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ValDor CONSHIPPING srl

CONSHIPPING Maritime Crewing Agency CONSHIPPING


Str.Petru Vulcan, Nr.33
Constanta-Romania

Phone: 0040 767 923 883; Phone: 0040 721 300 229
Email: office@conshipping.ro; WebAddress: www.conshipping.ro

Consimţământ de prelucrare şi transfer al Datelor cu Caracter Personal

Subsemnatul Mocanu Costin Daniel, confirm că am citit și am luat la cunoștință


Politica cu privire la prelucrarea datelor personale a Agenției de Crewing ValDor
CONSHIPPING referitoare la Regulamentul (UE) 2016/679 al Parlamentului European și al
Consiliului din 27 aprilie 2016 cu privire la Protecția Persoanelorfizice, cu accentul pe
Prelucrarea datelor cu Caracter Personal, incluzând libera circulație a informațiilor, cât și
termenii și notele explicative a acestora.
Declar, pe proprierăspundere, că am înțeles în ce scop sunt folosite aceste date cu caracter
personal, care îmi sunt drepturile și la ce riscuri mă expunneacordândconsimțământul de
preluare și prelucrare a acestora, de către agenția de crewing ValDor CONSHIPPING, în
special dacă acestea sunt folosite în scopulangajării.
Prin urmare, semnând acest formular, nesilit de nimeni, îmi acord CONSIMȚĂMÂNTUL în
ceea ce priveștepreluarea, prelucrarea și stocarea datelor cu caracter personal în
scopulprestăriiactivității de crewing și facilitareașansei de a putea fi un potențial angajat prin
cadrul acesteiAgenții.

Data Semnătura,

05.01.2023

Dacă NU sunteți de acord cu prelucrarea și stocarea datelor dumneavoastră, vă


rugăm să NU completați șisă NU trimiteți aplicația / C.V.-ul.

F.8.5/8, ed.2, rev.0, pag.1/1


ValDor CONSHIPPING srl
CONSHIPPING Maritime Crewing Agency CONSHIPPING
Str.Petru Vulcan, Nr.33
Constanta-Romania

Phone: 0040 767 923 883; Phone: 0040 721 300 229
Email: office@conshipping.ro; WebAddress: www.conshipping.ro

SEAFARER'S APPLICATION FORM - PERSONAL

photo

PERSONAL INFORMATION
Family Name Mocanu First Name (s) Costin Daniel
Birth Date 21.08.1999 Birth Place Romania
Father’s Name Vasilică Mother’s Name Daniela
Nationality Romania Religion Orthodox
Marital Status Single No. of Children
Height (cm) 170 Weight (kg) 65
Shoes Size 41 Overall S
Eye Color Brown Hair Color Black
Nearest Airport Otopeni
ADDRESS (include telephone country & area codes, advise also secondary or contact addresses)
Street &Nr. Nufărului, 4 Email Address Costinvocal@yahoo.com
Location Brăila Mobile Phone 0725413408
City Brăila Residence Phone
State, Country Romania Skype/Facebook Costin Mocanu
Postal (ZIP) Code 810001 P.O. Box (if any)
NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
Family Name Mocanu First Name(s) Vasilică
Nationality Romanian Relationship Father
Street &Number Nufărului,4 Email Address vasilicamocanu@gmail.ro
Location Brăila Mobile Phone 0720165914
City Brăila Residence Phone
State, Country Romania Skype/Facebook
Postal (ZIP) Code 810001 P.O. Box (if any)
REMARKS:
Requested Rank Engine boy Availability Date 20.01.2023
Prefer. Vessel Type Ro Ro Pax Minimum Salary 1800e
English Language Skills Spoken: fluent Written: good
Other Foreign Languages
ProfessionalSchool / Academy - Naval Academy Mircea cel Batran, Constanta
Name & Period (From - To) 01.10.2018--20.08.2022
Foreign Crew Experience Ukrainian, Russian,Polish,Croatian, Yugoslav
(specify nationalities)
Other Skills

Further Remarks

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge.

F.8.5/2, ed.3, rev.0, pag.1


ValDor CONSHIPPING srl
CONSHIPPING Maritime Crewing Agency CONSHIPPING
Str.Petru Vulcan, Nr.33
Constanta-Romania

Phone: 0040 767 923 883; Phone: 0040 721 300 229
Email: office@conshipping.ro; WebAddress: www.conshipping.ro

Date: Signature:
05.01.2023
Family First Rank
Name Name(s)
A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES
Document Name (Description) Document Number Country Issue Place Issue Date Exp. Date
Passport 059321229 Rou Braila 14.10.2020 14.10.2030
Seaman's Book (national) 39316CT Rou Constanta 16.11.2020 18.07.2027
Seaman's Book (flag state)
Seaman's Book (flag state)
Visa - United States (type C1/D)
Visa - Others (Work/Resid. Permits)
Medical Examination Report
Drug & Alcohol Test
Vaccination against Yellow Fever
Vaccination against Cholera
B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES
Document Name (Description) Document Number Country Issue Place Issue Date Exp. Date
Certificate of Competency 87116 Rou Constanta 16.11.2020 02.05.2024

Endorsement
Basic Safety Training
Proficiency in Survival Craft and Rescue
Boats, other than Fast Rescue Boats
Designated Security Duties
Medical First Aid/ Medical Care
Advanced Fire-Fighting
Maritime English
Risk Assessment in Ship Operation
Prevention of the Marine Pollution of the
Marine Environment
Transport and Handling of Dangerous
Goods
HELM
Passenger Specialization
Basic Training for Oil and Chemical
Tanker Cargo Operations
Advanced Training for Chemical Tanker
Cargo Operations
Advanced Training for Oil Tanker Cargo
Operations
Basic Training for LPG Tankers Cargo
Operations
Advanced Training for LPG Cargo
Operations

F.8.5/2, ed.3, rev.0, pag.2


ValDor CONSHIPPING srl
CONSHIPPING Maritime Crewing Agency CONSHIPPING
Str.Petru Vulcan, Nr.33
Constanta-Romania

Phone: 0040 767 923 883; Phone: 0040 721 300 229
Email: office@conshipping.ro; WebAddress: www.conshipping.ro

Date: Signature:
05.01.2023

F.8.5/2, ed.3, rev.0, pag.3


ValDor CONSHIPPING srl
CONSHIPPING Maritime Crewing Agency CONSHIPPING
Str.Petru Vulcan, Nr.33
Constanta-Romania

Phone: 0040 767 923 883; Phone: 0040 721 300 229
Email: office@conshipping.ro; WebAddress: www.conshipping.ro

Family Name:Mocanu First Name(s):Costin Daniel Date of Birth:21.08.1999

Vessel's Name IMO Flag DWT kW Vessel Engine Rank S/On Date S/Off Date Sign off Recruiting Agency Ship Owner
Type Type Reason (company to contact for
reference)
Opaline 9424869 Malta 33960 10800 RoRo MAK Engine 19.06.2021 18.09.2021 Finish contract Fair Play Maritime Anglo Eastern
Cargo V12 Cadet
Opaline 9424869 Malta 33960 10800 RoRo MAK Engine 02.12.2021 28.02.2022 Finish contract Fair Play Maritime Anglo Eastern
Cargo V12 Cadet
Zimbru 4 Roma 481 3530 TUG Engine 02.03.2022 03.05.2022 Finish contract Coremar Coremar
nia Cadet
Faustine 9889708 Malta 50455 12460 RoRo 2 Stroke Engine 23.07.2022 17.09.2022 Extension Fair Play Maritime Anglo Eastern
Cargo Cadet contract
Yasmine 9337353 Malta 49166 21800 RoRo 4 Stroke Engine 18.09.2022 05.12.2022 Finish contract Fair play Maritime Anglo Eastern
Cargo Cadet

Date: Signature:
05.01.2022

F.8.5/2, ed.3, rev.0, pag.4


ValDor CONSHIPPING srl
CONSHIPPING Maritime Crewing Agency CONSHIPPING
Str.Petru Vulcan, Nr.33
Constanta-Romania

Phone: 0040 767 923 883; Phone: 0040 721 300 229
Email: office@conshipping.ro; WebAddress: www.conshipping.ro

F.8.5/2, ed.3, rev.0, pag.5

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