Eastern Pacific Shipping Pte Ltd.

EMPLOYMENT APPLICATION FORM

RECENT PASSPORT SIZE

COLOUR PHOTOGRAPH
STAFF CODE: RANK: Cadet Maritime Electrical Officer
Office use only

VESSEL:
DATE AVAILABLE: 7/11/2017
Office use only

SURNAME: Craciun FIRST NAME: Liviu OTHER NAME:

DATE OF BIRTH: 31/08/1992 PLACE OF BIRTConstanta NATIONALITY: Romana

PASSPORT NO. 54132053 ISSUED ON: EXPIRY DATE: 9/9/2021

9/9/2016
S/BOOK NO. 36062CT ISSUED ON: EXPIRY DATE:
3/10/2016 20/05/2018

PERMANENT
Soveja Nr.98, Bl.58, Sc.E, Ap.72
ADDRESS:

PHONES: 40733726296 FAX: E-MAIL: craciun.liviu92@gmail.com

NEXT OF KIN: NAME: Dida

Relationship

ADDRESS: Soveja Nr.98, Bl.58, Sc.E, Ap.72

PHONES: 40721057457 FAX: E-MAIL:

NEAREST For officers - Please specify the nearest domestic

AIRPORT: airport. For all ratings - the nearest international airport.

MARITAL STATUS: Single SPOUSE NAME:

MARRIAGE DATE:

CHILDREN

SON / DAUGHTER NAME DATE OF BIRTH

PRE-SEA TRAINING / NAUTICAL SCHOOL / MARITIME SCHOOL (Specify School Name / Country, and Year attended)

PAGE 1 OF 7 OFC06-04/17
 Eastern Pacific Shipping Pte Ltd.

DOCUMENT STATUS
LICENSES GRADE REGULATION NUMBER ISSUE EXPIRY PLACE Authenticated
NATIONAL LICENSE (LIC)

NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - OIL

NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - CHEM

NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - GAS

REVALIDATION OF NATIONAL LICENSE (REV)

S T C W COURSES Mark / Delete GRADE REGULATION NUMBER ISSUE EXPIRY PLACE Authenticated
SURVIVAL AT SEA / PERSONAL SURV. TECH. (SAS / PSST) Basic 11685 20/05/201620/05/2021 Constanta

PROFICIENCY IN SURVIVAL CRAFT (PSC) 20/05/201620/05/2021 Constanta

FIRE PREV. AND FIGHTING Basic 11685 20/05/201620/05/2021 Constanta

FIRST AID / SHIP'S MEDICARE Basic 11685 20/05/201620/05/2021 Constanta

PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES (PSSR) Basic 11685 20/05/201620/05/2021 Constanta

FAMILIARIZATION COURSE (OIL / CHEM / GAS) Basic 8092 ### 6/10/2022 Constanta

ADVANCED / SPECIALISED TANKER COURSE (OIL /CHEM / GAS)

PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOAT (PSCRB)

ADVANCED FIRE FIGHTING

MEDICAL FIRST AID AND MEDICAL CARE

GMDSS

BRIDGE TEAM AND RESOURCE MANAGEMENT (BTRM)

ENGINE TEAM RESOURCE MANAGEMENT (ETRM) / ERM

ELECTRONIC CHART DISPLAY AND INFORMATION SYSTEM (ECDIS)

as per IMO 1.27

RISK MANAGEMENT AND INCIDENT INVESTIGATION COURSE (RMI)

SAFETY OFFICER COURSE (SOT)

SHIP SECURITY OFFICER (SSO)

SDSD-Designated Security Duties= YES Basic 2617 27/05/2016 Constanta

HIGH VOLTAGE TRAINING COURSE (C/E, 1/AE, 2/AE, 3/AE, E/E)

ENVIRONMENTAL OFFICER TRAINING COURSE

RADAR OBSERVER (ROC)

