ANGLIAN MARINE SERVICES

6 Birch Court, Sprowston, Norwich, NR7 8LJ, UK

APPLICATION FORM

PHOTO

ENGINEERS AND ENGINEROOM RATINGS

2nd Eng

APPLICATION FOR POSITION AS

OTHER POSITION (IF ANY)

1. PERSONAL DETAILS
TITLE MR/MRS/MISS

MR

SURNAME

TURKOVIC

FIRST NAME
DATE OF BIRTH
NATIONALITY
MOTHERS NAME
HEIGHT (CM)

SINISA

SEX

MALE

OTHER NAMES
PLACE OF BIRTH
MARITAL STATUS
FATHERS NAME
WEIGHT (KG)

28.08.1972.
CROATIAN
MARIJA
191

FEMALE

TROGIR, CROATIA
SINGLE
90

NEAREST INTERNATIONAL AIRPORT:

2. ADDRESS

ADDRESS (TEMP.) FROM/TO:

NO & STREET

USKOCKA 12

NO & STREET

CITY

KASTEL NOVI

CITY

POST CODE
COUNTRY

POST CODE
COUNTRY

CROATIA

TEL. NO.

TEL. NO.

MOBILE

00385 (0)92 1464244

MOBILE

E-MAIL

sinisaturkovic1972@gmail.com

E-MAIL

FAX

FAX

3. NEXT OF KIN
FULL NAME

MARIJA TURKOVIC

ADDRESS

SAME

CITY

SAME

TEL. NO.

385 21 231210

RELATIONSHIP

MOTHER

COUNTRY
MOBILE

FAX NO.

4. CHILDREN
NAME OF CHILD

DATE OF BIRTH

SEX
M

5. TRAVEL DOCUMENTS
TYPE

DOCUMENT NO.

ISS.DATE

EXP. DATE

ISS. BY (AUTHORITY)

PLACE OF ISSUE

PASSPORT

037914488

14.01.2014.

14.01.2024.

PP

KASTELA

SEAMANS BOOK

00039342

21.08.2009.

21.08.2019.

PORT HARBOUR

SPLIT

OTHER SEAMANS
BOOK
OTHER SEAMANS
BOOK
OTHER SEAMANS
BOOK

6. VISAS
TYPE

VISA NUMBER

US C1/D VISA

ISS DATE

EXP DATE

ISSUED BY

PLACE OF ISSUE

24.05.2012.

21.05.2017.

EMBASSY ZAGREB

ZAGREB

OTHER VISA
OTHER VISA
OTHER VISA

7. EDUCATION
SCHOOL NAME

MARINE HIGH SCHOOL

SCHOOL NAME

FROM

TO

FROM

TO

8. PROFESSIONAL QUALIFICATION / CERTIFICATE OF COMPETENCY (Also include any flag state

endorsements that you hold)
NUMBER

ISSUE DATE

EXPIRY
DATE

ISSUED BY
(AUTHORITY)

SECOND ENGINEER OFFICER ON A SHIP

POWERED BY THE MAIN 3000 KW or MORE

400158479

25.01.2013.

31.12.2016.

PORT HARBOUR

SPLIT

CHIEF ENGENEER OFFICER ON A SHIP

POWERED BY THE MAIN PROPULSION
MACHINERY UP TO 3000 KW PROPULSION
POWER

400052649

25.05.2015.

PORT HARBOUR

SPLIT

CERTIFICATE NAME & LIMITATIONS

DANGEROUS CARGO ENDORSEMENT

PETROLEUM

25.05.2010.

NUMBER
050046559

ISSUE DATE

ISSUED AT

EXPIRY DATE

30.03.2007.

30.03.2017.

