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LIBRA   CREWING
 

 

 

 

 

 

 

 


        116, AL LAPUSNEANU Str., X2 / 9,  Constanta,  ROMANIA,

Tel.++40 241  670071     Fax++40 241 559940    Cellular  ++40 724 309203                                                                             

 EMail  : libra_maritime@yahoo.com     libramaritime@libramaritime.ro      

                                     www.libramaritime.ro                 

 

A P P L I C A T I O N   F O R M   E M P L O Y M E N T

DECK / ENGINE DEPARTMENT

 

Position applied for  :

 

Surname / First Name :

 

Date of birth / Place :

 

Parents (Father/Mother name)

 

Nationality / Religion :

 

Marital status :

 

Numbers/Children Names:

Children under 18 years :

 
 

Full style address/ address Email / telefon /telefon:

 
 

Next of kin : name/relationship

/address/ telefon/telefon:

 

 

P H Y S I C A L   A P P E A R A N C E

 

Color of hair

Color of eyes

Height(cm)

Weight(kg)

Shoes size

Overall size

TRAVELLING AND SAILING DOCUMENTS

 

 

Number

Issued by

Date of issue

Date of expiry

Passport:

CONSTANTA

National Seaman book:

ANR CONSTANTA

Certificate of Competency:

ANR CONSTANTA

Endorsement STCW 95:

ANR CONSTANTA

SSO Endorsement:

ANR CONSTANTA

GMDSS Endorsement:

ROMANIA

Marshall Isl. Flag State:

Panama Flag State :

Another Flag State :

 

Vaccination - Yellow Fever :

 

Valid US visa :

 

Australian MCV:

 

Flag Medical Certificate :

 

K N O W L E D G E   L A N G U A G E S :

Please mark with the symbol “x” wherever applicable.

 

K N O W L E D G E    L A N G U A G E S :

                 (excelent, good, average, none)

ENGLISH:

GREEK:

OTHER:

 

C O L L E G E S   /   I N S T I T U T E S,  ETC.

 

NAME OF INSTITUTION

COURSE ATTENDED

DATES FROM

DATES TO

QUALIFICATIONS GAINED

 

C O U R S E S   A T T E N D E D

 

Please write the number and the year of the IMO course.

 

Personal Survival Tehniques (Basic/Advanced) :

    

Fire prevention and fire fighting (Basic/Advanced):

First aid / Medical Care (Basic/Advanced) ::

Personal Safety and Social Responsibility:

Maritime English :

Survival Craft / Fast Rescue Boats :

Transport and Handling Dangerous Goods (HAZMAT):

Prevention & Fighting Marine Pollution (MARPOL 73/78):

SSD (SECURITY AWARNESS TRAINING & SECURITY):

Ship Security Officer :

G.M.D.S.S.:

G.O.C :

ARPA, Bridge Teamwork, Search and Rescue:

Radar Simulator Certificate:

ECDIS Electronic Chart Display and Information System :

Ship Handling and Maneuvering Simulation :

BTRM Bridge Team Management :

Steam Ship Propulsion

Passenger Ship /RO-RO Familiarization Training:

Tanker Familarization :

Chemical Tanker Familiarization:

LPG Specialization:

Advanced tanker (Pet):

Advanced tanker(Chem, LPG, LMG):

Safety in oil tanker:

Inert gas system operation:

Crude oil washing:

Cookery certificate:

*   

*   

*   

 (*other additional IMO/STCW Courses)


SEA SERVICE RECORD

 

 

Rank

 

Vessel Name

 

Flag

 

Type

 

GRT

Engine/KW

 

Sign-on

 

Sign-off

Name Principal

(ship owner or manager)

Contact details 

telefon,telefon

Sign off reason

(eoc,..)

 

Kindly remember to always attach picture on the application and provide contact details of former employers.

 

I hereby declare and  confirm that all above mentioned and enclosed information’s is true, and I take full responsibility of any arrest or delay of the ship on board of which I will sign on, in case this arrest  and /or delay occur /arises because of my documents and /or  behavior.

 

Date                                                                                                     Signature

 

 

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