ARPA / RADAR SIMULATOR

OTHER COURSES GRADE REGULATION NUMBER ISSUE EXPIRY PLACE

SHIP HANDLING SIMULATOR & BRIDGE TEAM (SHS)

LIQUID CARGO HANDLING SIMULATOR (LCH)

SHIPBOARD MANAGEMENT (SBM)

ISM

ENGINE SIMULATOR

U.S. VISA C1/D STATUS

YELLOW FEVER

LIBERIAN SEAMAN'S BOOK

LIBERIAN LICENSE

LIBERIAN GMDSS CERTIFICATE

LIBERIAN "TANKERMAN (OIL)" V/1

LIBERIAN SPECIAL QUALIFICATION CERTIFICATES

SINGAPORE CERTIFICATE OF ENDORSEMENT (COE)

SINGAPORE - TANKER ENDORESEMENT (MGMT / OPERATIONAL)

SINGAPORE GMDSS CERTIFICATE OF ENDORSEMENT (COE)

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 Eastern Pacific Shipping Pte Ltd.

DETAILS OF PREVIOUS SEA SERVICE

LAST VESSEL ON TOP

TYPE OF VESSEL PERIOD OF SERVICE

YEAR AND TYPE OF ENGINE* DWT NAME OF OWNERS / MANAGERS
NAME OF VESSEL FLAG RANK
BUILT (Example: Container Carrier / B&W / H.P.* FROM TO AND THEIR CONTACT DETAILS
12K98MC-C) (DD/MM/YYYY) (DD/MM/YYYY) Period in Months

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0
1. APPLICANTS TO ENSURE THAT COMPLETE SEA SERVICE FROM THE BEGINNING OF SEA CARRIER IS GIVEN. IF THIS PAGE IS INSUFFICIENT, PLEASE MAKE A PHOTOCOPY OF THIS PAGE AND WRITE THE SEA
SERVICE.

2. ENGINE DEPARTMENT APPLICANTS TO ENSURE THAT HORSE POWER AND DEAD WEIGHT IS WRITTEN UNDER COLUMN 4 FOR VESSEL SERVED.

3. MANNING OFFICE TO CHECK AND ENSURE THE ABOVE SEA-SERVICE IS TALLYING AGAINST CANDIDATE'S NATIONAL SEAMAN BOOK.

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 Eastern Pacific Shipping Pte Ltd.

SUMMARY OF OFFICER'S EXPERIENCE

Crude Oil Chemical LPG
EXPERIENCE AS Product Tanker Bulk Geared Bulk Container Car Carrier
Tanker Tanker Tanker

MASTER C/E

C/O 1 / AE

2/O 2 / AE

3/O 3 / AE

RJ/O E/E

TOTAL

ENGINE APPLICANT DECK APPLICANT

TYPE OF AUXILIARIES Please mention Model & Type TYPE OF ECDIS Please mention Mo

GENERATORS JRC

BOILERS FURUNO

PURIFIERS TRANSAS

COMPRESSOR PAPERLESS NAVIGATION EXPERIENCE :

ELECTRONIC MAIN ENGINE EXPERIENCE :

EXPERIENCE WITH MULTINATIONAL CREW: YES / NO NATIONALITY: YEARS / MONTHS:

REASON FOR LEAVING LAST COMPANY:

IS APPLICANT 18 YEARS OR ABOVE? YES / NO

WHETHER AGREEABLE TO ACCEPT ONE RANK LOWER YES / NO

WHETHER AGREEABLE TO JOIN VESSEL PLYING IN WAR ZONE / HIGH RISK AREA YES / NO

Blood Type : Height Safety Shoes

Eye Sight with Glasses : Weight Boiler Suits

Eye Sight without Glasses : BMI Parka

HAVE YOU BEEN THE SUBJECT OF A COURT OF ENQUIRY OR INVOLVED IN A MARITIME ACCIDENT? YES / NO

MEDICAL HISTORY:
ALL PREVIOUS ILLNESSES OTHER THAN MINOR ILLNESSES SHOULD BE STATED BELOW OR UPDATED. IF NOT PREVIOUSLY DISCLOSED, THE CO
ENTITLED TO REFUSE ANY REIMBURSEMENT OF MEIDCAL COSTS, CLAIM FOR TREATMENT OR FOR ANY OTHER INSURED BENEFITS.

