APPLICATION FORM

Rank

ENGINE CADET/WIPER

Readiness from

**-**-****

Surname

PIANOWSKI

Christian Name

KAROL

Father's Name

ZBIGNIEW

Mother's Name

MARZENA

Date & place of birth

09. OCT 1986 GDYNIA

E- mail

aczadj@r.postjobfree.com

Home address

Przemyska 39b/1 80-180 Gdańsk

Phone

+486********

Matrimonial status

Single

No of children

0

Next of kin

Agnieszka Wierzchnicka

Relationship

Fiancee

Address of next of kin

Przemyska 39b/1

Phone

+486********

PERSONAL DOCUMENTS

NUMBER

PLACE & DATE OF ISSUE

VALID TILL

National Seaman’s Book

0269411

2015-03-02 GDYNIA

INDEFINITELY

Passport

EH 7371920

2014-12-03 GDAŃSK

2024-12-03

Usa Visa

-

-

-

Health Certificate

1/2017

2017-01-09 GDAŃSK

2018-01-09

Drug / Alcohol Test

Yellow Fever Vaccination

K5520-1

2015-02-12 GDYNIA

2025-02-02

LICENCES / CERTIFICATES

NUMBER

PLACE & DATE OF ISSUE

VALID TILL

National Licence

GUM-131**-******-***/2015

2015-02-13 GDYNIA

INDEFINITELY

Foreign Licence / Endorsment

Radar Observer

ARPA

GMDSS

GMDSS Endorsment

HAZMAT

Bridge/ Engine Resource Management

Advanced Fire Fighting

GUM-1315-133980-62771/2016

2016-10-18 GDYNIA

2021-10-13

Fire Prevention & Fire Fighting

GUM-5425-133980-2274/2015

2015-01-26 GDYNIA

2020-01-29

Personal Survival Techniques

GUM-5425-133980-2274/2015

2015-01-26 GDYNIA

2020-01-29

Survival Crafts and Rescue Boats

Elementary first aid

GUM-5425-133980-2274/2015

2015-01-26 GDYNIA

2020-01-29

Medical first aid

GUM-5421-133980-62801/2016

2016-10-18 GDYNIA

2021-10-13

Medical Care

Pesonal Safety and Social Res.

GUM-5425-133980-2274/2015

2015-01-26 GDYNIA

2020-01-29

Sec. Awareness

GUM-1350-133980-27750/2016

2016-05-24 GDYNIA

INDEFINITELY

Sec. Duties

GUM-1351-133980-27805/2016

2016-05-24 GDYNIA

INDEFINITELY

Basic Oil Tanker Familiar.

GUM-1337-133980-29218/2016

2016-05-31 GDYNIA

INDEFINITELY

Basic Chem. Tanker Familiar.

GUM-1337-133980-29218/2016

2016-05-31 GDYNIA

INDEFINITELY

Basic Liquified Gas Tanker Familiar.

GUM-1303-133980-29406/2016

2016-05-31 GDYNIA

INDEFINITELY

LANGUAGE ( good, average, poor)

SPOKEN

WRITTEN

English

Fluent

Fluent

Polish

Fluent

Fluent

LAST FIVE YEARS

Type of vessel

Name of Vessel

Deck Officers List Gross Tons

Engineers List KW propulsion power

Type of Engine

FLAG

Name of Company

Rank

Signed on/signed off

TOTAL SERVICE

REFERENCES

VESSEL’S NAME

SHIPOWNER/CREWING AGENCY ADDRESS

CONTACT PERSON

PHONE NUMBER

EDUCATION

Name of school

Address

Country

Dates attended From To

Type of Degree of Diploma received

Maritime University in Gdynia

Morska 81-87 81-225 Gdynia

Poland

OCT/2005-Apr/2011

Master of Engineering

Maritime School in Gdynia

Polska 13a 81-339 Gdynia

Poland

SEP/2015- Jan/2017

REMARKS

I need only 6 months to be able to participate in an exam for 3rd Engineer.

I have participated in an overhaul of semi submersible accomodation vessel Safe Concordia for three months in Rio de Janeiro at Maua Shipyard, i worked for Callenberg company. I am eager to work and learn and would be glad to to establish a long term co-operation with your company.

Zgodnie z Ustawą O ochronie danych osobowych” z dn. 29.08.1997 zawartą w Dzienniku ustaw nr. 133 z dnia 29.10.1997, poz. 883 wyrażam zgodę na przetwarzanie moich danych osobowych

i przekazywanie ich armatorom zagranicznym.

Date and Signature

Contact this candidate