CHEMICAL
GAS

9. LANGUAGES
ENGLISH

FLUENT

GOOD

FAIR

POOR

GERMAN

FLUENT

GOOD

FAIR

POOR

FRENCH

FLUENT

GOOD

FAIR

POOR

SPANISH

FLUENT

GOOD

FAIR

POOR

ITALIAN

FLUENT

GOOD

FAIR

POOR

RUSSIAN

FLUENT

GOOD

FAIR

POOR

10. MARLINS TEST (Required for all whose native language is not English)
TEST LEVEL (Management,
Operational, Support)
MANAGEMENT LEVEL

ISSUED
DATE
21.08.2012.

RESULT %
90%

ISSUED BY
(AUTHORITY)
MARLINS

ISSUED AT
SPLIT

TOSE

11. VACCINATIONS
NAME
YELLOW FEVER

ISSUE
DATE
02.01.2012.

EXPIRY DATE
02.01.2022.

ISSUED BY
(AUTHORITY)

ISSUED AT
SINGAPORE

CHOLERA
TYPHOID
TETANUS
HEPATITIS A
POLIO

12. SAFETY CLOTHING

BOILERSUIT SIZE

BOOTS SIZE

58/XXL

13. MARINE COURSES

COURSE NAME
PERSONAL SURVIVAL TEQ.

CERTIFICATE
NUMBER

ISSUE DATE

EXPIRY
DATE

ISSUED BY
(AUTHORITY)

ISSUED AT

400100226

13.04.2011.

13.04.2016.

PORT HARBOUR

SPLIT

400100227

13.04.2011.

13.04.2016.

PORT HARBOUR

SPLIT

BASIC FIRE FIGHTING

ADV. FIRE FIGHTING
ELEMENTARY FIRST AID
MEDICAL FIRST AID

400100219

13.04.2011.

13.04.2016.

PORT HARBOUR

SPLIT

400100224

13.04.2011.

13.04.2016.

PORT HARBOUR

SPLIT

MEDICAL CARE
PERS. SAFETY & SOC. RESP.
CPSC
FAST RESCUE BOAT(STCW95)
CROWD MGMT
CRISIS MGMT
HAZMAT
OIL TANKER FAMILIARISATION
ADVANCED OIL TANKER

050046559

30.03.2007.

30.03.2017.

PORT HARBOUR

SIBENIK

010030415

14.12.2007.

14.12.2017.

PORT HARBOUR

SPLIT

400100221

13.04.2011.

SPLIT

PTLAC3500015490

21.01.2011.

ABERDEEN

PTLAC3500015532

25.01.2011.

ABERDEEN

CHEMICAL TANKER
FAMILIARISATION
ADVANCED CHEM. TANKER
GAS TANKER
FAMILIARISATION
ADVANCED GAS TANKER
INERT GAS PLANT
SHIP SAFETY OFFICER
SHIP SECURITY OFFICER
E/R TEAM MANAGEMENT
E/R RESOURSE MGMT
ABRASIVE WHEELS
WORKSHOP TRAINING
ITSO (OPITO)
FRC BOATMAN (OPITO)
FRC COXWAIN (OPITO)
DAUGHTER CRAFT COXWAIN
(OPITO)
BOSIET
HUET
EBS
HLO
DANGEROUS AND HAZARDOUS
SUBSTANCES IN SOLID FORM IN
BULK AND IN PACKAGED FORM
TRAINING FOR SHIPBOARD
OPERATIONS OPITO APPROVED
FOR ERRV CREWS
FAST RESCUE CRAFT BOATMAN
OPITO APPROVED FOR ERRV
CREWS

ADVANCED MEDICAL AID

(OPITO)

14. MEDICAL FITNESS CERTIFICATE

NUMBER

ISSUE DATE

EXPIRY
DATE

ISSUED BY
(AUTHORITY)

ISSUED AT

ENG1
INTERNATIONAL

01.07.2013.

01.07.2015.

