East Star Shipping Co.

, Ltd
No. 29, No. 4 street, Waterfront City, Vinh Niem Ward, Le Chan District, Hai Phong City, Vietnam.
Tel: +84.225.3734698; Fax: +84.225.8832705; Email: hrd@eastar-shipping.com;
Web: www.eastar-shipping.com

PHOTO
Seamen Employment Application Form

Rank Applied For Recommended By Relationship to Applicant Date of Application

CHIEF OFFICER ESS MANNING AGENT 30/Oct/2018
NAME Nationality Height Weight Body Mass Index
NGUYEN VAN A VIETNAMESE 1.75 75 24.5
Date of Birth Place of Birth Blood Group Overall Size Safety Shoe Size Sex Religion No. of Dependents Marital Status
8/May/1987 HAI PHONG O 6 42 MALE NIL 2 MARRIED
Applicant's Permanent Address Next of Kin, Relationship and Address Alternative Next of Kin, Relationship and Address

MOTHER : NGUYEN THI B

WIFE : NGUYEN THI C
VAN CAM COMMUNE, HUNG HA DISTRICT, THAI BINH NO 9/173 HONG DUY VUONG WARD, HONG
VAN CAM COMMUNE, HUNG HA DISTRICT, THAI
PROVINCE, VIETNAM BANG DIST, HAI PHONG CITY, VIET NAM.
BINH PROVINCE, VIETNAM

Contact Numbers 0999 999 999 0888 888 888 0966 666 666
Email address nguyenvana@gmail.com

Education

Course Name Institution Duration Passing Year

Deck department VIMARU 4.5 2005
Document Number Issued by Date of Issue Date of Expiry
International Passport C0888980 VIETNAM 28/Sep/2019 28/Sep/2029
Seafarer's Passport T0017168 VIETNAM 4/May/2011 4/May/2016
VISA - USA (Please circle : Type B / C1 / D)
Seaman's Book HCM-00337 VIETNAM 27/Jun/2006 NIL
STCW10 & Flag State Doucments STCW Regulation No.
Officers' Certificate of Competency A0393.CO1 VIETNAM 14/Nov/2013 14/Nov/2018
Rating's Certificate of Competency
Panama Licence / Seaman's Book CTC156258 VIETNAM 28/Apr/2015 14/Nov/2018
Liberian Licence / Seaman's Book
STCW10 Basic Training Certificate 18058/DHHH VIET NAM 10/Jun/2004 NIL
STCW10 Prof in Survival Craft & Res Boat A3794/CD.I VIETNAM 4/Mar/2015 4/Mar/2020
STCW10 Prof in Fast Rescue Boats
STCW10 Advanced Fire Fighting A3545/CD.I VIETNAM 4/Mar/2015 4/Mar/2020
STCW10 Medical First Aid and Medical Care A3478/CD.I VIETNAM 4/Mar/2015 4/Mar/2020
STCW10 Ship Security Awareness
STCW10 Ship Designated Security
STCW10 Ship Security Officer
STCW10 ECDIS Generic
STCW10 Bridge Team Management
STCW10 Engine Team Management
STCW10 G.O.C (GMDSS) 4138-GOC/BTTT VIETNAM 21/Aug/2013 31/Dec/2017
STCW10 Endor. G.O.C (GMDSS) A11516.G VIETNAM 20/Sep/2013 31/Dec/2017
STCW10 Radar Observtion Certificate
STCW10 Arpa Certificate
Yellow Fever

Certificates & / Or Qualifications

On the last column, checker to please tick to confirm that the documents have been verified with the originals and initial in this row.
 NAME : NGUYEN VAN A RANK : C/O AGE: 35 East Star Shipping Co., Ltd - Seamen Employment Application Form

No Type Vessel Name GRT / Engine Type / KW Rank From To Mos. Crew Manning Agent Principal/Owner Sign Off Reason

1 BULK CARRIER ASEAN SEA 02 20,866 / MAN B&W / 7,502 AB 28/Jan/06 27/Jan/07 12.0 MARITIME MAN POWER SHINPETROL COMPLETED CONTRACT