A. HAVE YOU EVER SIGNED OFF A SHIP DUE TO MEDICAL REASONS? YES / NO
IF YES, PLEASE PROVIDE FOLLOWING DETAILS (IF SPACE IS INSUFFICIENT, ATTACH ADDITIONAL SHEETS) :
NAME OF VESSEL DATE OF OCCURRENCE PLACE OF OCCURRENCE

BRIEF DESCRIPTION OF ILLNESS / INJURY / ACCIDENT

B. HAVE YOU UNDERGONE ANY OPERATION IN THE PAST? YES / NO IF YES, PLEASE PROVIDE FOLLOWING DETAILS :
DETAILS OF OPERATION DATE PERIOD OF DISABILITY PRESENT CONDITION

C. FOR WHAT ILLNESSES OR ACCIDENTS HAVE YOU CONSULTED A DOCTOR DURING THE LAST 12 MONTHS?
DETAILS OF ILLNESS / ACCIDENT DATE THERAPY / TREATMENT
 Eastern Pacific Shipping Pte Ltd.

D. PLEASE GIVE DETAILS OF ANY HEALTH, ALLERGY OR DISABILITY PROBLEM

DETAILS:

I hereby confirm that all my certificates [Certificate of Competency, STCW certificates and other qualifications] are genuine and authentic. I confirm
holding any fake certificates.

I declare that all information provided herein is to the best of my knowledge is true and correct. I am fully aware that witholding or providing wrong i
lead to termination of employment and commencement of criminal proceedings.

Signature Date of application

I have confirmed the applicant is holding the certificates require as per QSP0912/0913 applicable for his position.

EPS Representative / Agent Date

PAGE 4 OF 7
 Eastern Pacific Shipping Pte Ltd.

In years and months

TOTAL

DECK APPLICANT
Please mention Model & Type

Safety Shoes

Boiler Suits

Parka

E STATED BELOW OR UPDATED. IF NOT PREVIOUSLY DISCLOSED, THE COMPANY IS

M FOR TREATMENT OR FOR ANY OTHER INSURED BENEFITS.

PLACE OF OCCURRENCE

IF YES, PLEASE PROVIDE FOLLOWING DETAILS :

PRESENT CONDITION

OCTOR DURING THE LAST 12 MONTHS?

THERAPY / TREATMENT
 Eastern Pacific Shipping Pte Ltd.

ROBLEM

W certificates and other qualifications] are genuine and authentic. I confirm that I am NOT

ge is true and correct. I am fully aware that witholding or providing wrong information will
edings.

Date of application

equire as per QSP0912/0913 applicable for his position.

Date

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 Eastern Pacific Shipping Pte Ltd.

EVALUATIONS
(For All Ranks)

Date :
Manning office :
Applicants name :
Rank :
Biodata Number :

Reference Check - 1 (Last Employer)

Employers Name and contact details

Reference check date :

Name of Person Giving this reference:
Detailed references (To be listed point by point)
1
2
3
4
5
6
7
8 Name of person taking reference
9
10

Reference Check - 2 (Previous Last Employer)

Employers Name and contact details

Reference check date :

Name of Person Giving this reference:
Detailed references (To be listed point by point)
1
2
3
4
5
6
7
8 Name of person taking reference
9
10

Special Remarks / Comments

Recommendation from any Ex EPS staff or Reliable known persons.

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 Eastern Pacific Shipping Pte Ltd.

CARGO INFORMATION SHEET

NOTE: Tick appropriate box for cargoes carried, and comment in the space provided.

