Position Applied for:

1 2

A/B

Date Filed: 17 August 2011

PERSONAL DATA: Surname DEMETERIO Nationality FILIPINO Preferred Name/Nickname CHRIS SSS No. Civil Status Single Married

Picture First Name CHRISTOPHER Date of Birth (mm/dd/yy) 05/15/68 Shoe Size 9 TIN Separated Widow/Widower Middle Name ROSELLO Place of Birth MANILA E-mail Address: Maiden Name (for female married applicant) Height 165 Weight 82

annademeterio@ymail.com
Phil. Health No. Divorced Contact Address City Country Contact No. Sex Male Female

Permanent Address

B5 L5 FIRENZE SUBD. PH2 BNT IMUS, CAVITE

City Country PHILIPPINES Contact No. 0918 6787542 / 0999 6734208 FAMILY DETAILS Name Spouse (pls indicate maiden name) (If deceased, pls indicate) Father (If deceased, pls indicate) Mother (pls indicate maiden name) (If deceased, pls indicate) Child/Children LOU-ANN S. DEMETERIO

Sex F M F M M

Date of Birth (mm/dd/yy) 04/17/77 09/10/39 05/10/39 11/15/03 06/26/11

Place of Birth

CAGAYAN DE ORO LEYTE LEYTE MANILA MANILA

DULCESIMO A. DEMETERIO (DECEASED) ROSARIO E. ROSELLO (DECEASED) SEAN ANDRIE S. DEMETERIO EMMANUELLE GABRIELLE S. DEMETERIO

Person to notify in case of emergency Name LOU-ANN S. DEMETERIO Address: B5 L5 FIRENZE SUBD. PH2 BNT IMUS, CAVITE Contact Number 0999 6734208 EDUCATIONAL BACKGROUND: Level School Collegiate Secondary
FEATI UNIVERSITY

Relationship WIFE

Highest Degree Earned MRO - BSMT

DON BOSCO PAMPANGA

Date From (mm/dd/yy) 2001 1981

Date To (mm/dd/yy) 2002 1985

Place QUIAPO, MANILA PAMPANGA

RECORD BOOKS Document No. Passport (Phil) Seamans Book (Phil) SRC (Phil) US Visa Seamans Book (Flag State*)
*Flag State 1. Bahamas 2. Marshall islands 3. Liberian 4. Singapore 5. Others- please indicate *Issuing Authority 1. Bahamas Maritime Auth 2. Marshall Island Auth. 3. Liberian Marshall Auth 4. Singapore Marshall Auth 5. Othersplease indicate

Issued Date (mm/dd/yy) 05/13/10 04/27/10 01/24/08

Expiry Date (mm/dd/yy) 05/12/15 04/26/15

Issuing Authority DFA BATANGAS MARINA OWWA

EB0209797 BO863701 0124296-94

(A) Have you ever been denied of any visa? If Yes, please provide following details: Country Date of refusal (B) Have you ever been deported? If Yes, please provide following details: Country Date of deportation

Yes

No

Reason of refusal Yes x No

Reason of deportation

TRAINING COURSES Training Name Basic Safety Course Proficiency in Survival Craft and Rescue Boat Advanced Firefighting General Tanker Familiarization Shore Based Firefighting Crowd Management Crisis Management Watchkeeping OTHER TRAINING COURSES Training Name Document No. HAZMAT SHIP SECURITY AWARENESS 206835 279928 Issued Date (mm/dd/yy) 01/09/03 09/22/05 Training Center PNTI PNTI with NAC Issued Date (mm/dd/yy)
205/01 12/19/01 ADMIRAL

Document No.
207136 65625

Issued Date (mm/dd/yy)

01/20/03 10/13/00

Training Center
PNTI TMTCP

with NAC
14220936 15138135

Issued Date (mm/dd/yy)

10/01/03 01/01/03

LICENSE ENDORSEMENTS Grad e OIC NAV. WATCH (Phil) OIC ENG. WATCH (Phil) OIC NAV. WATCH (Flag State) OIC ENG. WATCH (Flag State) GOC (Phil) GOC (Flag State)
*Flag State 1. Bahamas 2. Marshall islands 3. Liberian 4. Singapore 5. Others- please indicate *Issuing Authority 1. Bahamas Maritime Auth 2. Marshall Island Auth. 3. Liberian Marshall Auth 4. Singapore Marshall Auth 5. Othersplease indicate

Document No.

