POSITION APPLIED FOR:1st Choice3’rd Officer

2nd Choice AB

3nd Choice Deck Cadet

DATE AVAILABLE FOR SERVICE:27/01/2017

PERSONAL INFORMATION

Family Name / Costache / First Name / Madalin
Middle Name / Viorel / Birth Date (dd/mm/yy) / 04/08/1991
Nationality / Romanian / Birth Place / Budesti
Marital Status / Single / Religion / orthodox
Height (cm) / 177 / Weight (kg) / 76
Father’s Full Name / Costache Viorel / Mother’s Full Name / Costache Elena
Birth Date (dd/mm/yy) / 03/07/1961 / Birth Date (dd/mm/yy) / 17/09/1968
Shoes size / 42 / Uniform size / M
ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
Street & Number / George Murnu , Nr. 16 / E-Mail address /
City / 23 August / Mobile Number / 0749626990
State, Country / Romania / Residence Number / -
Postal (ZIP) Code / 907005 / Fax Number (If any) / -
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
Family Name / Costache / First Name / Alexandru
Middle Name / Florin / Birth Date (dd/mm/yy) / 30/10/1989
Nationality / Romnian / Relationship / Brother
Street & Number / George Murnu , Nr. 16 / E-Mail Address /
City / 23 August / Mobile Number / 0742522149
State, Country / Romania / Residence Number
Postal (ZIP) Code / 907005 / Fax Number (If any)
Name of Dependents / Sex / Relationship / Date of Birth (dd/mm/yy)
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REMARKS
English Language Skills / Spoken: Very good / Written: / Good
Other Foreign Languages
Professional School/Academy/ / Maritime University of / Constanta
Course / Period (From – To) / 2007-2011
A. TRAVEL DOCUMENTS AND COC
Document Name (Description) / Document Number / Country of Issue / Place of Issue / Date of Issue / Expiry Date
Passport / 052187462 / Romania / Constanta / 10/12/13 / 10/12/18
Seaman’s book (National) / 32054CT / Romania / Constanta / 14/12/16 / 20/05/18
Seaman’s book (FlagState)
Endorsement (FlagState)
Certificate of Competency / 70462 / Romania / Constanta / 14/12/16 / 23/09/21
Certificate of Endorsement
Vaccination of Yellow Fever / 25437-1B / Romania / Constanta / 16/01/17 / -
Vaccination (Others)
Visa – USA / 2016358273005 / Romania / Bucharest / 27/12/2016 / 22/12/21
Visa – Other (Work/Residence/Permits)
B. TRAINING CERTIFICATES
Certificates / Document Number / Country of Issue / Place of Issue / Date of Issue / Expiry Date
Basic Safety & Emergency Course
Personal Safety & Social Responsibility / 18524 / Romania / Ceronav / 16/11/16 / 16/11/21
BSC/PSSR NAC / 18524 / Romania / Ceronav / 16/11/16 / 16/11/21
Proficiency in Survival Craft and Rescue Boats / 10062 / Romania / Ceronav / 30/09/16 / 30/09/21
PSCRB NAC
Advance Fire Fighting / 8837 / Romania / Ceronav / 23/09/16 / 23/09/21
AFF NAC / 18524 / Romania / Ceronav / 16/11/16 / 16/11/21
Medical Emergency First Aid
MEFA NAC / 18524 / Romania / Ceronav / 16/11/16 / 16/11/21
Medical Care / 4680 / Romania / Ceronav / 16/09/16
MECA NAC
ECDIS / 5839 / Romania / Ceronav / 04/11/16 / -
Fast Rescue Boat
Hazardous Material
Bridge/Engine Resource Management
Ship Simulator & Bridge/Engine Teamwork / 808 / Romania / Ceronav / 26/07/16 / 26/07/21
MARPOL Annex 1
Radar Simulator Course
Automatic Radar Plotting Aid
Deck/Engine Watch Keeping
Global Maritime Distress and Safety System / 849 / Romania / Ceronav / 26/10/16 / 26/10/21
General Operator Course / 18178 / Romania / Ceronav / 25/10/16 / 26/10/21
ISPS/SSAS
SSO
SSO-NAC / 11080 / Romania / Ceronav / 13/12/13 / -
Culinary Course
Catering Management
Welding Course
IACS Certificate (Welders)
ISM

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NEW Application Form BULKERS

VESSEL / ENGINE / VESSEL / FLAG / MANNING / NAME OF / RANK / SALARY / SIGN-ON DATE / SIGN-OFF DATE / SERVICE / SIGN-OFF
GRT / TYPE / TYPE / NAME / AGENCY / PRINCIPAL / U$ / dd / mm / yy / dd / mm / yy / mm / dd / REASON
1518 / G.C. / SIBEL J. / PA / ARADOS SHIPPING CO. / DECK CADET / 400 / 01 / 03 / 14 / 31 / 07 / 14
6013 / G.C. / WHITE STAR / TZ / ARADOS SHIPPING CO. / DECK CADET / 400 / 17 / 03 / 15 / 06 / 08 / 15
9530 / G.C. / MICHELLE C. / GB / CARISBROOKE CO. / DECK CADET / 500 / 27 / 12 / 15 / 04 / 05 / 16

APPLICANT’S SIGNATURE

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NEW Application Form BULKERS