Chief engineer (Unlimited - Marine & OSV), ISM internal auditor, MLC
Resume:
CREW DATA SHEET - Sea Jobs
PERSONAL DATA Date: NAME:
PERSONAL DETAILS
Position: Alternative:
Vessel: Flag:
Surname:
First Name: Middle Name:
D.o.B.: P.o.B.:
Nationality: Sex :
Civil Status: No. of Children / Dependent:
ADDRESS
Street: Tel:
City: Tel:
Country: Fax:
Airport: E-mail:
NEXT OF KIN
Name: Tel * :
Relation: Fax * :
Street:
City / Country: * If same as above, please insert "As above" NATIONAL IDENTITY DOCUMENTS / VISA
Passport No: Issued: Expired:
SB-Book No: Issued: Expired:
US - VISA: Issued: Expired:
Other Visa: Issued: Expired:
LANGUAGES
Level of English Test passed Date :
Mother Language Remarks
Other Language
MEDICAL EXAMINATION ( HEALTH CERTIFICATES)
Clinic: Issued: Expired:
VACCINATIONS (VALID FOR DURATION OF CONTRACT)
1. SHOT 2.SHOT 3.SHOT
Cholera: Yellow Fever: X Typhoid: Tetanus: Hepatitis B: DRUG AND ALCOHOL TEST
NEG POS
Clinic: Issued: Result: X
IF TEST RESULTS ARE POSITIVE, PLS STATE REASON (E.G. PRESCRIBED MEDICATION ETC.) REPILLOZA GIL,EDUARDO
CHIEF ENGINEER CHIEF ENGINEER
JULY 20,2016
Instructions:
This application form has to be completed by the Crewing Agent or CSM Representative prior joining Required Initially Not Required
REPILLOZA
EDUARDO ALBERTO
13/07/1963 CUMANA, VENEZUELA
VENEZUELA MALE
MARRIED 3
AVENIDA 5 ENTRE 10 Y 11
CABUDARE
VENEZUELA
VENEZUELA
JACINTO LARA
CARMEN FERNANDEZ
WIFE
AVENIDA 5 ENTRE 10 Y 11
CABUDARE
*******@*****.***
06/11/2010
132842846
T-8731-AGSI
03/02/2021
29/07/1985 NOT EXPIRE
Next Page ==>
16/08/2020
06/09/2020
GOOD
SPANISH
C1/D
USA B1/B2
Please select appropriate English level
18/08/2015
For Deck Engineers & Personel Only
INSTITUTO DIAGNOSTICO - CARACAS 02/05/2016
Photo
INSTITUTO DIAGNOSTICO - CARACAS 05/02/2016 05/02/2017 03/03/2016
Page 1
CREW DATA SHEET
EXPERIENCE Date: NAME:
This application form has to be completed by the Crewing Agent or CSM Representative prior joining TRAINING COURSES (All Training courses / Seminars / Upgrading courses other than STCW/Flag state requirements) CSM Training Courses
Safety Officer jan,19,2015
Incident Investigation
Navigation Training
FORM OF EDUCATION : University
WORKING CLOTHES : 48 Overall size/Safety shoes size SEA SERVICE (Complete sea service record for at least last 10 employments) Years with CSM Years on Oil / Chem tankers
Years in rank Years on LPG tankers
Years on tankers (All types)
Flag Type Engine Company S/on Months/
Year built GRT kW S/off Days
Rank
REPILLOZA GIL, EDUARDO
Port State Control & Vetting
Security Awareness
Cargo and Ballast Handling Simulator (Tankers)
dec,03,2014
Location Dates
JULY,20,2016
Caracas
GRADUATED FROM :Universidad Maritima del
Caribe Catia la Mar, Venezuela 1985
1,73mts
Height
DIGNITY
VENEZUELA
2010
product tanker
30235
b&w 6S50MC-C
Name of vessel
Crew Agent
9480
Sea Pride
C/E
09/04/2015
12/11/2015
4/7
HONESTY
VENEZUELA product tanker b&w 6S50MC-C
Sea Pride
C/E
19/2/2015
16/5
06/08/2015
ICE ENERGY
VENEZUELA crude tanker b&w 6S60MC
2006 388**-*****
DYNACOM
C/E
29/04/2014
30/6
27/11/2014
MAVERICK ONE
PANAMA bunker supply Wartsila 6L20
Amura Shipmanagement
C/E
16/10/2013
30/3
14/2/2014
FRINKA ENERGY
PANAMA AHTS EMD 16-645e7ba
Global Shipmanagement
10/12/2012
10/6
20/06/2013
FRINKA ENERGY
PANAMA AHTS EMD 16-645e7ba
Global Shipmanagement
C/E
30/07/2011
16/7
15/03/2012
GENERAL ZAMORA
VENEZUELA crude tanker b&w 6L60MC
1991 390**-*****
Global Shipmanagememt
C/E
14/04/2011
20/2
03/07/2011
GENERAL ZAMORA
VENEZUELA crude tanker b&w 6L60MC
1997 390**-*****
Global Shipmanagement
C/E
17/09/10
