Maersk Line Application Form Marius Iulian Lazar.xlsx

Maersk Line Ref. No

Officer Application Form

(for official use) Marius - Iulian, Lazar(Deck Cadet)

ver 003 / 06.2015 Please fill and send to

LOCATION YOU ARE APPLYING FROM:

[email protected] Romania Country

(please specify if other)

APPLICATION FOR POSITION AS

Deck Cadet

APPLICATION FOR VESSEL TYPE

OIL Tanker

AVAILABILITY DATE :

27-Mar-2016 dd-mmm-yyyy

Name:

Lazar

M.I first name

Nationality:

ROMANIAN

Place of Birth:

Fetesti

Marius - Iulian

middle initials

last name / surname

Romania city

Passport

Male

Sex:

country

(If Chinese Seafarer, please include details of Seafarer's Passport also)

Number

Place of Issue

Date of Issue

Date of Expiry

(dd-mmm-yyyy)

(dd-mmm-yyyy)

Issuing Authority

No. of Blank Pages

Seaman’s Book (CDC) Number

Place of Issue

Date of Issue

Date of Expiry

(dd-mmm-yyyy)

(dd-mmm-yyyy)

Issuing Authority

VISA Country / Type

Place of Issue

Date of Issue

Date of Expiry

(dd-mmm-yyyy)

(dd-mmm-yyyy)

Remarks

Yellow Fever Vaccination Date of Innoculation (dd-mmm-yyyy)

Date of Expiry (dd-mmm-yyyy)

Certificate of Competency (COC) Grade

Issuing Authority

Number

Date of Issue (dd-mmm-yyyy)

Date of Expiry

Place of Issue

(dd-mmm-yyyy)

Certificate of Endorsement (COE) Grade

Issuing Authority

Number

Date of Issue (dd-mmm-yyyy)

Date of Expiry

Place of Issue

(dd-mmm-yyyy)

GMDSS Issuing Authority

Number

Date of Issue

Date of Expiry

(dd-mmm-yyyy)

(dd-mmm-yyyy)

Place of Issue

Dangerous Cargo Endorsements (DCE) Type of Endorsement

Grade / Level

Issuing Authority

Number

Date of Issue

Date of Expiry

(dd-mmm-yyyy)

(dd-mmm-yyyy)

Chemical Oil Gas

Page 1 of 5

Maersk Line Ref. No

Officer Application Form

(for official use) Marius - Iulian, Lazar(Deck Cadet)

Full address :

Mun. Fetesti jud.Ialomita Str.Aleea Lamaitei nr.2 bl.Z14 ap.5 et.2

Country :

Romania

E-mail id :

[email protected]

Home telephone no :

0722242564

Domestic Airport :

Bucharest

Marital Status :

Single

Full Name of Next of Kin :

Marius Ion Lazar

Address of Next of Kin :

Mun. Fetesti jud.Ialomita Str.Aleea Lamaitei nr.2 bl.Z14 ap.5 et.2

Postal Code : 925150

Contact/Mobile phone : 0730221196 International Airport : Bucharest

Relationship : Father

0726309514

Contact Number of Next of Kin :

Email of Next of Kin :

[email protected]

Person to Contact In Case Of Emergency or Accident ( In case different from above ) Marius Ion Lazar

Name:

Father

Relationship with Person : Address:

Mun. Fetesti jud.Ialomita Str.Aleea Lamaitei nr.2 bl.Z14 ap.5 et.2

Contact Number :

0726309514

Email :

[email protected]

Details of other marine courses / STCW short course certificate Name of Marine Course

Place of Issue

Number

Date of Issue

Date of Expiry

(dd-mmm-yyyy)

(dd-mmm-yyyy)

Page 2 of 5

Maersk Line Ref. No

Officer Application Form

(for official use) Marius - Iulian, Lazar(Deck Cadet)

Employment History (Pls Start With Your Latest Sailing Experience On Top Row ) Company

Name of Vessel

From

To

(dd-mmm-yyyy)

(dd-mmm-yyyy)

Total MM-DD

Voyage Type

Type of Vessel Rank

(Foreign Going / Coastal)

Please complete all fields

Vessel Type

GRT

TEU

BHP

UMS

Main Engine

In Case You Have More Sea Experience Pls Utilise The Additional Seatime Sheet Date when promoted to Current Rank : dd-mmm-yyyy Last Wages Drawn : (in USD / month)

Notice Period Upon shortlisting, may we contact your last employer for reference check?

Yes

No

✘

By ticking the box or signing below, I hereby certify that the above information, to the best of my knowledge, is correct. I understand that falsification of this information may prevent me from being hired or lead to my dismissal if hired. I authorise the use, retention and distribution of my personal data contained in this application for the purpose of processing my job application.

26-Mar-2016

Date

Signature

Marius Lazar

dd-mmm-yyyy

Kindly let us know where did you find out about our recruitment exercise Please Check

Specify Details

Newspaper Flyers Friends / Family members already in this organization

X

Internet

Constanta Maritime Univeristy Internet Page (http://www2.cmu-edu.eu/)

Others: Please specify Please fill and send to

[email protected]

Page 3 of 5

Employment History (Pls Start With Your Latest Sailing Experience On Top Row ) Company

Name of Vessel

From

To

(dd-mmm-yyyy)

(dd-mmm-yyyy)

Voyage Total Type (Foreign MM-DD Going / Coastal)

Ver 1.4 dated 13 Feb 2012

Type of Vessel Rank

Please complete all fields

Vessel Type

Ver 1.4 dated 13 Feb 2012

GRT

TEU

BHP

UMS

Main Engine