APPLICATION FORM DATE: ……06.11.2013…… Position applied for THIRD MATE PIC TURE Date of availability 25.10.2013 Salary expectation Surname DENISOV Name MARCEL Date / place of birth 11.03.1979 Marital status MARIED Foreign languages ENGLISH, SPANISH, ITALIAN CONTACT INFORMATION Home address TULCEA, STR. ALUNISULUI, 22 Phone Mobile 07456 42 4881 Email [email protected]PERSONAL DETAILS & UNIFORM INFORMATION Hair Color SATEN Uniform size Eye Color BLUE Overall size Height (CM) 170 Shoes Weight (Kg) 70 Nearest airport HENRY COANDA NEXT OF KIN DETAILS Relationship (i.e. Wife, Father etc.) WIFE Name and Surname DENISOV MARIANA NOK Address (if same, write SAME) TULCEA, STR. ALUNISULUI, 22 NOK Contact Number Age of Children (if applicable) WORK ON SEA CREWING AGENCY Address: 62,Dacia Street, Constanta, Romania Tel: +4 0241 582 475 Mobile: +4 0736 026 709; +4 0757 620 365 E-mail: [email protected]website URL: www.workonsea.ro
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APPLICATION FORMDATE: ……06.11.2013……
Position applied for THIRD MATE
PIC TURE
Date of availability 25.10.2013Salary expectationSurname DENISOVName MARCELDate / place of birth 11.03.1979Marital status MARIEDForeign languages ENGLISH, SPANISH, ITALIAN
CONTACT INFORMATIONHome address TULCEA, STR. ALUNISULUI, 22 Phone
PERSONAL DETAILS & UNIFORM INFORMATIONHair Color SATEN Uniform sizeEye Color BLUE Overall sizeHeight (CM) 170 ShoesWeight (Kg) 70 Nearest airport HENRY COANDA
NEXT OF KIN DETAILSRelationship (i.e. Wife, Father etc.) WIFEName and Surname DENISOV MARIANANOK Address (if same, write SAME) TULCEA, STR. ALUNISULUI, 22NOK Contact NumberAge of Children (if applicable)
PRE-SEA EDUCATIONName of school or academy Department From ToUNIVERSITY MARITIME OF
CONSTANTAFACULTY NAVIGATION AND
SHIPPING 2008 2012
ACADEMY OF ECONOMIC STUDIES TOURISME 2002 2006
PERSONAL DOCUMENTSName of document Number Place of issue Date of
issueDate of expiry
National Passport 11610407 TULCEA 04.05.06 04.05.16National Seaman’s Book 12039CT CONSTANTA 26.08.03 12.06.14Certificate of Competency 43271 CONSTANTA 04.02.13 04.06.16
WORK ON SEA CREWING AGENCY Address: 62,Dacia Street, Constanta, Romania Tel: +4 0241 582 475 Mobile: +4 0736 026 709; +4 0757 620 365 E-mail: [email protected] website URL: www.workonsea.ro
Name of document Number Place of issue Date of issue
Date of expiry
Endorsement 28273 CONSTANTA 04.02.13 04.04.16Basic Safety Training Medical First Aid 13110 CONSTANTA 30.05.11 29.05.16 Basic Fire Fighting P S S R 15816 CONSTANTA 03.06.11 02.06.16 Personal Survival Techniques 15003 CONSTANTA 24.05.11 23.05.16Familiarization Safety Training 15816 CONSTANTA 03.06.11 02.06.16 Transp. and handling of Dang.