BARKLAV SRL

System Manual
Application Form (Sea Staff)
Chapter: Section: Page: 01 01 1 of 4

Office Forms Manual (FM)

First Issue: Date: Appr. by: 01 01/07/00 GM Rev.No : Date : Appr.by: 05 07/04/09 GM

SURNAME (NUME) : Radulescu RANK APPLIED FOR (FUNCTIE) : Steward on Oil Rig WILLING TO ACCEPT LOWER RANK (YES/NO) : yes PERSONAL DETAILS (DETALII PERSONALE) 75Kg HEIGHT (INALTIME) : MOTHER LANGUAGE (LIMBA MATERNA) : Romanian OTHER LANGUAGES (ALTE LIMBI STRAINE CUNOSCUTE) : ENGLISH NEAREST INTERNATIONAL AIRPORT (CEL MAI APROPIAT AEROPORT INTERNATIONAL) : OTP Bucharest MILITARY STATUS (STAGIU MILITAR) PARENTS (PARINTI) SATISFIED NOT SATISFIED Yes TO HERE (ATASATI POZA AICI) 175 Constanta PLEASE ATACH PHO NAME (PRENUME) : Victor

NATIONALITY (NATIONALITATE) : ROMANIAN

PLACE OF BIRTH (LOCUL NASTERII) :

MOTHER NAME (MAMA) : Sandulescu Maria

FATHER NAME (TATA) : Radulescu Alexandru

PRESENT ADDRESS (ADRESA ACTUALA) :

Str.C-tin Brancusi , Nr.58, Bl.8, Sc.A, Ap.8 / zip code 900356/

CONSTANTA/ ROMANIA
e-mail address:victoradulesku@yahoo.com PHONE (TELEFON NR) : 0040727584582 NEXT OF KIN NAME, RELATIONSHIP AND ADDRESS (NUME, GRAD DE RUDENIE SI ADRESA PERSOANEI IMPUTERNICITE): Chirila Adriana,/Sister /

Str.C-tin Brancusi , Nr.58, Bl.8, Sc.A, Ap.8 / zip code 900356/ CONSTANTA/
0040744296499 DATE OF BIRTH (DATA NASTERII ) PASSPORT NUMBER (NUMAR PASAPOR T) DATE ISSUE (DATA EMITERII) EXPIRY (DATA EXPIRARII) ISSUING AUTHORITY (AUTORITATE A EMITENTA) PLACE OF ISSUING (LOCUL EMITERII)

ROMANIA
PHONE (TELEFON NR): WIFE AND CHILDREN NAMES (NUMELE SOTIEI SI COPIILOR)

DOCUMENTS (NUME DOCUMENT) PASSPORT SEAMAN'S BOOK NATIONAL SEAMANS BOOK Marshall isl SEAMANS BOOK FLAG STATE 2 US VISA C1/D TYPE AUSTRALIAN MCV OTHER VISAS MEDICAL ILO CERTIFICATE (MI)

DOC. NO
(NUMAR/S ERIE)

ISSUED (EMIS) 07.12.200 7

EXPIRES (EXPIRA) 07.12.2017

ISSUING AUTHORITY (AUTORITATEA EMITENTA) POL. CTA

ISSUING PLACE (LOCUL EMITERII) CONSTANTA

1367633 5

NY 11287 2007351 3000007

10.19.200 9 03.01.200 8

10.19.2019 02.01.2013

Bahamas Maritime Authority American Embassy

LONDON BUCHAREST

BARKLAV SRL
System Manual
Application Form (Sea Staff)
VACCINATION YELLOW FEVER COLLEGES / INSTITUTES (STUDII ABSOLVITE) NAME OF INSTITUTION (NUMELE INSTITUTIEI) COURSE ATTENDED (CURS ABSOLVIT) DATES FROM 1999 TO 2003 QUALIFICATIONS GAINED (CALIFICAREA PRIMITA)

Office Forms Manual (FM)

Chapter: Section: Page: 01 01 2 of 4 First Issue: Date: Appr. by: 01 01/07/00 GM Rev.No : Date : Appr.by: 05 07/04/09 GM

