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
