Can be scanned / sent separately /
SEAFARER'S APPLICATION FORM - Page 1 of 4 - PERSONAL DATA
(Formular de aplicare pentru personal navigant-pagina 1 din 3 – Date personale)
PERSONAL INFORMATION ( DATE PERSONALE)Family Name (Nume) / First Name (s) (Prenume)
Birth Date (Data Nașterii) / Birth Place (Locul nașterii)
Nationality (Naționalitate) / Religion (Religie)
Marital Status (Starea civilă) / No. of Children (Nr copii)
Height (cm) (Înaltime) / Weight (kg) (Greutate în Kg)
Nearest Airport
(Cel mai apropiat aeroport int.)
ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
ADRESA (incluzand nr telefon, țara si cod zona, a doua adresă sau adresa de contact , dacă este cazul )
Street & Nr. (Stradă si Număr) / Email Address (Adresa Email)
Location (Localitate) / Mobile Phone (Tel mobil)
City (Oraș) / Residence Phone (Tel fix)
State, Country (Țara) / 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 APROPIATĂ/ ÎMPUTERNICITĂ ( persona de contact în caz de urgență și beneficiarul asigurărilor )
Family Name (Nume) / First Name(s) (Prenume)
Nationality (Naționalitate) / Relationship (Grad de rudenie)
Street & Nr. (Str. si Nr.) / Email Address (Adresa email )
Location (Localitate) / Mobile Phone (Tel mobil)
City (Oraș) / Residence Phone (Tel fix)
State, Country (Țara) / Fax (Fax)
Postal (ZIP) Code (Cod) / P.O. Box (if any) (C.P)
REMARKS(REMARCI)
Requested Rank(s) (Funcție) / Availability Date (Disponibil din)
Prefer Vessel Types (Tip de navă preferat) / Minimum Salary(Salariu minim)
Employment Preference
English Language Skills (Limba engleză/ Nivel cunoaștere)
Other Foreign Languages (Alte limbi străine)
Professional School / Academy - Name & Period (From - To) (Școala / Nume/ Perioada)
Foreign Crew Experience (specify nationalities)
Experința cu echipaje străine (specificați naționalitățile)
Other Skills
(Alte calitați 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 că toate informațiile date de către mine în aceast formular de aplicare sunt adevărate și corecte.
SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF
DOCUMENTS
(Formular de aplicare pentru personal navigant - pagina 2 din 3 – lISTA DOCUMENTELOR)
Family Name(Nume de familie) / First Name(s) (Prenume) / Rank
(Funcție)
A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES(DOCUMENTE DE CALATORIE/MEDICALE )
Document Name (Desciption)
Titlul documentului ( Descriere) / Document Number Număr Document / Country
Țara / Issue Place Locul eliberării / Issue Date
Data eliberării / Exp. Date
Data expirării
Passport (Pasaport)
Seaman's Book (national) (Carnet Marinar)
Seaman's Book (Norwegian) (Carnet NIS) (flag state)
Seaman's Book (Liberian) (Carnet Liberia ) (flag state)
Seaman’s Book (Panama) (Carnet Panama ) (flag state)
Visa - United States (type C1/D) (Viza USA)
Visa - Others (Work/Resid. Permits) (Alte Vize)
Medical Examination Report (Raport Medical)
Offshore Medical (UKOOA, ENG1)
Vaccination against Yellow Fever (Vaccin Febra Galbenă)
Vaccination against Cholera ( Vaccin Holeră)
Drug & Alcohol Test (Test Drog/ Alcool)
B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES CERTIFICATE DE COMPETENȚĂ & 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 / - deck, technical & management
courses (radar/ARPA, ISM, Marpol,
simulators, computer, welding etc.)
- Dynamic Positioning Experience
Document Name (Desciption)
Titlul documentului (Descriere) / Document Number Numar Document / Country
Țara / Issue Place
Locul eliberării / Issue Date
Data eliberării / Exp. Date
Data expirării
CERTIFICATE of COMPETENCY
ENDORSEMENT
DYNAMIC POSITIONING BASIC
DYNAMIC POSITIONING ADV.
DYNAMIC POSITIONING LICENCE
HUET
BOSIET
RADAR ARPA
GMDSS (GOC)
MARPOL
TRANSPORT AND HANDLING OF DANGEROUS CARGOES
BASIC/ADVANCED FIRE-FIGHTING
PERSONAL SURVIVAL TECH.
PROFIENCY SURVIVAL CRAFT AND RESCUE BOATS
PERSONAL SAFETY AND SOCIAL RESP. ON BOARD
MARITIME ENGLISH
ECDIS
SHIP SECURITY OFFICER
BRG/ENG TEAM MANAGEMENT
SHIP HANDLING
ELEMENTARY FIRST AID / MEDICAL FIRST AID
MEDICAL CARE
PREVENTION OF MARINE POLLUTION ON SHIPS
TANKER FAMILIARIZATION
RO-RO PASSANGER SHIPS
SECURITY AWARNESS (SSD)
Constanta Branch, Romania, 3rd Cristea Georgescu Street, 1st Floor, Int.04, Open every day 10am-6pm
T/F (004) 0733 183 933 - - Skype - marina.crewing - Facebook - LinkedIn - www.marinacrewing.com
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Please indicate your sea service in the last 10 years as exactly as possible - required are the actual sign-on and sign-off dates according to the service certificates resp. seaman's book entries. To speed up processing kindly indicate phone and/or fax numbers of your previous employers. Ship sizes are to be indicated in gross tons, total engine output in kilo Watt (1 kW = 1.34 bhp) to go along with STCW limitations. Please attach evidence for the listed sea service (copies of seaman's book entries, service certificates etc.). The information provided may be passed on to our clients and to flag state administrations to allow for verification of rank experience. Please use the European date format (DD.MM.YY).
SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)
Family Name(Nume): / First Name(s) (Prenume): / Date of Birth(Data Nasterii):Vessel's Name
(Numele Navei) / Flag
(Pavilion) / GT
(GRT) / kW
(Kw) / Ship Type
(Tipul Navei) / Eng.Maker
(Motor Principal) / Rank
(Funcție) / S/On Date
(Data ambarcării) / S/Off Date
(Data debarcării) / Employer (company to contact for reference)
(Angajator)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Date
Data: / Signature
Semnătura:
Constanta Branch, Romania, 3rd Cristea Georgescu Street, 1st Floor, Int.04, Open every day 10am-6pm
T/F (004) 0733 183 933 - - Skype - marina.crewing - Facebook - LinkedIn - www.marinacrewing.com