APPLICATION FORM
Rank
ENGINE CADET/WIPER
Readiness from
Surname
PIANOWSKI
Christian Name
KAROL
Father's Name
ZBIGNIEW
Mother's Name
MARZENA
Date & place of birth
09. OCT 1986 GDYNIA
E- mail
aczadj@r.postjobfree.com
Home address
Przemyska 39b/1 80-180 Gdańsk
Phone
Matrimonial status
Single
No of children
0
Next of kin
Agnieszka Wierzchnicka
Relationship
Fiancee
Address of next of kin
Przemyska 39b/1
Phone
PERSONAL DOCUMENTS
NUMBER
PLACE & DATE OF ISSUE
VALID TILL
National Seaman’s Book
0269411
2015-03-02 GDYNIA
INDEFINITELY
Passport
EH 7371920
2014-12-03 GDAŃSK
2024-12-03
Usa Visa
-
-
-
Health Certificate
1/2017
2017-01-09 GDAŃSK
2018-01-09
Drug / Alcohol Test
Yellow Fever Vaccination
K5520-1
2015-02-12 GDYNIA
2025-02-02
LICENCES / CERTIFICATES
NUMBER
PLACE & DATE OF ISSUE
VALID TILL
National Licence
GUM-131**-******-***/2015
2015-02-13 GDYNIA
INDEFINITELY
Foreign Licence / Endorsment
Radar Observer
ARPA
GMDSS
GMDSS Endorsment
HAZMAT
Bridge/ Engine Resource Management
Advanced Fire Fighting
GUM-1315-133980-62771/2016
2016-10-18 GDYNIA
2021-10-13
Fire Prevention & Fire Fighting
GUM-5425-133980-2274/2015
2015-01-26 GDYNIA
2020-01-29
Personal Survival Techniques
GUM-5425-133980-2274/2015
2015-01-26 GDYNIA
2020-01-29
Survival Crafts and Rescue Boats
Elementary first aid
GUM-5425-133980-2274/2015
2015-01-26 GDYNIA
2020-01-29
Medical first aid
GUM-5421-133980-62801/2016
2016-10-18 GDYNIA
2021-10-13
Medical Care
Pesonal Safety and Social Res.
GUM-5425-133980-2274/2015
2015-01-26 GDYNIA
2020-01-29
Sec. Awareness
GUM-1350-133980-27750/2016
2016-05-24 GDYNIA
INDEFINITELY
Sec. Duties
GUM-1351-133980-27805/2016
2016-05-24 GDYNIA
INDEFINITELY
Basic Oil Tanker Familiar.
GUM-1337-133980-29218/2016
2016-05-31 GDYNIA
INDEFINITELY
Basic Chem. Tanker Familiar.
GUM-1337-133980-29218/2016
2016-05-31 GDYNIA
INDEFINITELY
Basic Liquified Gas Tanker Familiar.
GUM-1303-133980-29406/2016
2016-05-31 GDYNIA
INDEFINITELY
LANGUAGE ( good, average, poor)
SPOKEN
WRITTEN
English
Fluent
Fluent
Polish
Fluent
Fluent
LAST FIVE YEARS
Type of vessel
Name of Vessel
Deck Officers List Gross Tons
Engineers List KW propulsion power
Type of Engine
FLAG
Name of Company
Rank
Signed on/signed off
TOTAL SERVICE
REFERENCES
VESSEL’S NAME
SHIPOWNER/CREWING AGENCY ADDRESS
CONTACT PERSON
PHONE NUMBER
EDUCATION
Name of school
Address
Country
Dates attended From To
Type of Degree of Diploma received
Maritime University in Gdynia
Morska 81-87 81-225 Gdynia
Poland
OCT/2005-Apr/2011
Master of Engineering
Maritime School in Gdynia
Polska 13a 81-339 Gdynia
Poland
SEP/2015- Jan/2017
REMARKS
I need only 6 months to be able to participate in an exam for 3rd Engineer.
I have participated in an overhaul of semi submersible accomodation vessel Safe Concordia for three months in Rio de Janeiro at Maua Shipyard, i worked for Callenberg company. I am eager to work and learn and would be glad to to establish a long term co-operation with your company.
Zgodnie z Ustawą O ochronie danych osobowych” z dn. 29.08.1997 zawartą w Dzienniku ustaw nr. 133 z dnia 29.10.1997, poz. 883 wyrażam zgodę na przetwarzanie moich danych osobowych
i przekazywanie ich armatorom zagranicznym.
Date and Signature