CREWING MANUAL

CMA SHIPS Singapore

Ref: Crew/Form/01b

SECTION 3

Version:01/03/2014
TITLE:

APPLICATION FORM FOR CADETS

CADET APPLICATION FORM

ATTACH
RECENT
PHOTO
MANDATORY

CMA Ships ROMANIA

13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail: cnz.application@cmaships.com
Personal data operator no.19478
Position applied for CMA CGM Vessel * :
Availabibity date:
* : For RTO, indicate the proposed vessel and, availability Date and planned duration

Are you applying upon personal or professional recommendation?

YES/NO

If YES, please state who

Surname:
Other names

First name:
Known as

Nationality:

Place of birth:

Date of Birth:

Age:

Male

Passport
Number

Place of issue

Date of issue

Date of expiry

Issuing Authority

Date of issue

Date of expiry

Visas
Type

Number

Place of issue

C1/D (USA)
Australia Entry visa
MCV (Australia)
Schengen

Education Background
Nautical School / College / University

From

To

Highest qualification attained

Personal details
Full address:
Postal code:

Country:

E-mail:
Home tel number:
Mobile phone:
Domestic Airport

International Airport

Marital status:
Full name of Next of Kin:

Relationship

Address of Next of Kin

different from above
Phone
if different from above

if

Dependents
Name

Date of birth

1/6

Age

Gender

Relationship

Female

CREWING MANUAL

CMA SHIPS Singapore

Ref: Crew/Form/01b

SECTION 3

Version:01/03/2014
TITLE:

APPLICATION FORM FOR CADETS

Person to contact in case of emergency

Name:

Relationship

Address:
Phone number:

Mobile number:

National Seaman's Book

Number

Place of issue

Date of issue

Date of expiry

Issuing Authority

National Cadet Diploma

Grade

Issuing Authority

Number

Date of issue Date of expiry

Place of Issue

Date revalidated

Date expiry

Medical Fitness Certificate

Type

Date of issue

Date of Expiry

Date of Issue

Date of Expiry

Yellow Fever Vaccination

Foreign languages other than English

Level:

Language

Beginner

Intermediate

Advanced

Personal details
Height:

Weight:

Colour of Hair:

Colour of eyes:

Safety shoes size:

Boiler suit size:

Uniform Shirt size:

Uniform Trousers size:

Details of other Marine courses

Type of Marine Course

1.19 - 1.20 1.13 1.21

Basic Training

Basic Fire Fighting

Elementary First Aid
Personal Safety & Social
Responsibilities (Human
Relationship)

1.19
BASIC TRAINING

Personal Survival
Techniques

IMO model
course

1.20
1.13

Reference- Regulation
STCW Reg.
A-VI/1-1 to A-VI/1-4
STCW Reg. A-VI/1-1
STCW Reg A-VI/1-2
STCW Reg A-VI/1-3
STCW Reg A-VI/1-4

1.21

Proficiency in survival craft & Rescue Boats

1.23

Medical First Aid

1.14

STCW Reg A-VI/2 par 1.3

STCW Reg A-VI/4-1

2/6

Number

Date of issue

Date of expiry

CREWING MANUAL

CMA SHIPS Singapore

Ref: Crew/Form/01b

Version:01/03/2014
TITLE:

Medical Care

1.15

APPLICATION FORM FOR CADETS

STCW Reg A-VI/4-2 par 2

3/6

SECTION 3

CREWING MANUAL

CMA SHIPS Singapore

Ref: Crew/Form/01b

SECTION 3

Version:01/03/2014
TITLE:

APPLICATION FORM FOR CADETS

Vessel type **

Flag

Employment history
Vessel *

Manning Agent

Position

Sign on date

Sign off date

Total mm/dd

* or industry sector if ashore

** Use abbreviation: PC = Pure container, GC = General Cargo, BC = Bulk Carrier, LNG = Tanker, LPG = Tanker, Chem = Chemical, RoRo = Roll on Roll off
*** Use abbreviation: MR = Medical Reason, VS = Vessel Sold, EOC = End of Contract

Regional Training Officer 's Selection Criteria

Level of English

Writing :

Speaking :

VOA / Pre Employment Test result :

Cadet details, Diploma and Certificates posting into MAP

Yes

No

Assessed potential of the Cadet :

Date

Place

Signature

Cadet's commitment to follow CMASHIPS training monitoring program

I, undersigned _________________ certified that I received detailed information to the CMASHIPS Cadet Training Monitoring Program
and I received a copy of the CMASHIPS Cadet Guide which was presented and fully explained.