2 BULK CARRIER ASEAN SEA 01 15,527 / MAN B&W / 8,390 AB 14/Jul/08 19/Jul/08 0.2 MARITIME MAN POWER SHINPETROL COMPLETED CONTRACT

3 BULK CARRIER VSP DIAMOND 36,254 / MAN B&W / 12,300 AB 8/Feb/09 11/May/09 3.0 MARITIME MAN POWER SHINPETROL COMPLETED CONTRACT

4 BULK CARRIER TERN SPIRIT 36,801 / MAN B&W / 9,266 3/O 26/Oct/10 12/Sep/11 10.6 INLACO - HP INLACO - HP COMPLETED CONTRACT

5 BULK CARRIER HOANG SON SOUTH 13,736 / MITSUBISHI / 5,882 3/O 28/Nov/11 22/Oct/12 10.8 HOANG SON SHIPPING HOANG SON SHIPPING COMPLETED CONTRACT

6 BULK CARRIER C. HARMONY 18,112 / MAN B&W / 6,546 2/O 12/Dec/12 18/Dec/13 12.2 INLACO - HP INLACO - HP COMPLETED CONTRACT

7 BULK CARRIER SEA ADELAIDE 18,112 / MAN B&W / 6,546 2/O 2/Jan/14 9/Nov/14 10.2 VIET SHIP CO., LTD. VIET SHIP CO., LTD. COMPLETED CONTRACT

8 BULK CARRIER GLORY HONGKONG 23,584 / MAN B&W / 6,480 C/O 16/Jan/15 12/Dec/15 10.8 AMAT JSC WEALTH STAR SHIPPING COMPLETED CONTRACT

9 BULK CARRIER HW GLOBAL 38,844 / MAN B&W / 7,338 C/O 4/Feb/16 18/Dec/16 10.5 AMAT JSC HW SHIP MANAGEMENT COMPLETED CONTRACT

10 LOG CARRIER SUZY 17,542 / MAN B&W / 8,243 C/O 17/Jan/17 16/Nov/17 10.0 AMAT JSC ZHANG JIAGANG OCEANICWIT SHIPPING COMPLETED CONTRACT

11 BULK CARRIER PHOENIX NEREID 18,465 / MAN B&W / 5,730 C/O 15/Aug/18 26/Dec/18 4.4 ESS ALFA SHIPMANAGERS PTE CHANGE SHIP MANAGEMENT

12 BULK CARRIER AOM JULIA 39,737 / MAN B&W / 10,320 C/O 10/Feb/19 14/Nov/19 9.1 ESS ISM SINGAPORE COMPLETED CONTRACT

Please answer the following questions Yes / No If yes, please provide details.

Have you previous injuries or sickness ? NO I certify that the information given by me herein are true and correct to the best of my
Premature termination of contract ? NO knowledge. Any false information may be subjected to legal actions and voiding of any
Have been dismissed or logged for mischief ? NO benefits arising from my employment contracts.
Have bee involved in industrial dispute ? NO
Any criminal offence ? NO
Have been refused entry by any country ? NO
Any special diet or religious restrictions ? NO
Any medical restrictions / drugs / allergies ? NO
Any alcohol drinking habits ? NO Signature of applicant
Any past history medical / mental condition? NO
Can we make reference check with ex employers? YES
FOR OFFICIAL USE ONLY

Interview assesment Reference check done by / Date Please provide details

Interview report to describe applicant's technical competence & experience
English Poor Ave. Good Previous employment /agent PIC ?
Speak/ Read Verify service record
Write Verify reason for leaving
Physical Verify overall appraisal
Personality Verify relationship / habits
Intelligence
Attitude
Co-Operations Interviewer's Name / Date
Motivation Suitability VERIFIED BY :
Learning ability Type of ships * Checker to tick against the no. column to verify sea service against original sea service record book

Safety Type of Trade / Principal Proposed / Assiged to principal / Ship / Date

Last Drawn Wages

Page 2 of 2. Revised 30-Oct-2018