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- Shipboard Officer / Personnel / Crew
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1. PERSONAL INFORMATION RANK ETO/ELECTRONIC ALTERNATIVE RANK (IF ANY) ELECTRICIAN/ELECTRONIC AVAILABLE FROM 28.10.2016 WORK/HOLIDAY ROTATION FLEXIBLE NATIONALITY POLISH MARITAL STATUS MARRIEGE PLACE OF BIRTH WEJHEROWO DATE OF BIRTH 09 OCT 1984 (NEAREST TO ) 2. DOCUMENTS & CERTIFICATES DOCUMENT NUMBER ISSUE DATE EXPIRY DATE REMARKS Passport EB 9542438 27 JAN 2011 27 JAN 2021 Visa 20070362360001
2011343038000705 FEB 2007
12 DEC 201104 FEB 2017
08 DEC 2021B1/B2
C1/DEndorsement National Seaman’s book 0243957 18 DEC 2009 PERMAMENT ETO GUM-13172-110131-3339/2014 13 SEP 2014 19 JUL 2019 COC from UK CEC0064943 03 MAR 2016 19 JUL 2019 UK 3. EDUCATION SCHOOL/INSTITUTE LEVEL FROM TO DIPLOME ElECTRIC HIGH SCHOOL ELECTRONIC TECHNICIAN 1999 2005 YES MARITIME UNIVERSITY ETO 2013 2014 YES 4. COURSE INFORMATION COURSE NAME ISSUE DATE EXPIRY DATE REMARKS Pers. Safety&Soc. Resp. GUM-1308-110131-22158/2013 PERMAMENT Pers. Survival Techniques GUM-5425-110131-20363/2009 18 NOV 2018 Adv. Fire Fighting GUM-1315-110131-27336/2013 05 NOV 2018 Elementary First Aid GUM-5425-110131-20363/2009 18 NOV 2018 Medical First Aid GUM-5421-110131-27302/2013 PERMAMENT Medical Care GMDSS Ship Security Officer Prof. Survival Craft Fast Rescue Boats Bridge Management HAZMAT DP Basic / Induction Course DP Advanced Course DP MAINTENANCE COURSE PERMAMENT DP Operator license ARPA Radar Navigator BNS – OLF / Nogepa / Opito 84715700051212004 04 DEC 2016 HUET 84715700051212004 04 DEC 2016 BASIC SAFETY TRAINING 84715700051212004 04 DEC 2016 5. ADDITIONAL INFORMATION ISSUE DATE EXPIRY DATE REMARKS Health Certificate 17 SEP 2014 16 SEP 2016 Yellow fever 02 APR 2010 02 04 2020 Other vaccinations Drug & Alcohol test 6. LANGUAGES RESULT REMARKS English MARLIN’S test VERY GOOD English interview by telephone VERY GOOD OTHER LANGUAGES GOOD POOR French German XXX Spanish Portuguese Russian 7. SAILING RECORD VESSEL NAME TYPE GRT KW RANK FROM TO AFRICAN LIFTER ACCOMODATION BARGE 9140 2100 ETO 14.04.2010 20.05.2010 AFRICAN LIFTER ACCOMODATION BARGE 9140 2100 ETO 24.06.2010 28.07.2010 KING OF RO-RO FERRY 31788 19600 ETO 23.08.2010 18.10.2010 KING OF RO-RO FERRY 31788 19600 ETO 15.11.2010 17.12.2010 MV CONSOUTH CONTAINER 7171 6300 ETO 05.06.2011 04.10.2011 UBC BULK CARRIER 5630 3000 ET 13.12.2012 21.04.2012 CONTAINER 9948 9736 ETO 19.07.2012 26.11.2012 FRISIA CONTAINER 25406 21770 ETO 17.02.2013 11.07.2013 FRISIA CONTAINER 25406 21770 ETO 29.01.2014 19.07.2014 CAPELLA PSV 4059 6660 ETO 21.09.2014 22.10.2014 FRISIA CONTAINER 21842 18080 ETO 11.11.2014 28.01.2015 MIRA PSV 3564 6688 ETO 08.02.2015 12.03.2015 MIRA PSV 3564 6688 ETO 08.04.2015 06.05.2015 WORLD DIAMOND PSV 3520 4608 ETO 22.07.2015 19.08.2015 