SEAFARER'S APPLICATION FORM

PERSONAL INFORMATION ( DATE PERSONALE)

Family Name (Nume)

ROSCA

First Name(s) (Prenume)

Vasilica-Dorel

Birth Date (Data Nasterii)

31.12.1988

Birth Place (Locul nasterii)

Constanta

Nationality (Nationalitate)

Romanian

Weight (kg) (Greutate in Kg)

89

Marital Status (Starea civila)

Not married

Height (cm) (Inaltime)

177

No. of Children (Nr copii)

Nearest Airport (Cel mai apropiat aeroport international)

ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)

ADRESA (incluzand nr telefon, tara si cod zona, a doua adresa sau adresa de contact, daca este cazul )

Street & Nr (Strada si Numar)

STR. ALEXANDRU ALIMANISTEANU NR. 35

Email Address (Adresa Email)

ade6cl@r.postjobfree.com

Location (Locatie)

CUMPANA

Mobile Phone (Tel mobil)

+407********

City (Oras)

CONSTANTA

Residence Phone (Tel fix)

State, Country (Judet)

CONSTANTA

Fax (Fax)

Postal (ZIP) Code (Cod)

P.O. Box (if any) (CP)

NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)

RUDA CEA MAI APROPIATA/ IMPUTERNICITA ( persona de contact in caz de urgenta si beneficiarul asigurarilor )

Family Name (Nume)

Rosca

First Name(s) (Prenume)

Lenuta

Nationality(Nationalitate)

Romanian

Relationship (Grad de rudenie)

Mother

Street & Nr. (Str. si Nr.)

STR. ALEXANDRU ALIMANISTEANU NR. 35

Email Address (Adresa email )

Location (Locatie)

CUMPANA

Mobile Phone (Tel mobil)

+407********

City (Oras)

CONSTANTA

Residence Phone (Tel fix)

State, Country (Judet)

CONSTANTA

Fax (Fax)

Postal (ZIP) Code (Cod)

P.O. Box (if any) (C.P)

REMARKS (REMARCI)

Requested Rank (Functie)

Chief mate - on ships of 3000 GRT or more

Availability Date (Disponibil din)

01.08.2020

Prefer. Vessel Type (Tip de nava preferat)

CONTAINER

Minimum Salary (Salariu minim)

SUMMARY OF QALIFICATION AND EXPERIENCE ( CALIFICARE SI EXPERINTA)

Years with operator (Ani cu actualul operator)

5

Years in rank (Ani in functia actuala)

2.1

Years on chemical-/oil tankers (Ani pe nave tip tanc ch/oil)

Years on LPG tankers (Ani pe nave tip tanc LPG)

Years on tankers (all types) (Ani pe nave tip tanc – in general)

English Language Skills (Limba engleza/ Nivel cunoastere)

Spoken: fluent/good/average - Written: : fluent/good/average

Advanced Average

Other Foreign Languages (Alte limbi straine)

Professional School / Academy - Name & Period (From - To)

(Scoala / Nume/ Perioada)

Master: Universitatea Maritima Constanta 2016 2018

Foreign Crew Experience (specify nationalities)

Experinta cu echipaje straine (specificati nationalitatile)

Serbian, Croatian, Russian, Montenegro, Filipino, Chinese, Indian, Myanmar

Other Skills (Alte calitati profesionale)

Further Remarks (Alte remarci)

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge.

Prin prezenta confirm ca toate informatiile date de catre mine in aceast formular de applicare sunt adevarate si corecte

Date:

Data : 28 - 07 - 2020

Signature:

Semnatura Vasilica-Dorel Rosca

LIST OF DOCUMENTS

Family Name (Nume de familie)

ROSCA

First Name(s)

(Prenume)

Vasilica-Dorel

Rank

(Functie)

Chief mate - on ships of 3000 GRT or more

A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES (DOCUMENTE DE CALATORIE/MEDICALE )

Document Name (Desciption)

Titlul documentului ( Descriere)

Document Number

Numar Document

Country

Tara

Issue Place

Locul eliberarii

Issue Date

Data eliberarii

Exp. Date

Data expirarii

Passport ( Pasaport )

055214687

Romania

Constanta

17.10.2017

17.10.2022

Seaman's Book (national) (Carnet Marinar)

24223CT

Romania

Constanta

30.09.2016

27.10.2021

Seaman's Book (Norwegian) (Carnet NIS)

Seaman's Book (Liberian) (Carnet Liberia )

Visa - United States (type C1/D) (Viza USA)

P6429994

---

Not specified

11.12.2019

09.12.2024

Visa - Others (Work/ Resid. Permits) (Alte Vize)

Medical Examination Report (Raport Medical)

Drug & Alcohol Test (Test Drog/ Alcool)

Vaccination / Yellow Fever (Vaccin Febra Galbena)

09.11.2009

Vaccination against Cholera ( Vaccin Holera)

Passport Photos ( Poza de pasaport )

B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES

CERTIFICATE DE COMPETENTA & ENDORSEMENTS, CURSURI

- deck & engine certificates & endor-

sements (officers / ratings)

- electrical & reefer certificates

- cook & steward certificates

- radio certificates & endorsements

- safety training (surv., fire, medical)

- tanker courses (oil, chem., gas)

- passenger vsl, roro, hazmat courses

- nav., deck, technical & management

courses (radar/ARPA, ISM, Marpol,

simulators, computer, welding etc.)