I certify that I will comply to the Cadet training program under supervision of the Traing Officers on board and ashore.
Date

Place

Signature

4/6

ACORDUL PERSOANEI CARE SOLICITA

SERVICIUL DE RECRUTARE SI PLASARE IN DOMENIUL NAVIGANT
cu privire la prelucrare si transmitere a datelor cu caracter personal
Subsemnatul:

Cod identificare (CNP/Pasaport):

CMA Ships ROMANIA

13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail:
cnz.application@cmaships.com
Personal data operator no.19478

1. mi exprim n mod expres consimtamntul ca societatea comerciala CMA SHIPS

ROMANIA S.R.L (denumita in continuare CMA SHIPS ROMANIA) inregistrata ca operator de
date cu caracter personal nr. 19478 sa prelucreze informatiile indicate la punctul 2 de mai jos
inregistrate pe numele meu in evidentele proprii si sa transmita aceste date catre societati de
shipping si/ sau crewing, cum ar fi, dar fara a se limita la acestea, CMA SHIPS (persoana
juridica franceza cu sediul in 4, Quai dArenc 13002 Marseille, France).
Imi exprim, de asemenea, acordul ca CMA SHIPS ROMANIA sa solicite date cu privire la
persoana mea de la institutii/societati, precum si consultarii informatiilor nregistrate pe numele
meu n bazele de date ale acestora, ori de cate ori este necesar, in scopul initierii si/ sau derularii
procesului de analizare si/ sau aprobare a solicitarii mele in vederea recrutarii/ plasarii ca
personal navigant.
2. Informatii prelucrate:
a) date cu caracter personal avnd functie de identificare precum (nume, prenume, data si local
nasterii, cod numeric personal, domiciliul, sex, numar de telefon fix/ mobil/ fax, adresa de email,
starea civila, numar de copii, fotografia, inaltimea, greutatea, numele si adresa angajatorului
actual si/ sau a angajatorilor anteriori, data angajarii, ocupatia, pasaport, carnet de marinar, vize)
b) informatii legate de educatia si pregatirea profesionala (studii, limbi straine cunoscute precum
si gradul de cunoastere a acestora, licente, certificate de capacitate, cursuri IMO)
c) informatii referitoare la activitatea anterioara (experienta pe functie si tipuri de nave,
calificativele obtinute , numele navelor, datele de imbarcare si debarcare, datele de contact ale
operatorilor navelor respective, nationalitatea celorlalti membrii de echipaj cu care a servit la
bordul navelor).
d) date referitoare la functia pentru care aplica, tipul/ tipurile de nave de care este interesat, data
de la care este disponibil, salariul minim acceptat.
Am luat la cunostinta faptul ca mi pot exercita toate drepturile prevazute de Legea nr.
677/2001 pentru protectia persoanelor cu privire la prelucrarea datelor cu caracter
personal si libera circulatie a acestor date, publicata n Monitorul Oficial nr.
790/12.12.2001, n mod special urmatoarele drepturi:

(i) Dreptul de acces la date: dreptul de a obtine la cerere si n mod gratuit, pentru o solicitare pe
an, confirmarea faptului ca datele n legatura cu mine sunt sau nu prelucrate de catre un anumit
operator. In ceea ce priveste CMA SHIPS Romania., acest drept poate fi exercitat in urmatoarele
conditii: se adreseaza o cerere catre CMA SHIPS Romania, intocmita in forma scrisa, datata si
semnata in care se va mentiona adresa de domiciliu a persoanei care isi exercita dreptul. Cererii
i se va atasa o copie xerox, lizibila, dupa actul de identitate al solicitantului;

(ii) Dreptul de interventie: dreptul de a obtine, la cerere si n mod gratuit, rectificarea,

actualizarea, blocarea, stergerea sau transformarea in date anonime a datelor a caror prelucrare
nu este conforma legii, n special a datelor incomplete sau inexacte. In ceea ce priveste CMA
SHIPS Romania acest drept poate fi exercitat in urmatoarele conditii: se adreseaza o cerere
catre institutia care a inscris datele la CMA SHIPS Romania intocmita in forma scrisa, datata si
semnata, in care se vor mentiona datele asupra carora se solicita interventia, motivul justificat
si modul de interventie. Cererii i se va atasa o copie xerox, lizibila, dupa actul de identitate al
solicitantului;

