CMA SHIPS Singapore

CREWING MANUAL

SECTION 3

Ref: Crew/Form/01a

Version: 01/03/2014
APPLICATION FORM
TITLE:

PAGE 1 of 1

APPLICATION FORM

ATTACH
RECENT
PHOTO

CMA Ships ROMANIA

13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail: cnz.application@cmaships.com
Personal data operator no.19478
Position applied for:
Type of vessel:
Availabibity date:

Are you responding to a media advertisement?

YES/NO

If YES, please state which one

Are you applying upon personal or professional recommendation?

YES/NO

If YES, please state who

Surname:
Other names

First name:
Known as

Nationality:

Place of birth:

Date of Birth:

Age:

Male

Passport
Date
Place of issue of
issue

Number

Date of expiry

Issuing Authority

Date of issue

Date of expiry

Visas
Type

Number

Place of issue

C1/D (USA)
C1 (USA)
D (USA)
Australia Entry visa
MCV (Australia)
Schengen

Education Background
School / College

From

To

Highest qualification attained

Personal details
Full address:
Postal code:

Country:

E-mail:
Home tel number:
Mobile phone:
Domestic Airport

International Airport

Marital status:

1/11

Female

Full name of Next of Kin:

Relationship

Address of Next of Kin

if different from above
Phone
if different from above

2/11

Dependents
Name

Date of birth

Age

Gender

Relationship

Person to contact in case of emergency

Name:

Relationship

Address:
Phone number:

Mobile number:

National Seaman's Book

Number

Place of issue

Date
of
issue

Date of expiry

Issuing Authority

National Certificate of Competency (COC)- Licences

Grade

Issuing
Authority

Number

National GMDSS & Endorsement

Issuing Authority

Number

Date
of
Date of expiry
issue

Date
of
issue

Place of Issue

Date revalidated

Date of expiry

Date expiry

Place of Issue

Medical Fitness Certificate

Type

Date of issue

Date of Expiry

Date of Issue

Date of Expiry

Yellow Fever Vaccination

Foreign languages other than English

Language

Level:

Begin
ner

Intermediate

Advanced

Yes / No

If yes give details

Medical History
Have you ever signed off from
a ship due to medical reasons?
Name of vessel

Date of Occurrence

Brief description of Illness or Injury

Other personal details

Height:

Weight:

Colour of Hair:

Colour of eyes:

Safety shoes size:

Boiler suit size:

Uniform Shirt size:

Uniform Trousers size:

3/11

Details of other Marine courses

IMO model
course

Type of Marine Course

1.19 - 1.20 1.13 1.21

Basic Training

Basic Fire Fighting

Elementary First Aid
Personal Safety & Social
Responsibilities (Human
Relationship)

1.19
BASIC TRAINING

Personal Survival
Techniques

1.20
1.13

Reference- Regulation
STCW Reg.
A-VI/1-1 to AVI/1-4
STCW Reg. A-VI/1-1
STCW Reg A-VI/1-2
STCW Reg A-VI/1-3
STCW Reg A-VI/1-4

1.21

Proficiency in survival craft & Rescue

Boats

1.23

Advanced Fire Fighting

2.03

Medical First Aid

1.14

Medical Care

1.15

ROP

1.08

ARPA / NCC

1.07

STCW Reg A-VI/2 par

1.3
STCW Reg A-VI/3
STCW Reg A-VI/4-1
STCW Reg A-VI/4-2
par 2
STCW Reg II/2
STCW Reg II/1

Radar Simulator
ECDIS

1.27

HAZ MAT
Ship simulator bridge teamwork
BTM / ETM
Ship Security Officer (SSO)

1.22

STCW Reg II/1

par.2.5
US 49 CFR 172.700172.204
STCW
Reg
II/1
STCW Reg VI/5 /
ISPS Code

BASSnet
Ship handling & manoeuvring
Bridge resource management

STCW Reg II/1 & II/2

STCW Reg VIII/2
US33CFR 157.415

Loading software (name it)

Large Vessel Handling Simulator /
Engine Room Simulator

CMA CGM

Indos Number
Upgradation Course
Revalidation Course for renewal of CoC
High Voltage Training
Reefer Training
Engine Makers Training
Crane Manufactures training
Vessel security training course
Ship Safety Officer
ISF Marlins English test

ISPS
code
IMO Assembly Res
A741(18)
UK MCA

4/11

Number

Date of issue

Date of expiry

Flag State Documents

Document

Grade

Number Place of Issue

Malta:

5/11

Date of Issue

Date Expiry

Employment history (at least the last 5 years)

Vessel *

Company

Manning Agent

Trading area Vesse

l type

Flag

DWT /
TEU

**

Year
built

Main Engine
Make

* or industry sector if ashore

Type

Position
KW

** Use abbreviation: PC = Pure container, GC = General Cargo, BC = Bulk Carrier, LNG = Tanker, LPG = Tanker, Chem = Chemical, RoRo = Roll on Roll off
*** Use abbreviation: MR = Medical Reason, VS = Vessel Sold, EOC = End of Contract
6/11

