SEAMAR s.c.

Aleja Jana Pawła II *

**-*** ******

Ph.: +48-58-660-**-**

+48-58-660-**-**

E-mail : ac8kph@r.postjobfree.com

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.

+48-734-***-***

MOBILE

+48-734-***-***

E-MAIL

ac8kph@r.postjobfree.com

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

Contact this candidate