- any flag state certificates

Document Name (Description)

Titlul documentului (Descriere)

Document Number

Numar Document

Country

Tara

Issue Place

Locul eliberarii

Issue Date

Data eliberarii

Exp. Date

Data expirarii

Chief Officer – on ships of 3000 GRT or more

85618

Romania

Constanta

19.12.2019

27.10.2021

Deck officer - on ships of 500 GRT or more

66648

Romania

Constanta

30.09.2016

27.10.2021

ENDORSEMENT Chief Officer – on ships of 3000 GRT or more

74471

Romania

Constanta

19.12.2019

03.08.2021

ENDORSEMENT Deck officer - on ships of 500 GRT or more

70141

Romania

Constanta

25.01.2019

03.08.2021

Program de actualizare brevet ofiter punte - nivel managerial

00004646

Romania

Constanta

17.12.2019

unlimited

Human Element, Leadership and Management - managerial level

00004569

Romania

Constanta

21.11.2019

unlimited

Ship Security officer

00006340

Romania

Constanta

11.01.2019

unlimited

Operational use of Electronic chart Display and Information System (ECDIS)

00005509

Romania

Constanta

27.09.2013

unlimited

Advanced fire fighting

00008026

Romania

Constanta

03.08.2016

03.08.2021

General operator's certificate for GMDSS (GMDSS - GOC)

9122

Romania

Bucuresti

25.08.2016

26.08.2021

Personal survival techniques

00016701

Romania

Constanta

28.09.2016

28.09.2021

Personal safety and social responsibilities on board the ship

00016701

Romania

Constanta

28.09.2016

28.09.2021

Proficiency in survival craft and rescue boats, other than fast rescue boats

00016538

Romania

Constanta

15.01.2019

15.01.2024

SSO - Ship security officer

00004631

Romania

Constanta

11.01.2019

unlimited

SEA SERVICE (LAST 10 YEARS)

Family Name:

(Nume)

ROSCA

First Name(s):

(Prenume)

Vasilica-Dorel

Date of Birth:

(Data Nasterii)

31.12.1988

Vessel's Name

(Numele Navei)

Flag

(Pavilion)

GT

(GRT)

Kw

(Kw)

Ship Type

(Tipul Navei)

Eng.Maker

(Motor Principal)

Rank

(Functie)

S/On Date

(Data ambarcarii)

S/Off Date

(Data debarcarii)

Employer (company to contact for reference)

Angajator (date de contact pentru referinte)

NYK ATLAS

Panama

75519 GRT

61350 kW

Container vessel

MAN B&W

Second Mate

24.01.2020

17.07.2020

AB CREWING

NYK ATLAS

Panama

75519 GRT

61350 kW

Container vessel

MAN B&W

Second Mate

28.02.2019

25.08.2019

AB CREWING

MERCURY LEADER

Japan

42487 GRT

14000 kW

Pure Car Carrier

MAN B&W

Second Mate

14.07.2018

30.11.2018

AB CREWING

NYK ATLAS

Panama

75519 GRT

61350 kW

Container vessel

MAN B&W

Second Mate

18.11.2017

02.04.2018

AB CREWING

NYK ATLAS

Panama

75519 GRT

61350 kW

Container vessel

MAN B&W

Second Mate

18.04.2017

22.08.2017

AB CREWING

MERCURY LEADER

Panama

42487 GRT

14000 kW

Pure Car Carrier

MAN B&W

Third Mate

29.10.2016

09.03.2017

AB CREWING

ANDROMEDA LEADER

Panama

62915 GRT

15540 kW

Pure Car Carrier

MAN B&W

Third Mate

08.03.2016

15.07.2016

AB CREWING

NYK THESEUS

Panama

76789 GRT

62810 kW

Container vessel

MAN B&W

Third Mate

05.08.2015

20.01.2016

AB CREWING

SUMMER E

Cyprus

38332 GRT

32490 kW

Container vessel

MAN B&W

32490

Third Mate

30.11.2014

14.05.2015

STARGATE CREWING AGENCY

DS AGILITY

Liberia

9940 GRT

9730 kW

Container vessel

MAN B&W

Third Mate

02.05.2014

06.06.2014

DS SCHIFFAHRT

DS AGILITY

Liberia

9940 GRT

9730 kW

Container vessel

MAN B&W

Third Mate

06.08.2012

05.12.2012

DS SCHIFFAHRT

HERCULES

Romania

3795 GRT

2465 kW

Tug

MAN B&W

Deck Cadet

10.11.2011

12.12.2011

ARSVOM ROMANIA

DS AGILITY

Liberia

9940 GRT

9730 kW

Container vessel

MAN B&W

Ordinary Seaman

17.07.2011

10.09.2011

DS SCHIFFAHRT

DS AGILITY

Liberia

9940 GRT

9730 kW

Container vessel

MAN B&W

Deck Cadet

20.02.2011

16.07.2011

DS SCHIFFAHRT

CELIA

Antigua & Barbuda

6264 GRT

5180 kW

Container vessel

MAN B&W

Deck Cadet

10.11.2009

10.04.2010

KRU MARIITIME

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