Ship repairsRecruitment

EUROBALKAN MANPOWER S.R.L.

Ship

repairsRecruitme

nt

F 01-01, Ed.1,Rev.0

SEAMAN’S APPLICATION FORM

DATE :

01.04.2015

RANK APPLIED FOR : 2/O (C/O)

AVAILABLE FROM :

01.04.2015

VESSEL : BUNKER, OIL/CHEM TANKER

NAME IN FULL : MARIN LUCIAN

DATE/ OF BIRTH : 08.09.1977

PLACE OF BIRTH : PLOIESTI

ADDRESS :

ALEEA MURELOR NR 4 BL P1 AP 9 CONSTANTAPHONE : 0770323356

FATHER: VASILE

MOTHER : IOANA

CIVIL STATUS :

MARRIED :

SINGLE :

DIVORCED :

NEXT OF KIN : MARIN CLAUDIA CORNELIA

ADDRESS :

STR BERARARIEI

NR 4 LOC BAIA MARE MARAMURES

PHONE :

CHILDREN(pendent to seaman) No :

ENGLISH : GOOD

ADEQUATE

POOR

PASSPORT No. : 13677025

ISSUED : 03.01.2008

EXPIRES : 03.01.2018

S. BOOK No : 18416CT

ISSUED : 13.09.2013

EXPIRES : 19.01.2017

GRADE OF NATIONAL LICENSE C/O :

ENDORSEMENT No. :

ABV9944933

ISSUED :

11.07.2014

EXPIRES : 31.12.2016

O T H E R / A D D I T I O N A L D O C U M E N T S

E N D O R S E M E N T S S E A M A N ’ S B O O K S

No

NATIONALITY NUMBER

ISSUED

EXPIRES

No

NATIONALITY NUMBER

ISSUED

EXPIRES

1 1

2 2

H O L D I N G C E R T I F I C A T E S

YES NOYES

NO YESNO

Tankers Safety X

Survival craft/Rescue Boat X MARPOL X

Adv. Tankers Safety X Personal Survival X Dangerous Cargoes X

Inert Gas System X

Social Responsibilities X

STCW ’95 endorsement X

S.S.O. X Fire Fighting Medical Fitness X

ARPA XAdvanced Fire Fighting X

Maritime English Course X

GMDSS operator X First Aid Yellow Fever X

Radar Simulator X

Advanced Medical Care X Ro-Ro-/Pass X

P R E V I O U S S E R V I C E S

VESSEL TYPE DWT OWNERSM/E TYPE -

BHP

RANK FROM TO

STEPHANIEBUNKE

R 7800BUNKERS

GIBRALTAR 2/O

31.10.2014

15.01.2015

SP DUBLINBUNKE

R 3798MEDALLION REEDEREI 2/O

26.02.2013

08.09.2013

FPMC 23OIL/

CHEM 50990 FPMC 3/O

10.09.2012

08.01.2013

GALAX MLP 20000 MARTIME 3/O

14.02.2010

21.05.2010

HAWK BK 50000EVELINA MARINE 2/O

27.03.2009

18.09.2009

U.S.A.VISA Y/N

TILL:13.02.2018

ABOVE SEA SERVICE IS DOUBLE CHECKED AND FOUND TO BE SAME ON SEAMAN’S BOOK

I HEREBY CONFIRM THAT ALL ABOVE INFORMATION ARE CORRECT AND TRUE TO MY BEST KNOWLEDGE. ANY MISREPRESENTATION OR FRAUDULENCE WILL BE SUFFICIENT GROUND FOR DISQUALIFICATION. I’VE NEVER BEEN CONVICTED OF ANY CRIMINAL ACTIVITY AND NEVER BEEN

INVOLVED IN ANY ACTIVITY WHICH CAUSED DAMAGE TO THE ENVIRONMENT.SEAMAN’S SIGNATURE:MARIN LUCIAN

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