EMPLOYMENT APPLICATION FORM

Position applied for CADET/ASSISTANT ELECTRICIANDate of availability 01/06/2015Surname StamateName / s Gabriel MarianDate / place of birth 28-01-1988 / SLOBOZIA/ IALOMITANationality RomanianMarital status Unmarried Sex : Male

CONTACT INFORMATIONHome address CONSTANTA , BDUL TOMIS , NR 226 , BLOC TD 10, SCARA A , AP

16, ETAJ 3Secondary address Romania, Constanta/Hirsova, Strada Lunei , Nr 5AMobile phone 0040765683115E-mail stamate_teo@yahoo.comNearest airport Bucharest/ Otopeni

PERSONEL DETAILS & UNIFORM INFOMATIONHair color DARK- HAIREDEye color BROWNHeight (centimeters) 180Weight (kilograms) 90Working clothes size MShoes size 43

NEXT OF KIN DETAILSRelationship (i.e. Wife, etc.) FIANCEESurname ROSU Given name/s DOINITANOK address CONSTANTA , BDUL TOMIS , NR 226 , BLOC TD 10, SCARA A ,

AP 16, ETAJ 3NOK contact number 0040768710216

PRE-SEA EDUCATIONName of school or academy Department From To

Maritime University of Constanta Faculty of Electrical Engineering 2011 2015

PASSPORTS, SEAMAN’S BOOKS AND VISASName of document Number Place of issue Date of issue Date of expiry

National Passport 052676703 CONSTANTA 22-10-2014 22-10-2019Viza S.U.A C1/D 201523165

200003Ambasada S.U.A

BUCURESTI21-08-2015 18-08-2020

National Seaman’s Book 33211CT CONSTANTA 28-07-2014 21-07-2016

CERTIFICATES (STCW A II/1-4 & A III/1-4)Name of document Capacity Number Place of issue Date of

issueDate of expiry

Certificate of competency Maritime Electrical Officer Cadet

48563 ANR 28-07-2014

31-12-2016

BASIC TRAINING (STCW A VI/1 & A VI/2-4) AND OTHER CERTIFICATES Name of document Number Place of

issueDate of issue

Date of expiry

Personal Survival Techniques 00002391 CERONAV 29/09/2013 29/09/2018Personal Safety and Social Responsibility

00002391 CERONAV 29/09/2013 29/09/2018

Medical First Aid 00001386 CERONAV 15/03-2013 15/03/2018Advanced Fire Fighting 00002503 CERONAV 17/05/2013 17/05/2018Security Awarness Training and Security Traing for Seafers With Designated Security Duties (SSD)

00020488 CERONAV 23/10.2014 -

Passenger Ships 00001039 CERONAV 16/07/2015 15/07/2015

MEDICAL AND VACCINATIONSName of document Number Place of issue Date of issue Date of expiry

Seafarer’s Medical 2415 CONSTANTA 21-07-2104 21-07-2016Yellow Fever vaccination 5239 MEDICOVER

CONSTANTA10-05-2015 10-05-2025

SEA SERVICE DURING THE LAST FIVE YEARS

Rank Company Name of vessel GRTEngine

type KWFrom To

MARITIME ELECTRICAL OFFICER CADET

AGENTIA DE SALVARE A VIETILOR OMENESTI PE MARE CONSTANTA

R/M ``HERCULES``

3795 2x2460 06-03-2015 06.05.2015

MARITIME ELECTRICAL OFFICER CADET

PETER DOHLE

MW/ WESTPHALIA

35824

26270 18/05/2015 20/06/2015

ENGLISH LANGUAGEMarlins Test in % If other test state details

85%

COMPUTER KNOWLEDGEGood computer knowledge