29/3
15/01/2011
ALLORO
VENEZUELA crude tanker sulzer RTA62
1997 422**-*****
Global Shipmanagement
C/E
04/06/2010
23/0
27/06/2010
ALLORO
VENEZUELA crude tanker sulzer RTA62
1997 422**-*****
Global Shipmanagement
C/E
12/01/2009
26/4
08/06/2009
ALLORO
VENEZUELA crude tanker
sulzer RTA62
1997 422**-*****
Global Shipmanagement
C/E
08/12/2008
8/0
16/12/2008
ALMIRANTE BRION
VENEZUELA crude tanker sulzer RTA72
1990 525**-*****(88.7%)
Global Shipmanagement
C/E
25/06/2008
7/1
02/08/2008
12 5
27
18 4
Caracas
Caracas dec,20,2014
48 48/43
Page 2
Marine enviromental Awareness (A-II/1)
8. ANY OTHER ADDITIONAL QUALIFICATIONS
Annex VI MARPOL 08/02/2015 08/02/2020
Internal Auditor SMS 19/2/2016
Leader auditor SMS 25/2/2016
Expiry date
Bridge Team & Ship Handling (IMO 1.22)
Dangerous,Hazardous and Harmful Cargoes 01:10 11/09/2014 Number Issue date Expiry date
GMDSS GOC CoC + Nat. Endo.((IV/2, I/2)
01:01
Medical Care (A-VI/4-2)
Ship Security Officer (A-VI/5)
2. STCW - ADDITIONAL TRAINING (A-VI/2 ~ 4)
Certificate Name
03:19 12/05/2014 12/05/2019
Certificate Name Number Issue date Expiry date
01:19
01:20 29/11/2013 29/11/2017
Personal Survival Techniques A-VI/1-1
Fire Protection & Fire Fighting (A-VI/1-2)
Security Awareness Training (A-VI/6-1) 03:27 12/03/2014 12/03/2019 With Designated Security Duties (A-VI/6-2)
JULY,20,2016
12/05/2013 12/05/2017
Elementary First Aid (A-VI/1-3) 01:13 12/09/2013 12/09/2017 Personal Safety & Soc. Respon. (A-VI/1-4) 01:21 12/02/2013 12/02/2017 Number Issue date Expiry date
Proficiency in Survival Craft & R.B. (VI/2) 01:23 16/10/2013 16/10/2017 Proficiency in Fast Rescue Boat (A-VI/2.2) 01:24 10/11/2013 10/10/2017 Certificate Name Number Issue date
01:14 10/10/2014 10/10/2019
03/04/2016
12/02/2014
HAZMAT + COFR
Certificate Name
11/09/2019
Pax & Cargo Safety & Hull Integrity (V/2-7)
HAZMAT (IMO Model Course 1.10)
Designee Person Ashore (DPA)
This application form has to be completed by the Crewing Agent or CSM Representative prior joining 1. BASIC SAFETY TRAINING STCW (A-VI/1)
CREW DATA SHEET
QUALIFICATION STCW-10 and CSM
Date:
Name: REPILLOZA GIL,EDUARDO
Advanced Fire Fighting (A-VI/3) 02:03 25/10/2013 25/10/2017 Medical First Aid (A-VI/4-1)
Crisis Mgt & Human Behaviour (V/2-6)
03:26 12/02/2014 12/02/2019
Certificate Name Number Issue date Expiry date
3. CERTIFICATE OF COMPETENCY (A II/1-4, A III/1-4) Officers and watchkeeping ratings 4. SPECIAL REQUIREMENTS TANKER (A V/1)
Capacity
01:38
12/02/2019
Oil Tanker Cargo Ops (Advanced) 01:02 01/10/2014 01/10/2017 COW/Inert Gas 18 & 21/11/2014 18 & 21/11/2019
Oil & Chem Tanker Cargo Ops (Basic)
Chem Tanker Cargo Ops (Advanced) 01:03 26/11/2014 26/11/2019 Gas Tanker Cargo Ops (Advanced) 01:05 12/05/2014 12/05/2019 09/09/2014 09/09/2019
Safety training (V/2-5)
5. SPECIAL REQUIREMENTS PASSENGER (RO-RO PAX VESSELS (A V/2, AV/3) 6. SPECIAL REQUIREMENTS DRY CARGO VESSELS CARRYING DANGEROUS CARGO Certificate Name Number Issue date Expiry date
Crowd Management (V/2-4)
Number Issue date Expiry date
4. OTHER CERTIFICATES (including additional CSM requirements) Gas Tanker Cargo Ops (Basic) 01:04
04/02/2016 04/02/2021
Leadership and Teamwork (A-II/2-6) 01:39 04/04/2016 04/04/2021 Annex I MARPOL 30/7/2015 30/7/2020
Measurements of cargoes (draft survey method) 28/01/2016 9. FOR OFFICE USE (Authenticity of documents as per section 3 checked) Name and Signature please.
PANAMA LICENSE AS A CHIEF ENGINEER, ENDORSEMENT 21CG004173, TC N0 CTC137221, CERTIFICATE N0 M-4-00024, EXPIRATION DATE 11-OCT-2018
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