Date: .......................................Ready for employment : .......................................E- mail: .......................................

1. Family name ..............................., First name .........................., Father's name ..............................2. Date of birth ...................................... 3. Place of birth: ...................................................................4. Nationality ........................................, Religions denominations ......................................................5. Identity card ............, № ....................., Date of issue ......................................................................Place of issue ............................................, ID № (ЕГН) .....................................................................6. Height ................., Weight ....................., Eyes color ...................., Hair color: ................................Overall №: ......................... Shoes №: ..................................., Preferred vessels: ..............................7. Marital status ................................................, Nearest Airport: ........................................................8. Present address .........................................., Str. ........................................................, № .............................................................................................................................................................................9. Tel. Number: ...............................................10. Next of kin / full name / ..................................................................., Address ............................................................................................................ Tel.: ........................... Relations: .............................11. Have you any health problems: ....................................................................................................................................................................................................................................................................12. Education .................................., Diploma № .......................... From: ........................................... Speciality: ............................................, Period: from .......................... to ......................, address ...............................................................13. Previous sea servise in years: ......................................................................................................................................................................................................................................................................14. Do you speak English Fluently: ........................ Read: ......................... Write: ..............................

Passed English test (Yes/No): ....................., (Marlins/CES/SETS), Percentage:..........................

phone: + 359 52 33 54 55 fax/phone: + 359 52 33 53 34phone: + 359 52 33 55 03 mobile: + 359 890 145 700mobile: + 359 887 272 672 mobile: + 359 899 145 700

Application For EmploymentRANK APPLIED FOR: .................................

photo

LIL - 12 v.5/2016 fr 01/02/01

58, Debar str., floor 5, Varna 9000, BULGARIAe-mail: crewing@lil-12.com, www.lil-12.com

15. What other languages do you speak:..............................................................................................

17. Seaman's book № ................................ Issued on ......................... Expire on ..............................18. International passport № ...................... Issued on ......................... Expire on ..............................

20. Flag Endorsements (if any)

21. STCW Certificates

LIL - 12 v.5/2016 fr 01/02/01

COUNTRY LICENCED AS CERTIFICATE NUMBER DATE OF ISSUE

CERTIFICATIONSPersonal Survival TechniquesFire Preventions & Fire FightingElementary First AidPersonal safety & Social ResponsibilitesProficiency in Survival Craft

Safe Oper. And Maint. of PS In Excess 1000V

Proficiency in Medical First Aid

SSO / SDSD / SSA

Competency in Advanced Fire Fighting

Medical Care

Main And Aux Machinery Operation And ACS

Bridge/Engine Team and Res. Management

ECDIS & AISOil Tanker Familiarization

Fast Rescue Boat

Chemical Tanker Operations

REFERENCE NUMBER DATE OF ISSUE

Oil Tanker OperationsChemical Tanker Familiarization

MSRC, Radar&Operational use of A.R.P.A

16. Seafarer's passport № .......................... Issued on ......................... Expire on ..............................

COUNTRY LICENCED AS CERTIFICATE NUMBER DATE OF ISSUE

19. Certificate Of Competency

COUNTRY LICENCED AS CERTIFICATE NUMBER DATE OF ISSUEBULGARIA

HAZMAT

Safety Officer

Marine Environmental Awareness

HUETDP Certificate

HLO

PeriodFrom To

RankVessel

Name Type GTMain Engine

Type KWEmployer IMO

Number

22. Previous Sea Service (last 6 contracts)

LIL - 12fr 01/02/01

v.5/2016

AUTOBIOGRAPHY

Of ..........................................................................................................................................................Address: .............................................................................................. Tel.: .........................................Date of birth: .................................................. Place of birth: ...............................................................Mother: ...................................................................................... Date of Birth: ....................................Father: ....................................................................................... Date of Birth: ....................................Brother: .................................................................................................................................................Sister: ...................................................................................................................................................Wife: ..................................................................................................................................................... Date of birth: ............................................... Place of birth: ..........................................................Children: 1. ....................................................................................................................................... 2. ....................................................................................................................................... 3. .......................................................................................................................................Military service: .............. Period: from ......................... to ....................... Position: ............................Ex-company name: ..............................................................................................................................Address: .............................................................................. Phone: ....................................................Contact person name: ..........................................................................................................................Position : ............................................................................. Phone: ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Information for the experience of the seafarer........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Signature: ......................................

LIL - 12 v.5/2016 fr 01/02/01

23. Diplomas and certificates for fitters, cooks, stewards ..................................................................... ......................................................................................................................................................24. USA Visa Issued date: ........................................, Expired date: ............................................................

25. Yellow Fever Issued date: ...................................., Other vaccinations: ..........................................