OVIDIUS University

ELECTRONICS

CAREER DETAILS DETAILS OF LICENCES / CERTIFICATES ( DETALII DESPRE CERTIFICATE/LICENTE) QUALIFICATIONS (CALIFICARI) NATIONAL LICENSE NATIONAL LICENSE 2 (IF APPLICABLE) FLAG STATE LICENSE Marchall Isl FLAG STATE LICENSE 2 STCW95 ENDORSEMENT GOC - NATIONAL SSO ENDORSEMENT TANKER FAMMILIARIZATION CHEM. TANKER HIGHEST GRADE OIL TANKER HIGHEST GRADE LPG TANKER HIGHEST GRADE RECORD OF PREVIOUS SERVICE (LAST EMPLOYMENTS) (SEA SERVICE) COMPA NY COMPA NIE RANK (POZITIA LA BORD SHIP PARTICULARS (DETALII CONSTRUCTIVE) NAME (NUME TYPE TIP NAVA FLAG PAVILI ON DWT TONAJ BUIL AN MAIN ENGINE TYPE POWE SIGN ON (DE LA) SIGN OFF (LA) DOC. NO (NUMAR) RANK
( FUNCT IA LA BORD)

STCW REG.

DATE ISSUED (EMIS EXPIRE LA) (EXPIRA LA)

ISSUING AUTHORITY (EMIS DE)

SUMMARY OF SEA SERVICE IN MONTHS FOR ALL CAREER ( SEA SERVICE IN LUNI PE TIPURI DE NAVE) DRY TANKER OFFSHORE

BARKLAV SRL
System Manual
Application Form (Sea Staff)
RANK (FUNCTI E) BULK CONTAIN

Office Forms Manual (FM)

Chapter: Section: Page:
PROD/ CHEM

01 01 3 of 4
CRUD

First Issue: Date: Appr. by:

LPG /

01 01/07/00 GM
FSO AHTS /

Rev.No : Date : Appr.by:

DP VSLS

05 07/04/09 GM
TOTAL (TOTAL)

SUMMARY OF EXPERIENCE ON ENGINE TYPE IN MONTHS FOR ALL CARRIER (ENGINEERS APPLICANTS ONLY) ENGINE TYPE RANK MAN SULZER B&W PIELSTICK MAK UNATTEN DED MACH SPACE 2 STROKE/ 4 STROKE M.E. TOTAL

IMO COURSES (CURSURI IMO) NAME OF COURSE (NUMELE CURSULUI) REG. STCW95 STCW95 TRANING COURSES ISSUED DATE EXPIRES D A T E ISSUING AUTHORITY

DOC. NO

PERSONAL SURVIVAL TECHNICS BASIC FIRE FIGHTING ELEMENTARY FIRST AID PERSONAL SAFETY AND SOCIAL RESPONSABILITY PROFICIENCY IN SURVIVAL CRAFT PROFICIENCY IN FAST RESCUE BOATS ADVANCED FIRE FIGHTING MEDICAL FIRST AID MEDICAL CARE GENERAL OPERATORS CERTIFICATE FOR GMDSS RADAR ARPA MANAGEMENT TRANSPORT AND HANDLING OF DANGEROUS, HAZARDOUS AND HARMFUL CARGOES PREVENTION OF POLLUTION OF THE MARINE ENVIRONMENT (MARPOL 73/78) MARITIME ENGLISH, PROBLEMS OF COMMUNICATION IN HUMAN RELATIONSHIPS SHIP SECURITY OFFICER ENGINE ROOM SIMULATOR

A-VI/1-1 A-VI/1-2 A-VI/1-3 A-VI/1-4 A-VI/2-1 A-VI/2-2 A-VI/3 A-VI/4-1 A-VI/4-2 A-IV/2 A-II/12, II/2 A-II/1,2 OR III/1,2 A-I/1,2 OR III/1,2 A-I/1,2 OR II/1,2 A/1.3 OR XI/2 I/12 AI/12 B- / 12 AII/1 AII/2 BI/12 AII/1 AII/2 A-III/2 OR AVIII/2

SHIP HANDLING AND MANOEVERING SIMULATOR ECDIS BRIDGE / ENGINE TEAM RESOURCE AND MANAGEMENT

BARKLAV SRL
System Manual
Application Form (Sea Staff)
Chapter: Section: Page: 01 01 4 of 4

