Application for Sea Personnel
Application For Employment As : Engine Cadet
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F A M I L Y
Surname: Baranowski
First Name: Bartłomiej
Middle Name: Kacper
Nationality: Polish
Date of Birth: 04.09.1995
Place of Birth: Lębork
Marital Status: single
Name of Spouse:
Permanent Address:
ul. Krótka12, 84-223 Linia
Poland
Height: 182 Weight: 90
Telephone No.
Email address:
******************@*****.***
Passport No. EF 1805038
Place of Issue: Lębork
Date of Issue 05.08.2013
Date of Expiry: 05.08.2023
Seaman’s Book No. 0275486
Date of Issue 2016.01.15
Place of issue : Gdynia
Nearest International Airport: Gdańsk
US VISA
Date of Issue:
Date of expiry:
Shengen Visa
Date of Issue:
Date of expiry:
Medical examination
Date of Issue: 10.12.2015
Date of expiry: 10.12.2017
Vaccination Yellow Fever
Date of Issue:
Date of expiry:
Drug and Alcohol test
Date of Issue:
Result:
EMERGENCY
Next of Kin: Dorota Baranowska
Address: ul. Krótka12, 84-223 Linia
Poland
Relationship: Mother
Telephone No.:
Mob: +48-691******
Telephone No.:
Office:
ESTABLISHMENT Name (Nautical College / Institute)
Date Attended
Gdynia Maritime University
2014
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LICENCE PARTICULARS
Cert No
Date / Place of Issue
Validity
National Certificate of Competency
Other:
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S T C W 95 QUALIFICATION
Type of Certificate
Ref No
Date / Place of Issue
Expire date
Personal Survival
GUM-5425-139254-36055/2015
2015.12.14 Gdynia
2020.12.14
Elementary First Aid
GUM-5425-139254-36055/2015
2015.12.14 Gdynia
2020.12.14
Fire Fighting
GUM-5425-139254-36055/2015
2015.12.14 Gdynia
2020.12.14
Personal Safety / Responsibility
GUM-5425-139254-36055/2015
2015.12.14 Gdynia
2020.12.14
Proficiency in Security-awareness
GUM-1350-139254-37128/2015
2015.12.22 Gdynia
Valid indefinitely
Proficiency for seafarers with designated security duties
GUM-1351-139254-74490/2016
2016.11.25 Gdynia
Valid indefinitely
Training in Liquified Gas Tanker Familiarization
GUM-1303-139254-71862/2016
2016.11.17 Gdynia
Valid indefinitely
Training in Oil and Chemical Tanker Familiarization
GUM-1337-139254-71891/2016
2016.11.17 Gdynia
Valid indefinitely
Survival Craft & Rescue Boats
Advanced Fire Fighting
Medical First Aid
ARPA
GMDSS / GOC
ECDIS
Ships Safety Officer
HAZMAT
HUET
BOSSIET
DP courses :
Name of Vessel
Flag
Type of
Vessel
and Engine
(Type)
HP
Rank
Period of Service
Name of Owners,
Crew Agent
( Their Contact details),
Remarks
s/v Dar Młodzieży
Polish
School sailing / frigate
1500
Engine cadet
27.01.2016
26.03.2016
AM Gdynia