / place of birth
Nationality
Marital status Sex
CONTACT N!O"MATON
#ome address
Secondary address
#ome phone / !A$
Mobile phone
%&mail
Nearest airport
P%"SON%' D%TA'S ( )N!O"M N!OMATON
#air color
%ye color
#ei*ht +centimeters,
-ei*ht +.ilo*rams,
-or.in* clothes si/e
Shoes si/e
N%$T O! 0N D%TA'S
"elationship +i1e1 -ife2 etc1,
Surname
3iven name/s
NO0 address
NO0 contact number
A*e and *ender of children
+if applicable,
P"%&S%A %D)CATON
Name of school or academy Department !rom To
ic%&e's Ma'ine A!enc( Ro&ania )RL
*+.Ma&aia ,-. 2
n+
F/oo' . 900,0, Constanta Ro&ania
Te/. 120 22 ,2, ,2. Fa3:1 20 22 ,2, ,4. e5&ai/: c'e6in!.'o7'ic%&e's.co&

Quality Management System
Issue 2 Revision 0
Date: Dec 2009
EMPLOYMENT APPLICATION FORM
CRW 2.
Pa!e 2 o" #
PASSPO"TS2 S%AMAN4S 5OO0S AND 6SAS
Name of document Number Place of issue Date of issue Date of expiry
National Passport
National Seaman4s 5oo.
Seaman4s Passport +if applicable,
)S C7/D visa
C%"T!CAT%S +STC- A /7&8 ( A /7&8,
Name of document Capacity Number Place of issue Date of
issue
Date of
expiry
Certificate of competency
%ndorsement
3MDSS
5ASC T"ANN3 +STC- A 6/7 ( A 6/9&8, AND OT#%" C%"T!CAT%S
Name of document Number Place of
issue
Date of
issue
Date of
expiry
5asic !irst Aid
5asic !ire !i*htin*
Personal Survival Techni:ues
Personal Safety and Social "esponsibility
Medical !irst Aid
Medical Care Person in Char*e
Advanced !ire !i*htin*
Proficiency in Survival Craft
!ast "escue 5oat
A1"1P1A1
"adar Observer Certificate
%CDS Certificate
5"M MO Model Course 7199
Ship4s Security Officer +SPS&A 7;19,
#A<MAT +Acc )S C!",
M%DCA' AND 6ACCNATONS
Name of document Number Place of issue Date of issue Date of expiry
Seafarers Medical
ic%&e's Ma'ine A!enc( Ro&ania )RL
*+.Ma&aia ,-. 2
n+
F/oo' . 900,0, Constanta Ro&ania
Te/. 120 22 ,2, ,2. Fa3:1 20 22 ,2, ,4. e5&ai/: c'e6in!.'o7'ic%&e's.co&

Quality Management System
Issue 2 Revision 0
Date: Dec 2009
EMPLOYMENT APPLICATION FORM
CRW 2.
Pa!e # o" #
Yellow Fever vaccination
S%A S%"6C% D)"N3 T#% 'AST !6% =%A"S
"an. Company Name of vessel
=ear
5uilt
!la* Type 3"T
%n*ine type
0-
!rom To
"%!%"%NC%S
Company Contact Name of vessel Tel !ax %mail
OT#%" >)A'!CATONS AND S#O"% 5AS%D %MP'O=M%NT
%N3'S# 'AN3)A3%
Marlins Test in ?
f other test state details
COMP)T%" 0NO-'%D3%
3%N%"A' >)%STONS
%xpected @a*es per month
Duration of contract re:uired
"eason for leavin* present employer
-hy did you choose 3lobal Mana*ement
Remarks for Seafarer
APPRO!E" #y
8as a99/ica:/e;
C/ient: O6ne': Tec<:
RE$ECTE" %if re&e'te( )lease e*)lain t+e reasons,
Cont'o//e+ co9(
ic%&e's Ma'ine A!enc( Ro&ania )RL
*+.Ma&aia ,-. 2
n+
F/oo' . 900,0, Constanta Ro&ania
Te/. 120 22 ,2, ,2. Fa3:1 20 22 ,2, ,4. e5&ai/: c'e6in!.'o7'ic%&e's.co&

Quality Management System
Issue 2 Revision 0
Date: Dec 2009
EMPLOYMENT APPLICATION FORM
CRW 2.
Pa!e 2 o" #
ic%&e's Ma'ine A!enc( Ro&ania )RL
*+.Ma&aia ,-. 2
n+
F/oo' . 900,0, Constanta Ro&ania
Te/. 120 22 ,2, ,2. Fa3:1 20 22 ,2, ,4. e5&ai/: c'e6in!.'o7'ic%&e's.co&