Office Forms Manual (FM)

First Issue: Date: Appr. by: 01 01/07/00 GM Rev.No : Date : Appr.by: 05 07/04/09 GM

IMO COURSES FOR TANKERS/LPG/LNG/CHEMICALS TANKER FAMILIARIZATION SPECIALIZED TRAINING FOR OIL TANKER (IGS/COW) SPECIALIZED TRAINING FOR CHEMICAL TANKER SPECIALIZED TRAINING FOR LIQUEFIED GAS TANKER PROFICIENCY IN CROWD MANAGEMENT ON RO-RO / PASSENGER SHIPS RO-RO / PASSENGER SHIPS FAMILIARIZATION TRAINING PROFICIENCY IN PASSENGER SAFETY, CARGO SAFETY, HULL INTEGRITY ON RO-RO / PASSENGER SHIPS PROFICIENCY IN CRISIS MANAGEMENT AND HUMAN BEHAVIOR ON RO-RO / PASSENGER SHIPS A-V/1, A-V/1, 8-14 A-V/1, 15-21 A-V/1, 22-34 A-V/2, 1 A-V/3, 1 A-V/2, 2 A-V/3, 2 A-V/2, 4 A-V/3, 4 A-V/2, 5 A-V/3, 5 L013A120 30969416 16.06.2010 16.10.2020 PCH Onboard

IMO COURSES FOR RO-RO / PASSENGER VESSELS

MEDICAL HISTORY( ISTORIC MEDICAL) HEALTH QUESTIONNAIRE CHESTIONAR MEDICAL HAVE YOU EVER SIGNED OFF A SHIP DUE TO MEDICAL REASONS? DEBARCARI CAZ MEDICAL HAVE YOU UNDERGONE ANY OPERATION IN THE PAST? OPERATII SUFERITE IN TRECUT HAVE YOU CONSULTED A DOCTOR DURING THE LAST 12 MONTHS DUE TO AN ILLNESS AND/OR ACCIDENT? BOLI SI/SAU ACCIDENTE IN ULTIMUL AN DO YOU HAVE ANY HEALTH OR DISABILITY PROBLEMS NOW? STAREA ACTUALA A SANATATII ADDITIONAL INFORMATION ( SHORE BASED EXPERIENCE, ETC) (INFORMATII ADITIONALE (EXPERIENTA IN ACTIVITATI DESFASURATE LA USCAT, ETC ) IF THE ANSWER IS YES TO ANY OF THE QUESTIONS PLEASE GIVE BELOW FULL DETAILS DACA DA, DETALIATI

BARKLAV SRL
System Manual
Application Form (Sea Staff)
REFERENCES (REFERINTE) NAME OF COMPANY NUMELE COMPANIEI MTN(Maritime Telecommunications Regent Sevene Seas Cruises Princess Cruises OTHERS : HOBBIES, INTERESTS (INTERESAT DE) CONTACT PERSON / POSITION PERSOANA DE CONTACT/ Maria FUNCTIA DETINUTA Figueras/Onboard Senior Sales Manager Erdy Macasan/HeadBartender CURRENT ADRESS ADRESA CURENTA Miami Miramar/Florida/USA Miami/Florida/USA Miami/Florida/USA TELEPHONE TELEFON

Office Forms Manual (FM)

Chapter: Section: Page: 01 01 5 of 4 First Issue: Date: Appr. by: 01 01/07/00 GM Rev.No : Date : Appr.by: 05 07/04/09 GM

I hereby declare that I do not suffer from any illnes or chronic or pre-existent medical condition and that the informations given are correct to the best of my knowledge. I also declare that I have not been convicted or refused for entry or declared undesirable by any state. I understand that supplying false informations or misrepresentation or omitting any facts or informations is cause for my refusal to hire or dismissal. Further, I understand that my employment is conditioned upon a favorable health evaluation. I do hereby authorize an investigation of all statements contained in this Application. SIGNED (SEMNATURA) Radulescu Victor DATE (DATA) 24.12.2012 PLACE (LOCUL) Constanta/Romania