Rom Trust S.R.L.

Form F-01-1 - APPLICATION FOR EMPLOYMENT

(rev.2 / 20.02.2014)

SC ROM TRUST SRL prelucreaza datele cu caracter personal furnizate de dvs. prin acest document in scopul prezentarii candidaturii dvs. pentru o posibila angajare. Datele vor fi dezvaluite numai
potentialilor angajatori. Pe viitor, aceste date ne permit sa va tinem la curent cu activitatea noastra. In cazul in care nu doriti aceasta, nu va vom putea lua in considerare aplicatia si nu va vom
inregistra in baza noastra de date. Conform Legii nr.677/2001, beneficiati de dreptul de acces, de interventie asupra datelor, dreptul de a nu fi supus unei decizii individuale. Aveti dreptul sa va
opuneti prelucrarii datelor personale care va privesc si sa solicitati stergerea datelor din baza noastra de date. Pentru exercitarea acestor drepturi, va puteti adresa cu o cerere scrisa, datata si
semnata la sediul nostru. De asemenea, va este recunoscut dreptul de a va adresa justitiei. Datele dvs. vor fi transferate in statele Uniunii Europene in vederea unei posibile angajari.
Numr Registrul General Autoritatea Nationala de Supraveghere a Prelucrarii Datelor cu Caracter Personal: 22497.

Family Name:
Date and Place of birth:
Height (m):
Wear glasses?

Yes/No

Given Name:
Weight(kg):
Dioptric left eye:

Overall size:
Dioptric right eye:

Fathers Name:
Mothers Name:
Education:
Between years:
Home address:
Phone no.1:
Phone no.2 :
Language proficiency (delete as appropriate)
English: working good
MARITAL STATUS:
Date/Place of birth:
Childrens Name
Date of birth
PERSONAL DOCUMENTS
National I.D. Card
Seamans Book
Passport
USA Visa
Australian MCV
Certificate of competency:
Rank & Number
Endorsement

NEXT OF KIN:

No.

Shoes size:
photo

Rank/Rating:
E-mail:
fluent

working

Other
language:

Family name:
Relationship:

Place issued

Personal survival techniques

Basic fire-fighting
Medical first aid
P.S.S.R.
Prevention of pollution MARPOL 73/ 78
Transport & handling dangerous, hazardous cargoes
Maritime English
Proficiency in survival craft& rescue boats
Advanced fire-fighting
G.M.D.S.S. G.O.C.
Radar navigation, radar plotting, use of A.R.P.A.
Medical care
Ship Security Officer/Security Awareness

fluent

Given name:
Phone no.:

Date issued

I . M . O . S T C W 7 8 / 9 5 C E RT I F I C AT E S
Nr.
Date issued
Certificate

Certificate

good

Valid / Endorsed until

Nr.

Date issued

Proficiency in fast rescue boats

Tanker familiarization
Specialization in oil tanker
Specialization in chemical tanker
Specialization in gas tanker
Bridge/Engine Team & Resource Management
Ships Handling & Manoeuvring
ECDIS
Bridge Simulator/Engine Room Simulator
ISM / ISO Course
Ro-Ro / Pass /Ferry
Vaccination against yellow fever expire:

P R E V I O U S S E RV I C E - E X P E R I E N C E AT S E A
Vessels Name

Date:

Flag

Type

DWT/
GRT

ME/ BHP

Rank

Period
from to

Applicant signature:

Ships Managers and Crewing Agents

(include telephone number)