EMPLOYMENT APPLICATION FOR SHIP PERSONNEL

Application For Employment As:

Date Available for Joining

P SURNAME: Roman First Name: Irina

E
Middle Name:Alexandra Nationality:Romanian
R
S Date of Birth:24.04.1989 Place of Birth: Constanta
O
Marital Status: Single Name of Spouse:
N
A Address: Str.Dr.S.Al.Marcovici,Nr.2,Bl.MG.11,Sc.A,Ap.17,Et.4,Loc.Constanta,Jud.Constanta
L

Telephone No: Nearest International Airport

P Mobile: +40735643195
A Passport No: 052970577
R
T Date of Issue: 19.05.2015
I
C US Visa
U Seaman Book No.: 34156CT
L
A Date of Issue 30.03.2015
R Medical certificate
S Date of issue:16.01.2017
Otopeni Bucharest
Place of Issue: Constanta
Date of Expiry: 19.05.2020
Yes/No Date of Expiry:
Place of Issue: Constanta
Date of Expiry: 15.01.2019
Date of Expiry: 15.01.2019

Blood type: A2 Height:1.68 m Clothes size( M, L, XL, XXL ) Shoe size: 37

F Give particulars of your immediate family members and indicate your relationship with them.
A
M Name/ Relationship Date of birth Occupation
I
Mamut Emrin 23.01.1991 Third Mate
L
Y Garoafa Iulia 20.07.1984 Manager
EMERGENCY
Next of Kin: Garoafa Iulia Address:
Str.Dr.S.Al.Marcovici,Nr.2,Bl.MG.11,Sc.A,Ap.17,Et
.4,Loc.Constanta,Jud.Constanta
Relationship: Sister
Telephone No. Telephone No.
Home:+40725280459 Office/Mobile:
L LICENCE PARTICULARS
I Certificate Grade Cert No Issue Date Place of Issue Validity
C
E National Licence
N Endorsement Deck Officer-on 77058 20.04.2017 Constanta 06.02.2020
S ships of 500 GT
E or more
Tankers certificate
Liq. gas tankers cert
Chemical tankers cert
Fast rescue boat cert.
Other flag endorsem.

S.T.C.W. COURSES
Ref No Date of Issue
Personal survival techniques/Survival at Sea 00001140 25.02.2015
Proficiency in survival craft and rescue boats, 00002184 19.05.2015
C other than fast rescue boats
O First Aid Sea[ ] Advanced Medical Care[ ] 00000570 03.02.2015
U
R Fire Fighting [ ] Advanced Fire Fighting [ ] 00001088 06.02.2015
S Radar Observers
E Radar Simulator
S
A.R.P.A.
G.M.D.S.S G.O.C. 00001044 05.04.2017
Tanker familiarization
Tanker Specialized training
Chemical Tankers Advanced Training
Liquefied gas advanced training
Dangerous Cargo
Maritime English & Human Relationship
P.S.S.R. 00022030 24.03.2015
Fast Rescue Boat Leader
Prevention Of Pollution
RO-RO/Passenger Ships Proficiency 00000675 19.03.2015
Bridge Team Management 00002904 10.03.2017
Proficiency in Fast Rescue Boats
Other
Operational use of Electronic chart Display 00006513 03.03.2017
and Information System (ECDIS)
 SUMMARY OF EXPERIENCE( in months)
EXPERIENCE BULK ORE CONTAINER CHEMICAL REEFER OIL GENERAL OTHERS TOTAL
AS CARRIER CARRIER CARRIER TANKER TANKER CARGO
CPT C/E
C/O 1/E
2/O 2/E
3/O 3/E
CDT E/E Ro-Ro Pax 15.6
months
TOTAL 15.6
months
ENGINEER APPLICANT NAVIGATING APPLICANT
TYPE OF ENGINE DURATION(Months) TYPE OF VESSEL DURATION(Months)
MAN BULK CARRIER

B&W GENERAL CARGO

SULZER CONTAINER CARRIER

MAK CHEMICAL TANKER

STEAM TURBINE/OTHERS REEFER

U.M.S. OIL TANKER

CRANE EXPERIENCE OTHERS(Specify) 15.6 months

(TYPE/MAKE) Ro-Ro Pax
Experience with Inmarsat YES / NO Duration (Months)

Experience with Multinational Crew YES / NO NATIONALITY: Greek, MONTHS: 15.6

Italian, Albanian, Arabian;
Reason For Leaving Last Company: End of deck cadet practice

Whether Agreeable To Accept One Rank Lower YES / NO

Whether Agreeable To Join Vessel Trading In War Zone YES / NO

Signature Date of application

Interview Date: Interviewed by: Result:

Level of English / 10 Appearance: / 10 Attitude: / 10

Interviewer notes:

Fleet Personnel Department Notes: