APPLICATION FORM

Applicants Surname: Cernisencu Rank: 3engineer

Applicants First Name: Age: 26

Alexandru Cristian tulcea

Date of birth:30.03.1986

Place of birth:

Home address:

blv 1 decembrie 1918 bl. C1 sc.b ap.5 constanta Next of kin: Cernisencu Alexandra Telephone: 004 0755896808

Marit Singl Marrie X al e d Statu s: DOCUMENTS Passport Seamans book National License/Diploma STCW Endorsement/COC Flag Endorsement Medical Fitness Certificate

NUMBER
14685204 22591 CT 31721

ISSUING AUTHORITY

Date Issued
29.06.09 31.07.07 02.07.09

Expiry Date
29.06.14 17.03.13 26.06.14

A&B,ROTTERDAM

TRAINING CERTIFICATES

YES NO

ISSUING AUTHORITY

Date Iss ue d

Expiry Date

LIFE-SAVING & FIRE FIGHTING VI / 1-1, 1-2, 1-3, 14 PERSONAL SURVIVAL TECHNIQUES A-VI/1 PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES A-VI/1 SURVIVAL CRAFT & RESCUE BOATS ADVANCED FIRE FIGHTING MEDICAL FIRST AID MEDICAL CARE RADAR, ARPA, BRIDGE TEAMWORK A-I/12 A-I I/2 WATCHKEEPING GMDSS (GO) PREVENTION OF POLLUTION A-II/1 A-II/2 HANDLING OF DANGEROUS CARGOES A-II/1 A-II/2 MARITIME ENGLISH A-II/1 A-II/2 TANKER FAMILIARIZATION SPECIALIZED CHEMICAL TANKER V/1, 1-7 SPECIALIZED TANKER FAMILIARIZATION V/1 8-14 II/III IV/2 VI/ 2-1 VI/ 3-1 VI/ 4-1 VI/ 4-2

x x x x x x 24.11.11 24.11.16 30.11.2011 02.12.2011 29.11.2016 01.12.2016

x x x x x

8.12.2011 29.11.2011 22.11.2011

7.12.2016 28.11.2016 21.11.2016 18.02.11

18.02.11

18.02.16

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APPLICATION FORM
FAMILIARIZATION ECDIS TRAINING A-II/1 A-II/2 SHIP SECURITY OFFICER TRAINING BRIDGE/ENGINE TEAM AND RESOURCE MANAGEMENT SHIP HANDLING AND MANEUVERING SIMULATION A-II/1 A-II/2 ICE NAVIGATION TRAINING TANKER MANAGEMENT AND SELF-ASSESSMENT RISK ASSESSMENT AND INCIDENT INVESTIGATION SAFETY OFFICER TRAINING OTHERS: x 03.07.09 03.07.14 V/1 15-21

KNOWLEDGE OF ENGLISH: VETTING EXPERIENCE: USA TRANSIT VISA

VG

20082691790004

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APPLICATION FORM PREVIOUS SEA SERVICE - MINIMUM LAST FIVE YEARS COMPANY VESSEL RANK TYPE FLAG DWT ENGINE TYPE FROM TO 15.01.20 13 19.09.12 23.05.12 REASON FOR SIGNING OFF

TGT

AHTS GSP KING

3E

AHTS

gibraltar ROTTERD AM PANAMA

2700

vartsila

2.10.2012

End of contract Ship sold End of contract

End of contract End of contract End of contract End of contract End of contract End of contract End of contract

LOWLAND AB CREW

MARLENE GREEN NYK VEGA

3E 3E

CONT CONT

11890 97825

VARTSILA MAN B@W

07.08.12 19.01.12

AB CREW STATUS STATUS MARLOW MARLOW MARLOW FAIR PLAY

NYK LYRA NAFTOCEMENT8 ANDREEAS A AHTS MAGNUS AHTS JANUS AHTS JANUS BW BAUHINIA

3E 3E 3E EC EC EC EC

CONT CEMC CONT AHTS AHTS AHTS VLCC

PANAMA PANAMA PANAMA A&B A&B A&B HONG KONG

75201 3998 5967 1780 2900 2900 30101 9

MAN B&W MAN DEUTS MAN MAK MAK MAN B&W

16.04.11 04.11.10 01.04.10

28.09.11 23.01.11 06.08.10

20.07.09 3.03.2009 1.11.08

4.11.07

16.09.09 3.05.09 6.01.09

31.03.0 8

MASTER / OFFICER SUPPLEMENT

RANK TOTAL YEARS IN RANK TOTAL YEARS WITH OPERATOR TOTAL YEARS ON THIS TYPE OF TANKER applicable) TOTAL YEARS ON ALL TYPES OF TANKERS applicable) TOTAL YEARS ON BULK CARRIERS applicable) (as (as (as 0.4 0.4 0.8 3 engineer 2 Actual sea service Calendar years Actual sea service Actual sea service Actual sea service DATE: 18.01.2013

APPLICANTS SIGNATURE:

(use 1 decimal i.e., 2.4 yrs)

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APPLICATION FORM

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