Agentia autorizata de recrutare si plasare Personal Maritim Navigant

PETRIMAR SHIPPING LTD.

Address: Romania, Tulcea, 14th Babadag Street, Bldg. 8/A/16 Contact: Tel: +40 240 517633 ; +40 240 506676; +40 240 506677 Fax: +40 240 506675 Mobile: +40 724 231 975 E-mail: petrimar@tim.ro ; petrimar2005@yahoo.com Web: www.freewebs.com/petrimar
APPLICATION FORM
Desired type of vessel Desired length of contract Minimum accepted wage / month ATTACH YOUR PHOTO Rank:

HERE

Surname PERSONAL DATA

Date / Place of birth

Given name (s)

NATIONALITY ROMANIAN

Fathers name

Mothers name

Address / Phones no. (fix & mobile) / E-mail Marital status Wifes name Children (number of)

NEXT OF KIN (name / address / phone no)

DOCUMENTS
DOCUMENT PASSPORT USA VISA National SEAMANS BOOK MEDICAL EXAMINATION PANAMA S/BOOK MALTA S/BOOK OTHERS LICENSES DOCUMENT NATIONAL LICENCE NATIONAL ENDORSEMENT TANKER ENDORSEMENT OIL TANK ENDORSEMENT CH TANK ENDORSEMENT LPG ENDORSEMENT NUMBER PLACE / DATE OF ISSUE EXPIRES

NUMBER

STCW 95 rule

ISSUE

EXPIRES

I.M.O. CERTIFICATE General Operators Certificate for GMDSS (GOC)

STCW 95 COURSE A-IV/2

MODEL COURSE 1.25 ()1.07 ; () 1 . 0 8 1.19 1.20 1.14 1.21 1.23 1.24 2.03 1.15 1.11,

NUMBER

ISSUED ON

VALID TILL

Radar ARPA, Bridge Teamwork, Search and Rescue:()operation; ()management

A-I/12, II/1 2

Personal Survival Techniques Basic Fire-Fighting Medical First Aid Personal Safety and Social Responsibilities on Board Ships Proficiency in Survival Craft and Rescue Boats, other than Fast Rescue Boats Proficiency in Fast Rescue Boat Advanced Fire-Fighting Medical First Aid & Care Bridge Team Management Prevention of Pollution of the Marine Environment MARPOL 73/78 Transport and Handling of Dangerous, Hazardous and Harmful Cargoes Maritime English and Problems of Communication in Human Relationships Ship Security Officer Tankers Familiarization Oil Tanker Specialization Chemical Tanker Specialization LPG Specialization Ro/Ro Passenger Ships / Passenger Ships other than Ro/Ro Passenger Ships

A-VI/1-1 A-VI/1-2 A-VI/1-3 A-VI/1-4 A-VI/2-1 A-VI/2-2 A-VI/3 A-VI/4-1/2 B-I/12, VIII/2 AII/1,2,3;AIII/1 B-V/5

1 . 1 2

par5,9, 18 3.17; 5 . 0 4

A-III/1,A-III/1

Chapter XI2,ISPS A-V/1;1-7

1.01

1.28, A-V/2, A-V/3

1 . 2 9

SEA SERVICE (last one first)

Owners name (contact phones) Ranks Ship (type / name/ flag) DWT ENGINE (type / HP) From TO RESON OF S/OFF

ENGLISH Excellent Good

Communication

ITALIAN Excellent Good

Communication

FRENCH

GREEK

Excellent

Good

Communication

Excellent

Good

Communication

SPANISH Excellent Good

Communication

OTHERS Excellent Good

Communication

EXPERIENCE IN RANK:

(years / months)

MAIN ENGINES EXPERIENCE: MAN (_____ MTHS) , SULTZER (________ MTHS), B&W (________ MTHS) , MITSUBISHI (______ AUXILIARS EXPERIENCE: MTHS), OTHERS (_________ MTHS)

EXPERIENCE ON FOLL. MAIN TYPES OF VESSELS:

I hereby declare that I do not suffer from any illnes or chronic or pre-existent medical condition and that the informations given are correct to the best of my knowledge. I also declare that I have not been convicted or refused for entry or declared undesirable by any state. I understand that supplying false informations or misrepresentation or omitting any facts or informations is cause for my refusal to hire or dismissal. Further, I understand that my employment is conditioned upon a favorable health evaluation. I do hereby authorize an investigation of all statements contained in this Application.

SIGNED (SEMNATURA)

DATE (DATA)

PLACE (LOCUL)