Employment Application Form
Ordinary Seaman
Personal Data: * required field Ordinary Seaman
* Family Name: * Given Names:
chiricu george cristian
* Date of Birth: Place of Birth: Nationality:
05-08-1983 constanta romanian
Permanent Address: constanta,str mures,nr 62,romania
* Phone: * Mobile Phone Fax:
+4-072******* +4-072******* e-Mail: *************@*****.***
Weight: Height: Marital status:
72 171 MARRIED
Father's Full Name: Mother's Full Name:
gheorghe elena
Next of Kin:
Full Name: Date of Birh: Relationship: Phone:
cocolos elena 31-05-1988 wife 072*******
Permanent Address:
same
Dependants (e.g.children under age of 18):
Relationship: Full Name: Date of Birth:
*For cadets only:
Year of study: Maritime Education Institution: Attendance: Months to complete sea service:
* If you have completed your education state in the 'Year of study' field 'graduated'.
** If you have previous sea experience imput all the respective data into the dedicated section.
*** The 'Months to complete sea service' refers to remaining sea time necessary to apply for Officer exam.
General Documents:
Document: Number: Issue Place: Issue Date: Expiry Date:
Passport: 051714678 constanta 04-02-2013 04-02-2018
Seaman's Book, National: 22412ct constanta 19-06-2007 21-02-2015
US Visa, type C1/D: 56607305 bucuresti 05-03-2009 03-03-2014
Vaccination, Yellow Fever: constanta 22-05-2008 22-05-2018
National & International Courses and Licenses:
Document: Number: Issue Place: Issue Date: Expiry Date:
License (CoC Officers), National
Watchkeeping/Capacity Certif. (CoC Ratings), National
Revalidation/Endorsement, National
Proficiency in Survival Craft & Rescue Boats
00002723 constanta 15-02-2013 15-02-2018
Personal Survival Techniques 001467 constanta 01-02-2013 01-02-2018
Basic Fire Fighting 001467 constanta 01-02-2013 01-02-2018
Advanced Fire Fighting
Elementary First Aid 001467 constanta 01-02-2013 01-02-2018
Medical First Aid
Medical Care and Social
Personal Safety
Responsabilities 001467 constanta 01-02-2013 01-02-2018
Pollution Prevention 00000933 constanta 07-02-2013 07-02-2018
Dangerous Cargoes IMDG 00000933 constanta 07-02-2013 07-02-2018
GMDSS GOC, National
ARPA Radar Simulator
Bridge Team Management
Engine Team Management
Maritime English 00000619 constanta 13-02-2013 13-02-2018
ECDIS Training
Ship Security Officer
Ship Handling & Maneuvering Simulation
Risk Assessment & Incident Investigation
Safety Officer Training
Additional Courses and Licenses:
Issue Place / Flag* /
Document: Number: Class** Issue Date: Expiry Date:
Seaman's Book, Flag* 191950 marshall islands 31-03-2010 30-03-2015
License Endorsement, Flag*
GOC Endorsement, Flag*
Welder Class Certificate,
Class** (Fitters)
Naval Electrical Systems of
Medium and High Voltage
(Electricians/Engineers)
Marine Refrigerating
Systems/Reefer Containers
Hygiene Course for Catering
Personnel
Tanker Familiarization
Specialized Training for Oil
Tankers
Specialized Training for
Chemical Tankers
Specialized Training for
Liquified Gas Tankers
Oil Tankers Endorsement
Chemical Tankers
Endorsement
Liquified Gas Tankers
Endorsement
Tanker Endorsement, Flag*
Inert Gas System (IGS)
Crude Oil Washing (COW)
Vetting Experience (state: name/type of vessel,
issuing authority & aprox. date, last done)
Flag* - issued by other administration (except national); If more please insert/copy additional rows
Class** - Welder Qualification Certificate issued by Classification Society (please specify); If more please insert/copy
a revious rows
Pdditional Sea Experience (Last Vessel First):
Name of Vessel: Flag: Vessel Type: GRT/DWT/TEU ME type & Power:
1. mimi selmer majuro bulk 31218
Rank: (Date) From: (Date) To: Name of Operators / Contact Information
o.s 07-06-2011 27-11-2011 fair play
Name of Vessel: Flag: Vessel Type: GRT/DWT/TEU ME type & Power:
2. african ubuntu majuro container 16801
Rank: (Date) From: (Date) To: Name of Operators / Contact Information
o.s 19-09-2010 10-03-2011 fair play
Name of Vessel: Flag: Vessel Type: GRT/DWT/TEU ME type & Power:
3. frederike selmer majuro bulk 32957
Rank: (Date) From: (Date) To: Name of Operators / Contact Information
o.s 10-03-2010 28-03-2010 fair play
Name of Vessel: Flag: Vessel Type: GRT/DWT/TEU ME type & Power:
4. maersk derince hamburg container 54193
Rank: (Date) From: (Date) To: Name of Operators / Contact Information
o.s 08-06-2009 15-12-2009 fair play
Name of Vessel: Flag: Vessel Type: GRT/DWT/TEU ME type & Power:
5. hyundai dominion monrovia container 74373
Rank: (Date) From: (Date) To: Name of Operators / Contact Information
o.s 08-06-2008 26-10-2008 marlow navigation
Name of Vessel: Flag: Vessel Type: GRT/DWT/TEU ME type & Power:
6. adriana 3 kingstone passanger 4490
Rank: (Date) From: (Date) To: Name of Operators / Contact Information
o.s 21-02-2008 24-03-2008 glad solutions
Name of Vessel: Flag: Vessel Type: GRT/DWT/TEU ME type & Power:
7. adriana 3 nassau passanger 4490
Rank: (Date) From: (Date) To: Name of Operators / Contact Information
o.s 17-01-2008 21-02-2008 glad solutions
Name of Vessel: Flag: Vessel Type: GRT/DWT/TEU ME type & Power:
8. harmony g pireus yacht 498
Rank: (Date) From: (Date) To: Name of Operators / Contact Information
o.s 20-07-2007 15-11-2007 global shipping and tourist
nt Application Form
Ordinary Seaman
Ordinary Seaman
Phone:
Date of Birth:
Months to complete sea service:
'Year of study' field 'graduated'.
respective data into the dedicated section.
maining sea time necessary to apply for Officer exam.
Expiry Date:
04-02-2018
21-02-2015
03-03-2014
22-05-2018
Expiry Date:
15-02-2018
01-02-2018
01-02-2018
01-02-2018
01-02-2018
07-02-2018
07-02-2018
13-02-2018
Expiry Date:
30-03-2015
al); If more please insert/copy additional rows
Classification Society (please specify); If more please insert/copy
ME type & Power:
Name of Operators / Contact Information
fair play
ME type & Power:
Name of Operators / Contact Information
fair play
ME type & Power:
Name of Operators / Contact Information
fair play
ME type & Power:
Name of Operators / Contact Information
fair play
ME type & Power:
Name of Operators / Contact Information
marlow navigation
ME type & Power:
Name of Operators / Contact Information
glad solutions
ME type & Power:
Name of Operators / Contact Information
glad solutions
ME type & Power:
Name of Operators / Contact Information
global shipping and tourist