Medical Management

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SEAFARER'S APPLICATION FORM - Page * of * - PERSONAL DATA

PERSONAL INFORMATION

Family Name popovici First Name (s) Mihai-mircea

Birth Date 12 nov 1980 Birth Place constanta

Nationality romanian Religion ortodocs

Marital Status married No. of No children

Children

Height (cm) 1.83 Weight (kg) 67

Nearest Otopeni - bucharest

Airport

ADDRESS (include telephone country & area codes, advise also secondary

or contact addresses if any)

Street & Nr. Aleea daliei nr5 Email Address popovici_mihai_mircea

@yahoo.cm

Location Bl l 128 a sc a ap1 Mobile Phone 076*******

City constanta Residence +403********

Phone

State, Country romania Fax

Postal (ZIP) 900210 P.O. Box (if

Code any)

NEXT OF KIN INFORMATION (person to contact in case of emergency &

insurance beneficiary)

Family Name popovici First Name(s) luminita

Nationality romanian Relationship wife

Street & Nr. Aleea daliei nr 5 Email Address ***********@*****.***

Location Bl l 128 a sc a ap1 Mobile Phone 076*******

City constanta Residence +403********

Phone

State, Country romania Fax

Postal (ZIP) 900210 P.O. Box (if

Code any)

REMARKS

Requested steward Availability now

Rank(s) Date

Prefer Vessel Off shore vessel Minimum Salary 1300 euro per month

Types

Employment Preference All

English Language Spoken: good - Written: good

Skills

Other Foreign French-average-spoken and

Languages written,italian-average-spoken and written

Professional School / highshool

Academy - Name &

Period (From - To)

1995-1999

Foreign Crew No foreign crew experience on board of any vessel

Experience

(specify

nationalities)

Other Skills I am a hard worker,serious good organizer and I

don t have problems to integrate into a crew or a

team

Further Remarks I have experience in working with another

nationalities worker,but not on board of a vessel

and I don t have problems with alcohol and drugs

I hereby affirm that all the information provided by me in this

application is true and correct to the best of my knowledge.

SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF DOCUMENTS

Family First Rank

Name Name(s)

A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES

Document Name Document Number Country Issue Issue Exp.

(Desciption) Place Date Date

Passport 051634298 ro constan 6nov201 6nov201

ta 2 7

Seaman's Book 30766ct ro constan 4feb201 22nov20

(national) ta 3 14

Seaman's Book (flag

state)

Seaman's Book (flag

state)

Visa - United States

(type C1/D)

Visa - Others

(Work/Resid. Permits)

Medical Examination

Report

Offshore Medical (UKOOA, 2011/1697 ro constan 21feb20 21feb20

ENG1) ta 13 15

Vaccination against J5022-2b ro constan 21apr20 21apr20

Yellow Fever ta 13 23

Vaccination against

Cholera

B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES

- deck & engine - radio certificates & - deck, technical &

certificates & endor- endorsements management

sements (officers / - safety training courses (radar/ARPA,

ratings) (surv., fire, medical) ISM, Marpol,

- electrical & reefer - tanker courses (oil, simulators, computer,

certificates chem., gas) welding etc.)

- cook & steward - passenger vsl, roro, - Dynamic Positioning

certificates hazmat courses Experience

Document Name Document Number Country Issue Issue Exp.

(Desciption) Place Date Date

CERTIFICATE of 43266 ro constan 4feb201 22nov20

COMPETENCY ta 3 14

ENDORSEMENT

DYNAMIC POSITIONING

BASIC

DYNAMIC POSITIONING ADV.

DYNAMIC POSITIONING UK LONDON

LICENCE

HUET

BOSIET 000124 ro constan 30jan20 29jan20

ta 13 17

RADAR ARPA

GMDSS (GOC)

MARPOL 00012739 ro constan 6jan201 5jan201

ta 2 7

DANGEROUS CARGO 00012739 ro constan 6jan201 5jan201

ta 2 7

ADVANCED FIRE-FIGHTING

PERSONAL SURVIVAL TECH.

PROFIENCY SURVIVAL CRAFT 00028495 ro constan 31jan20 30jan20

ta 12 17

PERSONAL SAFETY 00019295 ro constan 27jan20 26jan20

ta 12 17

MARITIME ENGLISH 00006820 ro constan 12jan20 11jan20

ta 12 17

ECDIS

SHIP SECURITY OFFICER

BRIDGE TEAM MANAGEMENT

SHIP HANDLING

MEDICAL FIRST AID

MEDICAL CARE

Contact this candidate