(iii) Dreptul de opozitie: de a ma opune n orice moment, din motive ntemeiate si legitime
legate de situatia mea particulara, ca datele care ma vizeaza sa faca obiectul unei prelucrari, cu
exceptia cazurilor in care exista dispozitii legale contrare. In ceea ce priveste CMA SHIPS
ROMANIA. acest drept poate fi exercitat in urmatoarele conditii: se adreseaza o cerere catre
CMA SHIPS ROMANIA, intocmita in forma scrisa, datata si semnata, in care se vor mentiona
datele asupra carora se solicita opozitia si motivul intemeiat si legitim legat de situatia
particulara a persoanei. Cererii i se va atasa o copie xerox, lizibila, dupa actul de identitate al
solicitantului.

AGREEMENT OF THE PERSON WHO APPLIES

SEA-GOING RECRUITMENT AND CREWING SERVICE
In relation to personal data processing and submission
I, the undersigned:

Identification Code (Personal Number/Passport):

CMA Ships ROMANIA

13th Alexandru Puskin Street, CONSTANTA C.P. 900664
Tel: +40 241610778 / +40 241610779 E-mail:
cnz.application@cmaships.com
Personal data operator no.19478

1. I express expressly my consent that the trading company CMA SHIPS ROMANIA S.R.L
(hereinafter CMA SHIPS ROMANIA) registered as personal data operator no. 19478 to process
the information indicated in paragraph 2 below registered in my name in its own records and
submit these data to other shipping and/ or crewing companies, such as, but not limited to, CMA
SHIPS (French legal person with the registered office in 4, Quai dArenc 13002 Marseille,
France).

I also express my consent for CMA SHIPS ROMANIA to inquire data about me from
institutions/companies, as well as to consult the information recorded on my name in their
databases, whenever necessary, on purpose to initiate and/ or develop the review and/ or
approval process for my application for the recruitment/ crewing as sea-going personnel.
2. Processed information:
a) personal data with identification function such as (surname, name, date and place of birth,
personal number, domicile, sex, fixed/ mobile/ fax number, email address, civil status, number of
children, photograph, height, weight, name and address of present employer and/ or previous
employers, date of employment, occupation, passport, seaman book, visas)
b) information related to professional education and training (studies, foreign languages known,
as well as their degree of knowledge, licenses, ability certificates, IMO courses)
c) information related to previous activity (experience on positions and types of ships, ratings
obtained, names of ships, embarking and debarking dates, contact data of those ship operators,
nationality of the other crew members with whom he served on board the ships).
d) data related to the position for which he applies, type/ types of ships he is interested in, date
from which he is available, minimum wages accepted.
I took note of the fact that I may exercise all the rights provided by Law no. 677/2001 on
persons protection in relation to personal data processing and free circulation of these
data, published in the Official Gazette no. 790/12.12.2001, especially the following rights:

(i) Right of access to data: the right to obtain upon request and free of charge, for one
application per year, the confirmation of the fact that the data related to me are processed or not
by a specific operator. In relation to CMA SHIPS Romania., this right may be exercised under
the following conditions: an application is submitted to CMA SHIPS Romania, drawn up in
written form, dated and signed in which the domicile of the person who exercises his right shall
be mentioned. A Xerox, legible copy of the applicants identity document shall be attached to the
application;

(ii) Intervention right: right to obtain, upon request and free of charge, the rectification,
updating, blocking, deletion or transformation in anonymous data of the data whose processing
does not comply with the law, especially incomplete or inaccurate data. In relation to CMA
SHIPS Romania, this right may be exercised under the following conditions: an application is
submitted to the institution which recorded the data at CMA SHIPS Romania drawn up in
written form, dated and signed, in which the data on which the intervention is required, the
justified reason and the intervention manner shall be mentioned. A Xerox, legible copy of the
applicants identity document shall be attached to the application;

(iii) Opposition right: to oppose in any moment, for any justified and legitimate reason related
to my particular situation, to the processing of the data that regard me, except for the cases in
which there are contrary legal provisions. In relation to CMA SHIPS ROMANIA. this right may
be exercised under the following conditions: an application is submitted to CMA SHIPS
ROMANIA, drawn up in written form, dated and signed, in which the data on which the
opposition and the justified and legitimate reason related to the persons particular situation
shall be mentioned. A Xerox, legible copy of the applicants identity document shall be attached
to the application.