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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)
Nationality (Naionalitate)
Marital Status (Starea
civil)
Height (cm) (naltime)
Nearest Airport
(Cel mai apropiat
ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
ADRESA (incluzand nr telefon, ara si cod zona, a doua adres sau adresa de contact , dac este cazul )
Street & Nr. (Strad si
Email Address (Adresa
Numr)
Email)
Location (Localitate)
Mobile Phone (Tel mobil)
City (Ora)
Fax (Fax)
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
RUDA CEA MAI APROPIAT/ MPUTERNICIT ( persona de contact n caz de urgen i beneficiarul
Family Name (Nume)
First Name(s) (Prenume)
Nationality
(Naionalitate)
Street & Nr. (Str. si Nr.)
Location (Localitate)
Relationship (Grad de
rudenie)
Email Address (Adresa
email )
Mobile Phone (Tel mobil)
City (Ora)
Fax (Fax)
REMARKS(REMARCI)
Requested Rank(s)
(Funcie)
Prefer Vessel Types
(Tip de nav preferat)
Employment Preference
Availability Date
(Disponibil din)
Minimum Salary(Salariu
minim)
Constanta Branch, Romania, 15 Rascoalei 1907 Street, First Floor, Int.05, Open every day 10pm-6pm
T/F (004) 733 183 933 - marinacrewing@gmail.com - Skype - marina.crewing - Facebook - LinkedIn - www.marinacrewing.com
Exp. Date
Data
expirrii
SHIP HANDLING
ELEMENTARY FIRST AID / MEDICAL FIRST AID
MEDICAL CARE
PREVENTION OF MARINE POLLUTION ON
SHIPS:
TRANSPORT AND HANDLING OF
DANGEROUSCARGOES
TANKER FAMILIARIZATION
RO-RO PASSENGER SHIPS
Constanta Branch, Romania, 15 Rascoalei 1907 Street, First Floor, Int.05, Open every day 10pm-6pm
T/F (004) 733 183 933 - marinacrewing@gmail.com - Skype - marina.crewing - Facebook - LinkedIn - www.marinacrewing.com
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):
Vessel's Name
(Numele Navei)
Flag
(Pavilion)
GT
(GRT)
First Name(s)
(Prenume):
kW
Ship Type
(Kw)
(Tipul
Navei)
Eng.Maker
(Motor
Principal)
Rank
(Funcie)
S/On Date
(Data
ambarcrii)
Date of
Birth(Data
S/Off Date
Employer (company to
(Data debarcrii) contact for reference)
(Angajator)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
.
11
.
12
.
13
.
14
.
15
.
Date
Data:
Signature
Semntura:
Constanta Branch, Romania, 15 Rascoalei 1907 Street, First Floor, Int.05, Open every day 10pm-6pm
T/F (004) 733 183 933 - marinacrewing@gmail.com - Skype - marina.crewing - Facebook - LinkedIn - www.marinacrewing.com