Sign on
date

Sign off
date

Total
mm/dd

Reaso
n for
leaving

***

Summary of Experiences (in number of years)

Years as/
Container
on

Tanker

Bulk
carrier

Roro

others (Please state)

Sulzer
RND

B&W

MAN

SEMT
Pielstick

Master C/E
C/O - 2/E
2/O - 3/E
3/O - 4/E
E/O
Total
Years as/
on

Sulzer
RTA

Steam
Turbine

C/E
2/E
3/E
4/E
E/O
Total

References
Do you have any objection if we will contact your last employers for
reference?
If YES please specify why:
If NO please specify below:

employer
Name of company
Name of person to
contact
Address

Tel number

Please list two contactable referees or past employers

Name of company
Name of person to
contact
Address

Tel number
Name of company
Name of person to
contact
Address

7/11

Yes/No

others

Tel number

8/11

Bank details
Bank
name:
Branch
name

Sort code:
Swift name
IBAN number:

Address:
Account
name/
Title

Account
number:

I hereby affirm that all the information provided by me in this application is true and correct to
the best of my knowledge and belief; further, that no Certificate of Competency or License
issued to me has ever been revoked or suspended. I also certify that my medical history
contained abocve is true and any false statement or undisclosed material information about
past illness or injury will disqualify me from any employment benefits and claims.
Date_____________
___

Signature_______________________

* The company may contact my previous employer for references.

9/11

ACORDUL PERSOANEI CARE SOLICITA

SERVICIUL DE RECRUTARE SI PLASARE IN DOMENIUL NAVIGANT
cu privire la prelucrare si transmitere a datelor cu caracter personal
Subsemnatul:

Cod identificare (CNP/Pasaport):

CMA Ships ROMANIA

13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail:
cnz.application@cmaships.com
Personal data operator no.19478

1. mi exprim n mod expres consimtamntul ca societatea comerciala CMA SHIPS

ROMANIA S.R.L (denumita in continuare CMA SHIPS ROMANIA) inregistrata ca operator de
date cu caracter personal nr. 19478 sa prelucreze informatiile indicate la punctul 2 de mai jos
inregistrate pe numele meu in evidentele proprii si sa transmita aceste date catre societati de
shipping si/ sau crewing, cum ar fi, dar fara a se limita la acestea, CMA SHIPS (persoana
juridica franceza cu sediul in 4, Quai dArenc 13002 Marseille, France).
Imi exprim, de asemenea, acordul ca CMA SHIPS ROMANIA sa solicite date cu privire la
persoana mea de la institutii/societati, precum si consultarii informatiilor nregistrate pe numele
meu n bazele de date ale acestora, ori de cate ori este necesar, in scopul initierii si/ sau derularii
procesului de analizare si/ sau aprobare a solicitarii mele in vederea recrutarii/ plasarii ca
personal navigant.
2. Informatii prelucrate:
a) date cu caracter personal avnd functie de identificare precum (nume, prenume, data si local
nasterii, cod numeric personal, domiciliul, sex, numar de telefon fix/ mobil/ fax, adresa de email,
starea civila, numar de copii, fotografia, inaltimea, greutatea, numele si adresa angajatorului
actual si/ sau a angajatorilor anteriori, data angajarii, ocupatia, pasaport, carnet de marinar, vize)
b) informatii legate de educatia si pregatirea profesionala (studii, limbi straine cunoscute precum
si gradul de cunoastere a acestora, licente, certificate de capacitate, cursuri IMO)
c) informatii referitoare la activitatea anterioara (experienta pe functie si tipuri de nave,
calificativele obtinute , numele navelor, datele de imbarcare si debarcare, datele de contact ale
operatorilor navelor respective, nationalitatea celorlalti membrii de echipaj cu care a servit la
bordul navelor).
d) date referitoare la functia pentru care aplica, tipul/ tipurile de nave de care este interesat, data
de la care este disponibil, salariul minim acceptat.
Am luat la cunostinta faptul ca mi pot exercita toate drepturile prevazute de Legea nr.
677/2001 pentru protectia persoanelor cu privire la prelucrarea datelor cu caracter
personal si libera circulatie a acestor date, publicata n Monitorul Oficial nr.
790/12.12.2001, n mod special urmatoarele drepturi:

(i) Dreptul de acces la date: dreptul de a obtine la cerere si n mod gratuit, pentru o solicitare pe
an, confirmarea faptului ca datele n legatura cu mine sunt sau nu prelucrate de catre un anumit
operator. In ceea ce priveste CMA SHIPS Romania., acest drept poate fi exercitat in urmatoarele
conditii: se adreseaza o cerere catre CMA SHIPS Romania, intocmita in forma scrisa, datata si
semnata in care se va mentiona adresa de domiciliu a persoanei care isi exercita dreptul. Cererii
i se va atasa o copie xerox, lizibila, dupa actul de identitate al solicitantului;

