Cook Medical

APLICATION FORM

ION MATACHE

COOK-BAKER

APPLICATION FORM (SEA STAFF) Available 20/01/2013 [pic]

(This paragraph to be fulfilled by Salary 2300E//3000$

crewing agency's officer only) expectation

SEAFARER MATACHE ION TEL/MOB-004**********

(COOK-BAKER) HOME-004**********

INDENTIFICATION DETAILS: FIRST NAME ION

LICENSED RANK : COOK

BAKER

LICENSE STCW CODE :

SURNAME MATACHE

NATIONALITY ROMANIAN

PERSONAL DETAILS

MARITAL STATUS MARIED RELIGION CRISTIANS

DATE OF BIRTH 12/SEPT/1968 PLACE OF BIRTH CONSTANTA-ROMANIA

PASSPORT NO. 11676474 VALIDITY 26/MAY/2016

SEAMAN'S BOOK 13329CT VALIDITY 14/01/2013

ENGLISH LANGUAGE YES PHONE / MOBILE 004**********

OTHER LANGUAGE FAX / E-MAIL ***********@*****.***

HEIGHT 1.80 WEIGHT 90

OVERALL 50 SHOE SIZE 42

USA 01/IUN/2015 STUDIES BAC.

VISA-VALIDITY

PRESENT ADDRESS STR MARTISORULUI NR,20 BL.FC19 AP.21 ET.2 SC .B CONSTANTA

ROMANIA

NEXT OF KIN NAME & ADDRESS_MATACHE ANETA-STR MARTISORULUI NR,20 BL.FC19 AP.21 ET.2

SC .B CONSTANTA ROMANIA

NEXT OF KIN PHONE NO. : 004**********

WIFE & CHILDREN

NAME & DATE OF PLACE OF BIRTH RELATIONSHIP

SURNAME BIRTH

1.MATACHE ANETA 06-05-1972 TECUCI WIFE

2.MATACHE ANDRA GABRIELA 19/SEPT/1994 CONSTANTA CHILDREN

3.MATACHE ADRIAN GEORGE 15/DEC/2005 CONSTANTA CHILDREN

4.

5.

DOCUMENTS / NO. ISSUED VALIDITY AUTHORITY PLACE OF

CERTIFICATES ISSUED

CERTIF. 13550 02/12/2008 08/07/2013 ANR CONSTANTA

COMPETENCY

ROMANIAN SB 13329CT 15/10/2003 14/01/2013 ANR CONSTANTA

OTHER'S BOOK//UK DB00063820 03/12/2009 UK of great RSS

BRITAIN and

NORTHERN

IRELAND(DEP for

TRANSPORT)

MARLINS ENGLISH A9061F8D52 19/11/2009 MARLINS

3FFD24 ASSESSMENT

CERTIFICATE A5765-3 28/01/2008 27/01/2018 PORT REALTH CONSTANTA/ROMA

YELLOW FEVER AUTORITY NIA

CONSTANZA

RANK: COOK-BAKER

NAME: SURNAME: MATACHE ION

RECORD OF

PREVIOUS SEA SERVCE* Please start nominate as first as backward

SHIP'S PARTICULARS DATES

COMPANY (OWNER) / RANK

FLAG

NAME TYPE DWT MAIN FROM TO

ENG/H.P

.

