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Full name of Next of Kin: Relationship

Address of Next of Kin
if different from above
Phone
if different from above

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Flag State Documents
Document Grade Number Place of Issue Date of Issue Date Expiry

Malta:

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Tel number

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Bank details
Bank
Sort code:
name:
Branch Swift name
name IBAN number:

Address:
Account
Account
name/
number:
Title

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issued to me has ever been revoked or suspended.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 benefitsand claims.

Date_____________
___ Signature______________________

* The company may contact my previous employer for references.

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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. Îmi exprim în mod expres consimtamântul 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 d’Arenc 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 înregistrate pe numele
meu în 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 având 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 îmi 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 în Monitorul Oficial nr. 790/12.12.2001, în mod
special urmatoarele drepturi:

(i) Dreptul de acces la date: dreptul de a obtine la cerere si în mod gratuit, pentru o
solicitare pe an, confirmarea faptului ca datele în 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 în mod gratuit, rectificarea,

actualizarea, blocarea, stergerea sau transformarea in date anonime a datelor a caror prelucrare nu
este conforma legii, în 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 în orice moment, din motive întemeiate 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 d’Arenc 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 applicant’s 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 applicant’s 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 person’s particular situation shall be
mentioned. A Xerox, legible copy of the applicant’s identity document shall be attached to the
application.