SEAMAR s.c.
Aleja Jana Pawła II *
Ph.: +48-58-660-**-**
E-mail : ******@******.**
www.seamar.pl
1. PERSONAL DETAILS
RANK
Engine Cadet
ALTERNATIVE RANK (IF ANY)
WIPER
LAST NAME
ZIELONKA
FIRST NAME
KAMIL
OTHER NAMES
KRYSTIAN
NATIONALITY
POLAND
SEX
M
BIRTH PLACE
LĘBORK
DATE OF BIRTH
27.12.1997
MARITAL STATUS
SINGLE
COLOUR OF EYES
BLUE
COLOUR OF HAIR
BLONDE
MOTHER’S NAME
HALINA
FATHER’S NAME
ARKADIUSZ
HEIGHT (CM)
186
WEIGHT (KG)
80
INTERNATIONAL AIRPORT (NEAREST TO HOME TOWN):
GDAŃSK
AVAILABLE FROM:
01.03.2019
2. ADDRESS
STREET
OSKARA KOLBERGA 16C/11
POST CODE
81-881
CITY
SOPOT
COUNTRY
POLAND
TEL. NO.
MOBILE
***.*@**.**
3. NEXT OF KIN
FULL NAME
ARKADIUSZ
RELATION
FATHER
ADDRESS
POLNA 6
DATE OF BIRTH
15.09.1975
CITY
GOWIDLINO
COUNTRY
POLAND
TEL. NO.
MOBILE PHONE NO.
668164707
4. BENEFICIARY IN CASE OF DEATH
FULL NAME
ARKADIUSZ ZIELONKA
RELATION
FATHER
ADDRESS
POLNA 6
CITY
GOWIDLINO
COUNTRY
POLAND
TEL. NO.
MOBILE PHONE NO.
668164707
5. DETAILS OF CHILDREN (UNDER 18 YEARS OLD)
NAME OF CHILD
SEX
DATE OF BIRTH
M F
M F
M F
M F
6. TRAVEL DOCUMENTS
DOC./VISA TYPE
DOC. NO.
ISS.DATE
EXP. DATE
ISS. BY (AUTHORITY)
PLACE OF ISSUE
PASSPORT
EM 6867188
28.03.2018
28.03.2028
Pomeranian voivode
GDYNIA
NAT. ID CARD NUMBER
SEAMAN BOOK
AA 0006508
10.07.2028
DIRECTOR OF MARITIME OFFICE GDYNIA
GDYNIA
US C1/D VISA
OTHER VISAS: <type>
7. BANK ACCOUNT INFORMATION (OPTIONAL)
BANK NAME
BRANCH
ADDRESS
CURRENCY
ACCOUNT NO
SWIFT/BIC CODE
ACCOUNT OWNER
8. EDUCATION
SCHOOL NAME
MARITIME UNIVERSITY GDYNIA
FROM
15.10.2016
TO
PRESENT
SCHOOL NAME
FROM
TO
9. CERTIFICATE (S) / LICENCE (S)
LICENCE NAME
NUMBER
ISSUE DATE
EXPIRY DATE
ISSUED BY (AUTHORITY)
ISSUED AT
NATIONAL:
OTHER:
COURSE NAME
ISSUE DATE
EXPIRY DATE
ISSUED BY (AUTHORITY)
ISSUED AT
PERSONAL SURVIVAL
2018.01.25
2023.01.21
MARITIME OFFICE GDYNIA
GDYNIA
BASIC FIRE FIGHTING
2018.01.25
2023.01.21
MARITIME OFFICE GDYNIA
GDYNIA
ADV. FIRE FIGHTING
ELEMENTARY FIRST AID
2018.01.25
2023.01.21
MARITIME OFFICE GDYNIA
GDYNIA
MEDICAL FIRST AID
MEDICAL CARE
PERS. SAFETY & SOC. RESP.
2018.01.25
2023.01.21
MARITIME OFFICE GDYNIA
GDYNIA
PROF. IN SURVIVAL CRAFT
FAST RESCUE BOATS
ECDIS
BRIDGE/ENGINE ROOM MANAGEMENT
CRISIS MANAGEMENT ON RO-RO VESSEL 5
CROWD MANAGEMENT ON RO-RO VESSEL 9
GMDSS
ARPA
HAZMAT
SHIP SECURITY OFFICER
HEALTH CERTIFICATE
06.02.2018
06.02.2020
POLMED
GDYNIA
YELLOW FEVER VACC
SECURITY AWARNESS
2017.12.11
MARITIME OFFICE GDYNIA
GDYNIA
DESIGNATED SECURITY DUTIES
OTHER CERTS
11. SEAFARER’S SAILING RECORD
COMPANY NAME
VESSEL NAME
VESSEL TYPE
FLAG
GRT
ENGINE TYPE
KW
RANK
SIGN ON
SIGN OF
UM Gdynia
Dar Młodzieży
s/v
PL
SULZER
1500
E/CD
16.08.2018
09.10.2018
UM Gdynia
Horyzont II
training
PL
SULZER
1280
E/CD
23.11.2018
30.11.2018
I hereby give consent for my personal data to be processed for the purpose of conducting recruitment for the position for which I am applying.
Kamil Zielonka 2019-02-07
Imię i Nazwisko Data Podpis
APPLICATION FOR SEAGOING APPOINTMENT