APLICATION
PERSONAL DETAILS
Surname
SPERBER
First Name
MAGDALENA
AMSL No.
Date of Birth
14.04.1991
Place of Birth
GDANSK
Nationality
POLISH
Permanent Address
OBRONCOW POKOJU 7/36, 83-000 PRUSZCZ GDANSKI, POLAND
Tel. No.
Other Tel. No.
Email:
******-***@**.**
GENERAL DETAILS
Document
Number
Date and
Place (country) of Issue
Date of Expiry
Passport
EH3663157
31.03.2015, GDANSK(POLAND)
21.03.2025
Seaman’s Book
0266478
24.04.2014, GDYNIA(POLAND)
Seaman’s Book other flag than Polish
Medical Certificate
871/2016
02.03.2016, GDYNIA(POLAND)
02.03.2018
QUALIFICATION
Type
Grade / Class
Number
Date and
Place (country) of Issue
Date of Expiry
Certificate of Competency
O/S
GUM-13141-129548-3478/2015
21.07.2015, GDYNIA(POLAND)
Certificate of Competency of other flag than Polish
SEA SERVICE (last 5 years)
Name of Vessel
Type
Flag
DWT/HP
Type of Main Engine
Owner (Phone No.)
Rank
Date From dd/mm/yy
Date To dd/mm/yy
DAR MLODZIEZY
SAILING
POLAND
667
SULZER 8AL 20/24
AM GDYNIA
DECK CADET
31.08.2012
19.09.2012
DAR MLODZIEZY
SAILING
POLAND
667
SULZER 8AL 20/24
AM GDYNIA
DECK CADET
17.05.2014
23.06.2014
HORYZONT II
RESEARCH/SURVEY
POLAND
288
SULZER 8S20UD
AM GDYNIA
DECK CADET
23.03.2015
04.04.2015
WAWEL
ROPAX
BAHAMAS
3501
SULZER 7RLA56
SEA TROPID LTD.
DECK CADET
14.04.2016
12.05.2016
AKUL
TUG
POLAND
2003
BERGEN DIESEL KRMB-9
WUZ PORT AND MARITIME SERVICES LTD Sp. Z o.o.
DECK CADET
08.06.2016
30.08.2016
WAWEL
ROPAX
BAHAMAS
3501
SULZER 7RLA56
SEA TROPID LTD.
DECK CADET
01.09.2016
28.09.2016
FURTHER EDUCATION AND SHORE EMPLOYMENT
Date From
Date To
Schools, Colleges
Exams Passed - Certificates Obtained
2011
2016
Gdynia Maritime Academy
IV year
Nature of Work
Employer’s Name and Address
CERTIFICATES:
PRACTICAL EXPERIENCE
Courses
Issue Date and Certificate No.
Personal Survival Techniques
26.02.2016 GUM-5412-129548-9451/2016
Fire Prev & Fire Fighting
25. 02.2016 GUM-5414-129548-9446/2016
Advanced Fire Fighting
Elementary First Aid
15.02.2016 GUM-1311-129548-7238/2-16
Medical First Aid / Med.Care
Personal Safety & Soc. Resp.
15.02.2016 GUM-1308-129548-7237/2016
Profic. in Security Awareness
13.05.2014 GUM-1350-129548-25811/2014
REFERENCES
Profic. Design. Security Duties
29.04.2014 GUM-1351-129548-24445/2014
Name of Company
Address and Phone
References
Survival Craft & Rescue Boat
Fast Rescue Boat
Oil Tanker – Basic/Advanced
06.02.2015 GUM-1337-129548-3736/2015
GMDSS
Radar
25.10.2016 GUM-1335-129548-65084/2016
ARPA
25.10.2016 GUM-1335-129548-65084/2016
Ship Security Officer
HAZMAT
ECDIS
20.04.2015 GUM-1346-129548-11025/2015
DPO
Bridge Team Management
KNOWLEDGE OF LANGUAGES
Language
Speaking
Reading
Written
VG
G
S
F
P
N
VG
G
S
F
P
N
VG
G
S
F
P
N
English
x
x
x
CONFIDENTIAL INFORMATION FOR OFFICE USE ONLY
Full Name of Next of Kin
KRZYSZTOF SPERBER
Relationship HUSBAND
Address of Next of Kin OBROŃCÓW POKOJU 7/36, 83-000 PRUSZCZ GDANSKI, POLAND
Marital Status
MARRIED
Number of Children
0
Date of Birth of Child
Wyrażam zgodę na przetwarzanie moich danych osobowych dla potrzeb niezbędnych do realizacji procesu rekrutacji (zgodnie z Ustawą z dnia 29.08.1997 roku o Ochronie Danych Osobowych; tekst jednolity: Dz. U. z 2002r. Nr 101, poz. 926 ze zm.).
Date : 22.11.2016
Signature