Issued Date (mm/dd/yy)

Expiry Date (mm/dd/yy)

Issuing Authority

PREVIOUS EMPLOYMENT Please complete below with details of your previous employment for the past ten years. SEA EXPERIENCE (with recent on top line) Rank Vessel Date From (mm/dd/yy) 10/22/10 09/26/09 03/12/09 01/01/09 05/06/08 02/06/08 07/03/07 09/24/06 10/07/05 01/16/05 01/02/04 03/19/03 Date To (mm/dd/yy) 04/29/11 04/02/10 08/27/09 02/09/09 11/04/08 04/09/08 01/16/08 04/04/07 08/18/06 09/08/05 10/28/04 11/11/03 DWT Engine Make Vessel Type R/O CON CON CON R/O R/O R/O R/O CON CON CON CON Indicate Foreign Employer or Agent Reason for Leaving

A/B A/B A/B A/B A/B A/B A/B A/B A/B A/B A/B A/B

MAAS VIKING CLAES MAERSK LAUST MAERSK SAFMARINE CONCORD MAERSK EXPORTER MAERSK IMPORTER MAERSK VLAARDINGEN MAERSK VLAARDINGEN SHION CALA PIEDAD SAFMARINE GONUBIE CALA PORLAMAR

MERIDIAN MAERSK MAERSK MAERSK MAERSK MAERSK MAERSK MAERSK WINTER BROS GMBH WINTER BROS GMBH WINTER BROS GMBH WINTER BROS GMBH

LONG VACATION LONG VACATION

NO LINEUP

Use only following abbreviation for vessel types: GCD General Cargo B/C Bulk Carrier OBO Ore/Bulk/Oil Carrier TNC Tanker (Crude) GAS LPG/LNG Gas Carriers OSV Off Shore Supply Vessel CHM Chemical Carriers DRG Dredgers

CON Cellular Container TNP Tanker (Product) PAS Passenger Ship SRV SURVEY Vessels

MLP Multipurpose TNV VLCC / ULCC R/O Ro/Ro Carriers LOG Log/Timber

O/O Ore / Oil Carrier TNS Tanker (Storage) C//S Car Ship RFR - Reefer

Land Based Experience (with recent on top line) Date From (mm/dd/yy) Position Employer

Date To (mm/dd/yy) Address of Employer Contact No.

Immediate Supervisor

Salary

Reason for Leaving

MEDICAL HISTORY It is important that all illness other than minor afflictions should be stated. The Company is entitled to refuse any claim for treatment, cost or any other benefits if a complete statement of all previous illness has not been given. (A) Have you ever signed off a ship due to medical reasons? Yes No X If Yes, please provide following details: Name of vessel Date of occurrence Brief description of illness/injury/accident Place of occurrence

(B) Have you undergone any operation in the past? If Yes, please provide following details: Details of operation Date

Yes

No Present condition

Period of disability

(C.) For what illness or accidents have you consulted a doctor during the last 12 months? Details of illness Date Therapy / Treatment NIL

(D) Do you have any of the following conditions? Hypertension Diabetes Hepa A/B Asthma

Yes X X X X

No

References: Please give references from two recent employers who we may contact for references. Reference 1 Name of Company Name of person to contact Address Country Telephone Reference 2

PB MARITIME MS. HAZEL QUISUMBING RAMON MAGSAYSAY CENTER PHILIPPINES 4053012

MAERSK FILIPINAS MS. GRACE RINA 7/F SALCEDO TOWERS 169 HV DELA COSTA ST. SALCEDO VILLAGE MAKATI CITY PHILIPPINES 8988200
Yes X No

Other info: (A) Do you have any relatives working for us at present? If Yes, please provide following details: Name of Crew Position and Principal

Relationship

(B) Have you ever applied for a job with us before? If Yes, please provide following details: When

Yes Position

No

I hereby declare that the above, including Medical History, is true. Place MANILA Date 17 AUG. 2011 Signature