FPD 101

APPLICATION FORM

POSITION APPLIED FOR : 3rd Engineer

Are you willing to accept a lower position ? Yes

Date available if selected ? 15.03.2017

Surname : Mehmet

First Name : Ergean Mid Name : Elis

Marital Status : Single Nationality : Romania

Date of Birth : 28.06.1987 ( dd/mm/yyyy ) Place : Constanta

Height (cms) : 181 Weight (kgs) : 88 Shoe Size : 42 Blood Group :

UK / USA / Europe
Religion

I.C.Bratianu, Nr 186, Bl Sr5 Sc C Ap 68 Telephone : 40723538479

(Present) Mobile : 40723538479
E-mail : mehmet.ergean@yahoo.com
Fax :

Address (2) : Telephone :

(Permanent) Mobile :
E-mail :
Fax :

Nearest Airport: OTOPENI

(International) (Domestic)

FAMILY DETAILS

Next of Kin : Croitoru Maria Relation : Mother

Address : I.C.Bratianu, Nr 186, Bl Sr5 Sc C Ap 68 Telephone : 0726313532

Mobile : 0726313432
E-mail : croitoru.maria@yahoo.com

Date of Birth
Name Sex
Children : (dd/mmm/yy)

BW Fleet Management Pte. Ltd. 30 Hill Street #03-00, Singapore 179360

Tel: 6337 2133 Fax: 63371623 www.bwshipping.com, www.bwgroup.net
BW Fleet Management Pte. Ltd. 30 Hill Street #03-00, Singapore 179360
Tel: 6337 2133 Fax: 63371623 www.bwshipping.com, www.bwgroup.net
EDUCATION / TRAINING

Period (dd/mm/yy)
School / College / Institution Attended Certificate / Diploma obtained
From To
Universitatea Maritima Constanta 09-Jan-10 09-Jul-14 Electromecanic Naval

MEDICAL HISTORY

Have you ever signed off any ship due to medical reasons ? No
Have you undergone any surgery in the past ? No
Have you consulted a doctor during the last 12 months for any illness or accident ? No
Have you ever been tested positive for any drug and alcohol test ? No
(Please mention Yes, No or N/A if the form is being filled manually)
If the answer is YES to any of the above, please give full details below and attach a separate page if necessary

TRAVEL DOCUMENTS AND COMPETENCY CERTIFICATES (Date in dd/mm/yy)

Place of
Document Capacity Cert. No. Issued Date Expiry Date Remarks
Issue
Passport -
U.S visa (C1/D) -
U.S visa (B1/B2) -
Medical Certificate -
Yellow Fever -
National
Seaman's book

Panama
Liberia
NIS
Bahamas
Others
National
Panama
Certificate of

Hong Kong
competency

Singapore
Liberia
NIS
Bahamas
Others
National
Panama
Dangerous Cargo
Endorsement

Hong Kong
Singapore
Liberia
NIS
Bahamas
Others
National
Panama
Hong Kong
GMDSS

Singapore
Liberia
NIS

BW Fleet Management Pte. Ltd. 30 Hill Street #03-00, Singapore 179360

Tel: 6337 2133 Fax: 63371623 www.bwshipping.com, www.bwgroup.net
 GMDS
Bahamas
Others

PROFESSIONAL COURSES (Date in dd/mm/yy)

Type Certificate Number Date Issued Remarks

Advanced Fire Fighting

Fire Prevention and Fire Fighting
Basic Fire Fighting (shore based)
Personal Survival Techniques
Proficiency in Survival Craft & Rescue Boat
Personal Safety & Social Responsibility
Ship Captain's Medicare
Medical First Aid
Radar Simulator
Radar Observer
Automatic Radar Plotting Aid
Basic Tanker Familiarization (Oil / Gas / Chemical) *
Specialised Tanker Safety Course (Oil) - TASCO
Specialised Tanker Safety Course (Gas) - GASCO
Specialised Tanker Safety Course (Chemical) - CHEMCO
Crude Oil Washing / Inert Gas
AMOS (or any other electronic Planned Maintenance System) *
Ship Security Officer
Company Security Officer
Watchkeeping for Engine Room Watches (E/R Ratings)
Watchkeeping for Navigational Watches (Deck Ratings)
Ship Manoeuvring Simulator & Bridge Teamwork
Engine Room Simulator *
NABCO M/E Manoeuvring & Control *
Radar Maintenance Course
Electronic Navigation Aids
Electronic Chart Display & Information Systems
Collision Avoidance Course
Liquid Cargo/Ballast Handling Simulator *
Bridge Team Management
Bridge/Engine Resource Management
Dangerous, Hazardous and Harmful Cargoes (HAZMAT)
Internal Auditor's Course
Port State Control
Hydraulics and Pneumatics
Applied Electronics
Marine Electrical
Welding Course
Computer Knowledge
Catering or Cooking Course
Corrosion Protection & Painting Course
Others than above :

BW Fleet Management Pte. Ltd. 30 Hill Street #03-00, Singapore 179360

Tel: 6337 2133 Fax: 63371623 www.bwshipping.com, www.bwgroup.net
1) Please mention the level/category of course in remarks column if marked with an asterisk *
2) Details of any additional courses attended to be filled-up in the blank spaces

BW Fleet Management Pte. Ltd. 30 Hill Street #03-00, Singapore 179360

Tel: 6337 2133 Fax: 63371623 www.bwshipping.com, www.bwgroup.net
SEAGOING EXPERIENCE (If space not sufficient below, please use separate sheet)

Period of Service
Vessel M/E Type BHP (for (dd/mmm/yy)
Rank Name of Vessel Your Employer DWT Days
Type* (for Engr)* Engrs)
From To

0
0
0
0
0
0
0
0
0
0
0
* Please complete the 'vessel type' or 'engine type' categories as per nomenclature below, in case application form is being completed by hand

CONSOLIDATED SEAGOING EXPERIENCE

Deck Officer Rank Served Years Months Engineer Officer Rank Served Years Months
Product Carrier B&W
Crude Carrier SULZER
VLCC / ULCC MAN
Chemical Carrier PIELSTICK
Bulk Carrier Gas Turbine
OBO Steam Turbine
General Cargo / Cont. UMS
LPG / LNG
Others

REFERENCES (Must mention details of person to contact from applicant's last employers. Reference check shall not be taken without the consent of applicant)

Name Company Contact details

Have you been involved in either or both of the following, during service with any of your previous employers?
(a) a maritime accident involving loss of life and/or a considerable loss of property
(b) an incident involving oil pollution damage to environment

If the answer to above is YES, please give details and attach a separate page if necessary

I certify that the above information is true and correct. I fully understand and agree that any false declaration herein above shall result in instant
dismissal without any responsibility or liability whatsoever on the part of the company.

Date : Applicant

BW Fleet Management Pte. Ltd. 30 Hill Street #03-00, Singapore 179360

Tel: 6337 2133 Fax: 63371623 www.bwshipping.com, www.bwgroup.net