Fleet A GAS TANKERS Fleet A PRODUCT / CRUDE TANKERS

Acetaldehyde JET A1
Anhydrous Ammonia NAPTHA
Butadiene PREMIUM UNLEADED PETROL (UNDYED)
Butane PREMIUM UNLEADED PETROL (DYED)
Butane / Propane Mixture UNLEADED PETROL/MOGAS
Butene LEADED PETROL/MOGAS
Butylenes AUTOMOTIVE GAS OIL
Diethyl Ether VGO
Dimethylamine CAT CRACKED GASOLINE
Ethyl Chloride CRACKER FEED
Ethane LIGHT CYCLE OIL
Ethylene Oxide / Propylene Oxide Mixtures REFORMATE
Isoprene FUEL OIL 380 CST
Isopropylamine FUEL OIL BLEND COMPONENT
Methyl Acetylene Propadiene Mixture HIGH SULPHUR FUEL OIL
Methyl Chloride LOW SULFUR WAXY RESIDUE
Monoethylamine CUTBACK BITUMEN
Propane BITUMEN FEEDSTOCK
Propylene CRUDE OIL
Vinyl Chloride Monomer CONDENSATE
Vinyl Ethyl Ether HIGH POUR POINT CRUDE

Vinylidene Chloride CLOUD POUR POINT CRUDE

Crude C4 CRUDE WITH HIGH VAPOUR PRESSURE

Methane HEATED CARGO

Fully Pressurized Ships

Semi Pressurized / Refrigerated Ships

Fully Refrigerated Ships

Special Cleaning After Prop OX (Give Detail)

Special Cleaning After Butadiene (Give Detail)

LNG

Fleet A CHEMICAL TANKERS

Dodecylbenzene (Lab) Vegetable Oils

Hydrogen Peroxide Molasses

Acrylonitrile Ethylene Dichloride (EDC)

Sulfuric Acid Styrene Monomer

Nitric Acid Benzene

Phenol Vinyl Acetate Monomer (VAM)

Epichlorohydrin (ECH) IPA / NBA

Caustic Soda Methyl Ethylene Glycol (MEG)

Hexane Lub Additives / Lubrizol

Xylene Sodium Hydrosulphide

MDI / Diphenylmethane Diisocyanate Phosphoric Acid

Toluene Propylene Oxide / Ethylene Oxide

Methanol Ethanol

Palm Oils Paraffin Wax

Wall Wash Testing (HC / CL) Permangemate Testing (PTT)

Passivating Stainless Steel Tanks N2 Padding

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 Eastern Pacific Shipping Pte Ltd.

CARGO INFORMATION SHEET

NOTE: Tick appropriate box for cargoes carried, and comment in the space provided.

Fleet B BULK CARRIERS Fleet C - (CONTAINER AND CAR CARRIER)

Alumia DG Cargo

Sugar Reefer containers

Lime/ Cement Mediterranean Mooring

Understanding of the Regulation regarding Verification of the Gross Mass (VGM)

Petcoke
of a packed Container

Grain

Salt

Steel Products

Bagged Cargo

Coals

Ore

Iron

Sand & gravel

Copper

Limestone

Silica Sands

Pig Iron

Timber (UnderDeck)

Machinery (Boxed)

OTHER INFORMATION / AREAS OF KNOWLEDGE

Oil Company Inspections / CDI (Please List)

Trade Areas (Please List in detail last 2-3 vessel's trading areas)

Deep Well Pumps Experience (Types of Pumps)

Centrifugal Pumps Experience

Specialized Framo Pumps/Cargo System

Closed Loading / VECS.

Cargo Heating Oil/Steam/Deck htr (Please List)

Tank Coating Type Zn / SS / EPOXY (Please List)

Cargo Cooling Systems

Compressor Types

Inert Gas

Gas Freeing

Specialist Gas Training

Inhibited Cargoes (Please List)

STS (Ship To Ship) experience

Lightering

Transshipper
PAGE 7 OF 7 OFC06-04/17