Please fill in and send to nlashiprushrd@maersk.
com
DECK CADET
CONTAINER VESSEL
8TH JANUARY 2017
Position applied for:
Type of vessel
Availability date:
Are you responding to a media
advertisement?
If YES, please state which publication
Yes
Internet
Surname: TIPIAN SOSA
First Name: RENZO ALESSANDRO
Nationality: PERUVIAN
Date of Birth:
01/10/1993
Place of Birth: LIMA
Age:
22
Passport
Number
Place of Issue
Peru
3251414
Date of Issue
Date of Expiry
11/10/2015
11/10/2020
Issuing Authority
IMMIGRATIONS PERU
Seamans Book
Number
Place of
Issue
Peruvian
Date of Issue
11/10/2015
G45L1
Issuing
Authority
COAST
GUARD AND
HARBOUR
Date of
Expiry
11/10/2020
Remark
U.S. Visa
Type
Date of Issue
Date of Expiry
Place of Issue
B1/B2
11/09/2015
11/09/2019
LIMA-PERU
Remark
Education Background
School / College
From
I.E 6048JORGE
BASADRE
NATIONAL SCHOOL
MERCHANT MARINE
To
Highest Qualification Attained
2005
2010
COLLEGE CERTIFICATE
2013
2017
BACHELORS MARINES SCIENCE
Personal details
Full address
Str. 2 gpo 24 mz L lte 14
Postal Code:
051
Country:Peru
E-mail:
(required)* [email protected]
Home telephone no: 015701524
Contact/Mobile phone: +511 930484656
Domestic Airport:
International Airport: JORGE CHAVEZ
INTERNATIONAL
Page 1
Marital Status: SINGLE
Full Name of Next of Kin: GIOVANNA SOSA MURGA
Relationship: MOTHER
C/Eng
GMDSS
Issuing Authority
Number
Date of Issue
Date of Expiry
Place of Issue
Dangerous Cargo Endorsements (DCE)
Type of
Endorsement
Grade / Level
I / II
Issuing
Authority
Number
Date of Issue
Date of Expiry
Chemical
Oil
Gas
Details of other marine courses / STCW short course certificate
Type of Marine Course
Tanker Familiarization
Adv. Tank. Ops. (inc.COW
&IGS)
Radar Observer
Place of Issue
Number
LIMA-PERU
HG57H658
LIMA-PERU
LIMA-PERU
LIMA-PERU
LIMA-PERU
JG686HJ8
H77907J
HU89535
First Aid
Medical & First Aid
LIMA-PERU
H798KIBP
Ship Master Medical Guide
Personal Survival
LIMA-PERU
JU786J8J7
LIMA-PERU
HU786HHO
LIMA-PERU
LIMA-PERU
KI87KJ780
Proficiency In Survival Craft
Advance Fire Fighting
Chem. Tanker Familiarization
Chem. Tanker Advanced
Date of Expiry
JHY697H7
ARPA
Radar Simulator
Basic Fire Fighting
Human Relationship-PSSR
Date of
Issue
KJ685GR
Ship Security Officer (SSO)
ECIDS( DECK OFF)
Page 2
Employment History
*
Vessel
E
x
p
e
i
e
n
c
e
d
Company
Vessel
Type
Flag
DWT/
TEU*
Year
Built
Main Engine
Make
Type
on container vessels please fill in TEU
**
Required for engineer applicants only
**
Required for engineer applicants only,
Page 3 of 5
B.H.P.
**
Rank
Sign on
date
Sign off
date
Total
mm/dd
Reason for
leaving
r
Date when promoted to Current Rank :
Other Personal Details
Height : 173
Weight: 72
Color of Hair: black
Color of Eyes : dark brown
Safety shoes: 42
Boiler suit: 32
Distinguishing Marks :
A beauty mark on my left side of my cheek
References
Do you have any objection if we will contact your last employers for reference
Reference?
If NO please specify below:
Yes
Please give the name and address of your current or immediate past employer
Name of company
Name of person to contact
Address
No.
Please list two contactable referees or past employers
Name of company
Name of person to contact
Address
No.
Banks Name:
Banks Address:
Banks Name:
Type :
Current / Savings
Bank Swift Code:
Intermediary Bank Details (If Applicable):
* Please be informed that the bank account provided must be in your name as shown in your passport.
Person to Contact In Case Of Emergency or Accident
Name: GIOVANNA SOSA MURGA
Address: STR 2 GPO 24 ML Lte 14
Residential Contact: +511 991767841
Mobile Contact: +511 959202483
Medical Fitness Certificate
Date of Issue
Date of Expiry
22/11/2016
07/11/2017
Page 4
Yellow Fever Vaccination
Date of Issue
Date of Expiry
22/11/2016
05/11/2017
Medical History
Have you ever signed off from a ship due to Medical reasons?
(If Yes give details)
No
Name of Vessel
Date of Occurrence
Brief Description of Illness / Injury / Accident
I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge
and belief; further, that no Certificate of competency or License issued to me has ever been Revoked or Suspended. I
also certify that my medical history contained above is true and any false statement or undisclosed Material information
about past illness or injury will disqualify me from any employment benefits and claims.
Date _11.10.2007__________
_______________________
Signature
*The company may contact my previous employer for references.
Comments (for company use only)
APM id no:
Page 5
