APPLICATION FORM
PERSONAL DETAILS:
POSITION APPLIED FOR AB/CRANE OPERATOR
FAMILY NAME FRĄCZEK NAME KRZYSZTOF
FATHER’S NAME STANISŁAW
DATE OF BIRTH 25.01.1960 PLACE OF BIRTH ŻAGAŃ
NATIONALITY POLAND NEAREST AIRPORT: BERLIN
FULL ADDRESS KOMANDORSKA 13
72-600 ŚWINOUJŚCIE
MOBILE 004**********
E-MAIL *******@*****.***
CIVIL STATUS SINGLE NEXT OF KIN
NO. OF CHILDREN 1
PASSPORT NO. AP7665438 ISSUE DATE 21.06.2006 ISSUE PLACE SZCZECIN
EXPIRY 21.06.2016
EDUCATION / NAME OF SCHOOL:
MARINE ENGINE MECHANIC / ZSZ MSR ŚWINOUJŚCIE
INDUSTRIALE QUIPMENT MECHANIC TECHNIC /TECHNIKUM MSR ŚWINOUJŚCIE
CERTIFICATES OF COMPETENCE:
LICENCE: GRADE:
CERTIFICATE
NUMBER
PLACE OF ISSUE
DATE
EXPIRY
ABLE-BODIED SEAMAN
UMS-541**-******-***
SZCZECIN
06.02.2012
SEAMAN’S BOOK
234300
SZCZECIN
12.07.2006
FIRE FIGHTING
UMS-5425-098460-5527
SZCZECIN
18.07.2011
14.07.2016
PERS.SURVIVAL TECH.
UMS-5425-098460-5527
SZCZECIN
18.07.2011
14.07.2016
MEDICAL CERTIFICATE
09/2015
SWINOUJSCIE
08.01.2015
08.01.2016
PROF. SURVIVAL CRAFTS
UMS-541*-******-***
SZCZECIN
2.02.2012
BOSIET
98475700300512450
ABERDEEN
28.05.2012
30.05.2016
NORWEGIAN ESCAPE CHUTE
30051220
ABERDEEN
30.05.2012
29.05.2016
DESIGNET SECURITY DUTIES
UMS-1351-098460-317112
SZCZECIN
23.12.2013
PROFICIENCY IN SECURITY-AWARNEESS
UMS-1350-098460-31693/2013
SZCZECIN
23.12.2013
MEDICAL FIRST AID
UMS-5425-098460-5527
SZCZECIN
18.07.2011
14.07.2016
PERS.SAFETY & S.R.
UMS-5425-098460-5527
SZCZECIN
18.07.2011
14.07.2016
MIST
5301
ABERDEEN
08.11.2012
08.11.2016
SPARROWS STAGE 2
19796
ABERDEEN
21.08.2014
20.08. 2016
SPARROWS STAGE 1
18955
ABERDEEN
25.05.2012
25.05.2014
MARLINS TEST
88%
08.04.2013
BANKSMAN SLINGER SAGE 1
56269067260314005
NEWCASTLE
24.03.2014
26.03.2016
PREVIOUS EMPLOYMENT SEA SERVICE (LAST FIVE VESSELS):
SHIP’S
NAME/ FLAG
COMPANY
RANK
SIGNED ON
SIGNED OFF
VESSEL’S
TYPE
VESSEL’S
ENG.TYPE
GRT.HP
SAND HERON
CEMEX UK
AB
23.09.2015
14.10.2015
DREDGER
DIESEL
3751/3824
C-WARRIOR
EDISON-CHOUEST
AB
10.07.2015
25.07.2015
PSV
DIESEL
2419/5120
TROMS MIRA
TIDEWATER
AB
06.05.2015
03.06.2015
PSV
DIESEL
3564/6646
TROMS MIRA
TIDEWATER
AB
11.03.2015
13.04.2015
PSV
DIESEL
3564/6646
DEMAREST TIDE
TIDEWATER
AB
18.11.2014
12.12.2014
PSV
DIESEL
3943/4*2500
DEMAREST TIDE
TIDEWATER
AB
24.09.2014
22.10.2014
PSV
DIESEL
3943/4*2500
DEMAREST TIDE
TIDEWATER
AB
30.07.2014
27.08.2014
PSV
DIESEL
3943/4*2500
DEMAREST TIDE
TIDEWATER
AB
04.06.2014
02.07.2014
PSV
DIESEL
3943/4*2500
DEMAREST TIDE
TIDEWATER
AB
09.04.2014
07.05.2014
PSV
DIESEL
3943/4*2500
DEMAREST TIDE
TIDEWATER
AB
13.02.2014
12.03.2014
PSV
DIESEL
3943/4*2500
LUNDSTROM TIDE
TIDEWATER
AB
21.10.2013
18.11.2013
PSV
DIESEL
3943/4*2500
LUNDSTROM TIDE
TIDEWATER
AB
26.08.2013
23.09.2013
PSV
DIESEL
3943/4*2500
LUNDSTROM TIDE
TIDEWATER
AB
01.07.2013
29.07.2013
PSV
DIESEL
3943/4*2500
FANNING TIDE
TIDEWATER
AB
09.04.2013
31.05.2013
PSV
DIESEL
3943/4*2500
EJSBERG
M.LAUTERJUNG GMBH
AB/CRANE OPERATOR
14.11.2012
08.12.2012
CARGO
DIESEL
4591
MACGREGOR
80 SWL
TOISA
VIGILANT
SEALION
AB
25.07.2012
05.09.2012
ROV/PSV
DIESEL
3404
TOISA POLARIS
SEALION
AB
27.06.2012
11.07.2012
DSV
DIESEL
10720
NORTHERN COMRADE
TRICO
A/B
04.03.2012
15.04.2012
AHTS
DIESEL
1413/8020
NORTHERN COMRADE
TRICO
O/S
17.12.2011
21.01.2012
AHTS
DIESEL
1413/8020
JANO
J.FRĄCZEK
O/S
05.01.2011
15.12.2011
TUG
DIESEL
46,48/165
JANO
J.FRĄCZEK
O/S
02.01.2010
30.09.2010
TUG
DIESEL
46,48/165
JANO
J.FRĄCZEK
O/S
02.01.2009
30.09.2009
TUG
DIESEL
46,48/165
NORDKAPP
JENTA
HAVFISKE AS
FISHERMAN
01.062007
01.06.2007
FISHING
DIESEL
656/960
OTHERS:
OTHER EXPERIENCE / SKILLS, MECHANICAL,CARPENTER, ELECTRICAL, ELECTRONICS, COMPUTER
.
ENGLISH GOOD OTHER FOREIGN LANGUAGE : GERMAN GOOD
FOR REFERENCE CONTACT WITH PREVIOUS EMPLOYER(S) Katarzyna Malisz
Manning Superintendent
Wilhelmsen Marine Personnel Sp. z o.o.
SIGNATURE ….
DATA 12.07.2015 KRZYSZTOF FRĄCZEK