CAPELLA PSV 4059 6660 ETO 21.10.2015 18.11.2015 ESNAAD 222 PSV 2107 4440 ETO 17.12.2015 10.02.2016 STRIL EXPLORER MPSV 3657 6400 ETO 03.04.2016 08.06.2016 STRIL EXPLORER MPSV 3657 6400 ETO 03.08.2016 TILL NOW 8. REFERENCES COMPANY NAME VESSEL(S) NAME(S) RANK/POSITION PHONE/NAME OF CONTACT PERSON WILHELMSEN MIRA ELECTRICIAN V-SHIP WORLD DIAMOND ELECTRICIAN HARTMANN FRISIA ELECTRICIAN ADDRESS/CONTACT PERMANENT NEXT OF KIN (EMERGENCY) STREET 53 HOLMEWOOD GARDENS FULL NAME SABINA ŻYWICKA-LIPSKA POST CODE SW2 3DP RELATIONSHIP WIFE CITY STREET KASZUBSKA 26/32 COUNTRY POST CODE 84-200 TEL. NO. 07440410220 CITY WEJHEROWO COUNTRY FAX DETAILS OF CHILDREN NAME OF CHILD SEX DATE OF BIRTH NO CHILDREN HAVE YOU POLISH HEALTH INSURANCE YES DRIVING LICENCE YES DUTCH SoFi NUMBER GENERAL REMARKS
I HAVE ALSO HIGH VOLTAGE CERTIFICATE. ON MINE CARRIER I WAS ALWAYS SELF-WORKING ELECTRICIAN. HERE ARE THE LIST OF THE MACHINES AND THE ENGINES THAT I WAS WORKING WITH:
- WITH AZYMUT MAIN PROPULSION MADE BY ROLLS-ROYCE UND SCHAHTEL
- WITH DP 2 FROM KONGSBERG
- TWO STROKE ENGINE MADE BY MAN
- FOUR STROKE ENGINES MADE BY MAK, MAN AND WARTSILLA
- ALARM, INDICATION, AND STERRING SYSTEMS MADE BY KONGSBERG (KCHIEF 500), SAM ELECTRONICS, WARTSILLA AND MAN
- AUX GENERATORS, SHAFT GENERATORS MADE BY MAN, , MAK
- POWER PLANTS WITH VOLTAGE LEVEL 690 VAC, 440 VAC, 220 VAC AND 24 VAC AND DC
- CARGO CRANES MADE BY LIEBHER, PELEGRINI AND MC GREGOR
- ADJUSTING AND SERVICING PROGRAMATORS MADE BY SIEMENS (S300), SAM ELECTRONICS, ABB AND SCHRACK
- NAVIGATING EQUPMENT MADE BY FURUMO AND SAM ELECTRONICS
- BOW THRUSTERS FOR 440 VAC AND 690 VAC
- SEPARATORS MADE BY ALFA LAVAL AND GEA WESTFALIA
- PORTABLE AND STATIONARY COOLING PLANTS FOR THE VESSELS AND FOR CARGO
- AND MANY MORE ELEMENTS USED ON THE SEA
ON THE VESSELS I WAS ALWAYS SELFWORKING ENGINNER. I WAS WORKING IN ELECTRIC, ELECTRONIC AND AUTOMATIC FIELDS. I WAS RESPONSIBLE FOR ALL ELECTRIC COMPONENETS.
I declare, that information I’ve given is, to the best of my knowledge, true and complete.
Name Date Signature 06.08.2016 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 zmianami( niniejszym wyrażam zgodę na przechowywanie moich danych osobowych złożonych w firmie Transport & Offshore Services Poland Sp. z o.o. i jednocześnie zgadzam się na udostępnianie w/w danych osobowych armatorowi zagranicznemu w ramach działań, mających na celu moje zatrudnienie. Ponadto wyrażam zgodę na udostępnianie moich danych osobowych innym podmiotom świadczącym usługi pośrednictwa pracy dla osób poszukujących pracy na statkach, w szczególności wyrażm zgodę na udostępnianie moich referencji w celu zbadania mojej przydatności i kwalifikacji wymaganych przez armatora. Oświadczam, że poinformowano mnie, iż mam prawo do wglądu i poprawiania danych.
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