TIDE WATER/VANUATU C/COOK BERGERON AHTS/seis 1678 26/10/201 17/01/2013

TIDE mic cable 2

TIDE WATER/VANUATU C/COOK BERGERON AHTS/seis 1678 27/06/201 29/08/2012

TIDE mic cable 2

GSP/MALTA C/COOK JUPITER RIG 4812 23/05/201 20/06/2012

PLATFORMM 2

TIDE WATER/LIBERIA C.COOK MAWFORD TUG/seism 1500 15/02/201 25/04/2012

TIDE ic cable 2

TIDE WATER/LIBERIA C.COOK HANKS AHTS 1529 21/07/201 20/08/2011

TIDE /seismic 1

cable

TIDE WATER C.COOK GARY TIDE AHTS 1458 16/06/201 20/07/2011

/LIBERIA /seismic 1

cable

NAKKAS COOK SOLEY 1 OIL CHIM 200**-**-**-*** 03-05-2011

SHIPPING/MALTA 1

NAKKAS COOK SOLEY 1 OIL CHIM 20000 21/IUN/20 03-01-2011

SHIPPING/MALTA 10

CARESBRUKE /ENGLAND COOK LISA C GENERAL 500*-**-**-*** 17-05-2010

CARGO 9

ARPINAV/FRANCE COOK SUMMIT LPG 46613 07-AUG-20 21-SEP.200

TERRA 09 9

GROUP FLAIR/MALTA COOK CHEMICAL OIL/CHIM 7228 03-IUN-20 14-IUL-200

DISTRIBUI 09 9

TOR

ARPINAV/MALTA COOK CT DUBLIN CHIM/OIL 150**-**-**-*** 03-04-2009

9

ARPINAV/MALTA COOK CHIM/OIL 5000

CT 16/07/200 07/11/2009

BARCLAV/MARSHALL COOK WEXFORD CONTAINER 47000 9

GSP/MALTA COOK CMA CGM 13/02/200 30/05/2009

SEINE OIL 9

PETROMAR/RO COOK PROMETEU PLATFORM

CENTRAL 01/06/200 31/01/2009

PETROMAR/RO COOK PFCP PLATFORM 2

OIL

ATLAS PLATFORM 1997 05/2002

1993 1996

*

CERTIFICATES DETAILS

NO. / PLACE OF ISSUED VALIDITY STCW'95 CODE

SERIES ISSUED DATE DATE

FIRE PREV. AND 8246 CERONAV 27-06-2008 27-06-2013

FIRE- FIGH.

PREVENTION OF 8246 CERONAV 27-06-2008 27-06-2013 A-II/1;A-II/2;A-III/1;

POLLUTION A-III/2

MEDICAL FIRST AID 8246 CERONAV 27-06-2008 27-06-2013 A - VI / 4-1

TRANSP. AND HANDLING A-II/1; A-II/2

D.G.

RADAR PLOTTING A - I / 12; A - II / 1

ARPA RADAR, BRIDGE A - I / 12; A - II / 2

TEAM.

HYGIENE COURSE FOR 0306 CERONAV 20/05/2011 19/05/2016

CATERING PERSONNEL

MARITIME ENGLISH, A-III/1 ; A-III/2

PROBL

PROF. FAST RESCUE A-VI / 2-2

BOATS

ADVANCED A - VI / 3

FIRE-FIGHTING

ADVANCED MEDICAL A - VI / 4-2

CARE

GMDSS A - IV / 2

G.O.C.

BRIDGE TEAM MANAG. A - II / 2

PERSONAL A- VI / 1-4

SAFETY(PSSR)

TANKER FAM. 3242 CERONAV 08-07-2008 08-07-2013 A - V / 1; 1 - 7

C-TA

INERT GAS SYSTEM

(I.G.S.)

SPEC. OIL TANKER A - V / 1; 8-14

OPERAT.

CRUDE OIL WASHING A - V / 1.12

(COW)

GAS TANKER FAM.

CHEM. TANKER FAM.

SAFETY EQUPMENT ON A - V / 1

TANK

SPEC. CHEMICAL A - V / 1; 15-21

TANKERS

SPEC. LIQUIFIED GAZ A - V / 1; 22-34

TANK.

PERS. SURVIVAL 8246 CERONAV 27-06-2008 27-06-2013 A - VI / 1-1

TECHNIQUE

PROF. IN SURV. CRAFT A - VI / 2-1

RO-RO PASSENGER A - V / 2;1 up to A -

SHIPS V / 2;5

A - V / 3;1 up to A -

V / 3;5

SHIP SECURITY A / 13.2

OFFICER

ENGINE TEAM A - III / 2 ; A - VIII

MANAGEMENT / 2

ENDORSEMENT

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