OGUK
OTHER

15. DP HOURS AND SYSTEMS

SYSTEM NAME

TOTAL HOURS

SHIP TYPES AND OPERATIONS

16. YOUR REQUIREMENTS

SHIP PREFERENCE

MIN SALARY/DAY RATE

EXPECTED CONDITIONS

GBP()

LEAVE RATIO

US DOLLARS

1 ON,1 OFF

EURO

2 ON,1 OFF

3 ON,2 OFF

3 ON,1 OFF

MAX NO OF WEEKS

Please supply copies of all the certificates you have as detailed above, and also the pages from
your seamans book to support the seatime statement below.

17.SEA SERVICE DETAILS

NAME:
AVAILABLE:

SINISA TURKOVIC

COMPANY NAME

RANK

RANK:
VESSEL NAME

SIGNED
ON

SIGNED
OFF

VESSEL TYPE*

2 ENG
G.R.T.

D.W.T.

DATE
ENGINE TYPE

BHP

KW

NORTH STAR SHIPPING

(ABERDEEN) LTD

2/ENG

GR. PRIDE

28.12.2008.
25.01.2009.

ERRV

501

MOTOR

1022
KW

NORTH STAR SHIPPING

(ABERDEEN) LTD

2/ENG

GR. PRIDE

22.02.2009.
21.03.2009.

ERRV

501

MOTOR

1022
KW

NORTH STAR SHIPPING

(ABERDEEN) LTD

2/ENG

GR. PRIDE

18.04.2009.
16.05.2009.

ERRV

501

MOTOR

1022
KW

GLOBE MARINE

2/ENG

SANDRELLA

08.09.2009.
19.10.2009.

GENERAL CARGO

2577

MOTOR

1640
KW

GLOBE MARINE

2/ENG

VERVE

20.11.2009.
12.03.2010.

CHEM TANKER

2137

MOTOR

1365
KW

GLOBE MARINE

2/ENG

VERVE

26.05.2010.
04.11.2010.

CHEM TANKER

2137

MOTOR

1365
KW

NORTH STAR SHIPPING

(ABERDEEN) LTD

2/ENG

GR. CONQUEROR

21.12.2010.
16.01.2011.

ERRV

1125

MOTOR

1520
KW

NORTH STAR SHIPPING

(ABERDEEN) LTD

2/ENG

GR. CONQUEROR

11.02.2011.
13.03.2011.

ERRV

1125

MOTOR

1520
KW

FREESHIP

3/ENG

CGM TIGER

23.06.2011.
31.08.2011.

LPG

2997

STEAM

2460
KW

GOLAR WILHELMSEN MNG

3/ENG

LNG

97491

STEAM

VROON OFFSHORE
SERVICES LTD

2/ENG

VOS TRADER

25.12.2011.
05.04.2012.
04.09.2012.
01.10.2012.

ERRV

851

MOTOR

27006
KW
1324
KW

VROON OFFSHORE
SERVICES LTD

2/ENG

VOS TRADER

31.10.2012.
27.11.2012.

ERRV

851

MOTOR

1324
KW

VROON OFFSHORE
SERVICES LTD
VROON OFFSHORE
SERVICES LTD

2/ENG

VOS TRADER

ERRV

851

MOTOR

2/ENG

VOS RAASAY

27.11.2012.
23.12.2012.
01.05.2013.
28.05.2013.
28 DAYS
ON/OFF

ERRV

851

MOTOR

1324
KW
3500
KW

LNG GOLAR MARIA

REFERENCE CONTACT DETAILS

COMPANY NAME
ADDRESS
PHONE NO.

VROON OFFSHORE SERVICES LTD

NORTH STAR SHIPPING (ABERDEEN) LTD

FAX/E-MAIL
CONTACT PERSON
*Please indicate propulsion type where applicable, eg cpp, asd, z drive etc
I declare that the information I have given is, to the best of my knowledge, true and complete. I also declare that the documents submitted are genuine and signed by the
persons whose names appear on them.
DATE

SIGNATURE