PERSONAL DATA
* FIRST NAME : * SURNAME :
PRESENT RANK : SINCE DATE :
DATE OF READINESS : SALARY EXPECTED (EURO) :
* BIRTH DATE : BIRTH PLACE :
NATIONALITY :
EYES : HAIR :
HEIGHT(cm) : WEIGHT(kg) :
CIVIL STATUS : CHILDREN :
FATHER NAME : MOTHER NAME :
HOME ADDRESS
STREET :
ZIP CODE : CITY :
COUNTRY : CLOSEST AIRPORT :
* PHONE : FAX
MOBILE : E-Mail
PRIMARY ADDRESS
WIFE OR NEXT OF KIN (name, address, date of birth) :
FOREIGN LANGUAGES
LANGUAGE : LANGUAGE SKILL :
EDUCATION
SCHOOL'S NAME FROM TILL DEGREE REMARKS
1
DOCUMENTS
COUNTRY NUMBER ISSUED PLACE OF ISSUE ISSUED BY EXPIRES
PASSPORT
SEAMAN BOOK
SEAMAN BOOK 2
SEAMAN BOOK 3
HEALTH CERTIFICATE
HEALTH CERTIFICATE(2)
HEALTH CERTIFICATE(3)
MCV VISA
SCHENGEN VISA
OTHER VISA
D&A TEST
YELLOW FEVER
US VISA
CERTIFICATES OF COMPETENCY
CAPACITY COUNTRY NUMBER ISSUED PLACE OF ISSUE EXPIRES
LICENCE
ENDORSEMENT
OTHER ENDORSEMENT :
STCW - 78/95 CERTIFICATES
COUNTRY NUMBER PLACE OF ISSUE ISSUED EXPIRES
ARPA
SHIP SECURITY AWARENESS
SEAFARERS WITH DESIGNATED SECURITY DUTIES
BASIC SAFETY TRAINING (4 IN 1)
PERSONAL SURVIVAL TECHNIQUES
PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES
ELEMENTARY FIRST AID
FIRE FIGHTING
MEDICAL FIRST AID
MEDICAL CARE
ADVANCED FIRE FIGHTING
PROFICIENCY IN SURVIVAL CRAFT AND R. B.
SHIP SECURITY OFFICER
GMDSS GENERAL OPERATOR
GMDSS ENDORSEMENT
HAZMAT
BRIDGE TEAM MANAGEMENT
DP BASIC
DP ADVANCED (SIMULATOR)
DP OPERATOR (FULL)
BOSIET
HUET
FAST RESCUE BOATS
LOW VOLTAGE CERTIFICATE TO 1 KV
HIGH VOLTAGE ON SHIPS CERTIFICATE
BRIDGE RESOURCE MANAGEMENT
ARPA MNGMT LEVEL
DP MAINTENANCE
ECDIS
SHIP HANDLING
RIGGING & SLINGING COURSE
CRISIS MANAGEMENT ON PASSENGER SHIPS
CROWD MANAGEMENT ON PASSENGER SHIPS
H2S TRAINING
SAFETY TRAINING ON PASSENGER SHIPS
ENGINE ROOM RESOURCE MANAGEMENT
SEA SERVICE (LAST 5 YEARS)
CREWING AGENCY SHIP'S OWNER VESSEL'S NAME FLAG PERIOD FROM PERIOD TO VESEL'S TYPE/GRT ENGINE TYPE/BHP TUE YEAR OF BUILD RANK
1
REFERENCES (OPTIONAL)
NAME OF COMPANY
/CREWING AGENCY
PHONE NUMBER E-mail CONTACT PERSON
1
ADDITIONAL INFO:

W związku z treścią art. 23 ust. 1 pkt 1 Ustawy z dnia 29 sierpnia 1997 roku o ochronie danych osobowych (Dz.U. 2002, nr 101, poz. 926 ze zm.) niniejszym wyrażam zgodę na przechowywanie moich danych osobowych złożonych w firmie Romor PHU i jednocześnie zgadzam się na udostępnienie w/w danych osobowych armatorowi zagranicznemu w ramach działań, mających na celu moje zatrudnienie. Ponadto, wyrażam zgodę na udostępniania moich danych osobowych innym podmiotom świadczącym usługi pośrednictwa pracy dla osób poszukujących pracy na statkach, w szczególności wyrażam zgodę na udostępnianie moich referencji w celu zbadania mojej przydatności i kwalifikacji wymaganych przez armatora. Oświadczam, że poinformowano mnie, iż mam prawo wglądu i poprawiania danych.

In accordance to article 23, paragraph 1, point 1 of Personal Data Protection Act dated 29.08.1997 (Dz. U. 2002, no 101, position 926 with changes) I hereby agree for keeping my personal data information in Romor PHU and I agree for sharing a/m information with ship owner for the purposes of job recruitment. Also, I agree for make a/m information available for another individuals runing mediating services for persons searching for work on the vessels, especcially references and employment records for the purposes of checking my usefulness and qualifications requisited by ship's owner. I declare, that I was informed that I have a right to view and correct my personal data information.