Application

MIHAIL DRAGHIA
Form

Section 1 Position

Position Applied for Deck Cadet//Steward

Lowest Position Steward
Acceptable
Date of Availability 29.09.2016

Section 2 Personal Details

Family name / Toma

Surname
First Name / Given Andrei-Cristian
Name
Date & Place of Birth 22.04.1993 Pitesti Romania
Nationality Romanian
Permanent Address Constanta, Bd.Ferdinand, no.89, Bl.A3, Ap.6
Romania

Present Address Constanta, Bd.Ferdinand, no.89, Bl.A3, Ap.6

Romania
Present Contact +40724691814
Number
Fax Number
Mobile 0040724691814
Number
Email Address andy_tommy22@yahoo.com
Nearest Airport Bucuresti

Section 3 Passport & Seaman book

Place Issued Constanta Seaman Book 33438CT

no
Passport No 054189113 Seaman Book Issue 08.OCT.2014
 Date
Expires 2021 Seaman Book RO 33438CT
Expiry Date (if any) exp.29.SEP.2018

Section 4 Next of Kin

Full Name / Toma Andrei-Cristian ( unmarried )

Relationship
Address Constanta, Bd.Ferdinand, no.89, Bl.A3, Ap.6
Romania
Contact Numbers mob: +40724691814

Section 5 Courses Attended and Certificates Obtained

Name of Course / Certificate Institute Place Date Cert Expires
No
DD/MM/YY
Basic Safety Training CERONAV Constanta 02.04.14 00006247 2019
Watchkeeping Duties on CERONAV Constanta 13.10.15 00027 2020
the Bridge
Maritime English CERONAV Constanta 04.11.16 00001173
Language Training
Section 6 Declaration
I hereby declare that the above particulars are true and I authorize you to contact the referees listed
above
Signed TOMA ANDREI-CRISTIAN Date
22.11.2016

Section 7 Record of Sea Service

VESSE COMPAN Type DW Type BH RAN Sign on Sign off

of of DATE DATE
L Y T Engine
P K
Vesse
l s
M/V Alacia General MAN 3000 Deck 16.10.201 09.03.201
Maritime Cargo 6329 Eng: KW Cadet 5 6
BRAVE MAK
type
KNIGH 6MU
T 551AK