(ii) Dreptul de interventie: dreptul de a obtine, la cerere si n mod gratuit, rectificarea,

actualizarea, blocarea, stergerea sau transformarea in date anonime a datelor a caror prelucrare
nu este conforma legii, n special a datelor incomplete sau inexacte. In ceea ce priveste CMA
SHIPS Romania acest drept poate fi exercitat in urmatoarele conditii: se adreseaza o cerere
catre institutia care a inscris datele la CMA SHIPS Romania intocmita in forma scrisa, datata si
semnata, in care se vor mentiona datele asupra carora se solicita interventia, motivul justificat
si modul de interventie. Cererii i se va atasa o copie xerox, lizibila, dupa actul de identitate al
solicitantului;

(iii) Dreptul de opozitie: de a ma opune n orice moment, din motive ntemeiate si legitime
legate de situatia mea particulara, ca datele care ma vizeaza sa faca obiectul unei prelucrari, cu
exceptia cazurilor in care exista dispozitii legale contrare. In ceea ce priveste CMA SHIPS
ROMANIA. acest drept poate fi exercitat in urmatoarele conditii: se adreseaza o cerere catre
CMA SHIPS ROMANIA, intocmita in forma scrisa, datata si semnata, in care se vor mentiona
datele asupra carora se solicita opozitia si motivul intemeiat si legitim legat de situatia
particulara a persoanei. Cererii i se va atasa o copie xerox, lizibila, dupa actul de identitate al
solicitantului.

AGREEMENT OF THE PERSON WHO APPLIES

SEA-GOING RECRUITMENT AND CREWING SERVICE
In relation to personal data processing and submission
I, the undersigned:

Identification Code (Personal Number/Passport):

CMA Ships ROMANIA

13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail:
cnz.application@cmaships.com
Personal data operator no.19478

1. I express expressly my consent that the trading company CMA SHIPS ROMANIA S.R.L
(hereinafter CMA SHIPS ROMANIA) registered as personal data operator no. 19478 to process
the information indicated in paragraph 2 below registered in my name in its own records and
submit these data to other shipping and/ or crewing companies, such as, but not limited to, CMA
SHIPS (French legal person with the registered office in 4, Quai dArenc 13002 Marseille,
France).

I also express my consent for CMA SHIPS ROMANIA to inquire data about me from
institutions/companies, as well as to consult the information recorded on my name in their
databases, whenever necessary, on purpose to initiate and/ or develop the review and/ or
approval process for my application for the recruitment/ crewing as sea-going personnel.
2. Processed information:
a) personal data with identification function such as (surname, name, date and place of birth,
personal number, domicile, sex, fixed/ mobile/ fax number, email address, civil status, number of
children, photograph, height, weight, name and address of present employer and/ or previous
employers, date of employment, occupation, passport, seaman book, visas)
b) information related to professional education and training (studies, foreign languages known,
as well as their degree of knowledge, licenses, ability certificates, IMO courses)
c) information related to previous activity (experience on positions and types of ships, ratings
obtained, names of ships, embarking and debarking dates, contact data of those ship operators,
nationality of the other crew members with whom he served on board the ships).
d) data related to the position for which he applies, type/ types of ships he is interested in, date
from which he is available, minimum wages accepted.
I took note of the fact that I may exercise all the rights provided by Law no. 677/2001 on
persons protection in relation to personal data processing and free circulation of these
data, published in the Official Gazette no. 790/12.12.2001, especially the following rights:

(i) Right of access to data: the right to obtain upon request and free of charge, for one
application per year, the confirmation of the fact that the data related to me are processed or not
by a specific operator. In relation to CMA SHIPS Romania., this right may be exercised under
the following conditions: an application is submitted to CMA SHIPS Romania, drawn up in
written form, dated and signed in which the domicile of the person who exercises his right shall
be mentioned. A Xerox, legible copy of the applicants identity document shall be attached to the
application;

(ii) Intervention right: right to obtain, upon request and free of charge, the rectification,
updating, blocking, deletion or transformation in anonymous data of the data whose processing
does not comply with the law, especially incomplete or inaccurate data. In relation to CMA
SHIPS Romania, this right may be exercised under the following conditions: an application is
submitted to the institution which recorded the data at CMA SHIPS Romania drawn up in
written form, dated and signed, in which the data on which the intervention is required, the
justified reason and the intervention manner shall be mentioned. A Xerox, legible copy of the
applicants identity document shall be attached to the application;

(iii) Opposition right: to oppose in any moment, for any justified and legitimate reason related
to my particular situation, to the processing of the data that regard me, except for the cases in
which there are contrary legal provisions. In relation to CMA SHIPS ROMANIA. this right may
be exercised under the following conditions: an application is submitted to CMA SHIPS
ROMANIA, drawn up in written form, dated and signed, in which the data on which the
opposition and the justified and legitimate reason related to the persons particular situation
shall be mentioned. A Xerox, legible copy of the applicants identity document shall be attached
to the application.