Triton Marine Poland

Niecala 9 Street, Szczecin 71-027

Phone: +48 692 433 881
NIP 852 215 9459

INSTRUCTIONS – INFORMATION SHOULD BE ADDED TO THE CLEAR CELLS ONLY. THE FORMAT OF THE DOCUMENT SHOULD NOT BE AMENDED.

RANK APPLIED FOR:

DATE OF READINESS:

PERSONAL DETAILS
Father & Mother
Surname: Name:
Names:
Date of Place of
Birth: Nationality: Civil Status:
Birth:

Address: Tel. No: Mobile:

City/Zip Country: Nearest

E-mail:
Code: Airport:
Next of Kin/ Tel.No/
Address:
Family: Mobile:

Coverall Working Colour of Colour of

Size: Boots Size: Eyes: Hair:
Other Relevant
Height: Weight:
Information:

TRAVEL DOCUMENTS
Country: Number: Issue date: Place: Expiry date:
Passport:
National Seamans Book:
Other Seamans Book:
Visas/Type:

LICENSES & ENDORSEMENTS

License Country: Grade of License: Number: Issue date: Expiry date:

EDUCATIONAL DETAILS
Name of school/Place: From: To: Type of diploma:

LANGUAGES
Type: Speak: Read: Write:

Marlins English Test: %

* Please specify grade: 1-very good 2- good 3-satisfactory 4-fair 5-poor

1
 Triton Marine Poland
Niecala 9 Street, Szczecin 71-027
Phone: +48 692 433 881
NIP 852 215 9459

COURSES & CERTIFICATES

Course name: Number: Issue date: Place: Expiry date:
Basic Fire Fighting/Adv. Fire Fighting*
Elem. First Aid/Med. First Aid/Med. Care*
Personal Safety & Social Responsibilities
Personal Survival Techniques
Proficiency in Survival Craft
Proficiency in Fast Rescue Boat
Ship Security Awareness
Certificate of Proficiency for Seafarers with
Designated Security Duties
Ship Security Officer
Ship Safety Officer
Radar Observer
ARPA
GMDSS
HAZ-MAT
ECDIS
Bridge Team Management/Bridge Resource
Management
Engine Room Resource Management
DP Induction course
DP Simulator course
FULL DP certificate
BOSIET
HUET
FOET
Medical certificate
OTHER COURSES: (Add below)
DP maintenance
High Voltage

Other information:

* Please strike out whichever does not apply (proszę skreślić niepotrzebne)

2
 Triton Marine Poland
Niecala 9 Street, Szczecin 71-027
Phone: +48 692 433 881
NIP 852 215 9459

SEA SERVICE (minimum last 5 years, pls start from the recent one)

GRT (deck
Name of vessel / area of Type of the vessel & Flag positions) Date Date Owner/
Rank
operation DP class BHP/engine make signed on signed off Manager
(engine positions)

OŚWIADCZENIE

Wyrażam zgodę na umieszczenie moich danych osobowych zawartych w niniejszej Aplikacji w bazie danych Seven Seas Maritime Services oraz na
przetwarzanie ich w celu podjęcia niezbędnych działań poprzedzających zawarcie, oraz związanych z zawarciem na moje zlecenie umowy o
świadczenie usług celem podjęcia przeze mnie pracy u zagranicznego pracodawcy oraz realizacji marynarskiej umowy o pracę i jej finansowego
zabezpieczenia, zgodnie z wymaganiami Konwencji o pracy na morzu (MLC 2006) oraz do celów realizacji marketingu usług
Seven Seas Maritime Services.
Jednocześnie przyjmuję do wiadomości, iż dane te mogą być udostępnione celem wypełnienia obowiązków Seven Seas Maritime Services
wynikających z przepisów prawa.
Oświadczam, iż wyrażam zgodę na przetwarzanie moich danych osobowych w powyższych celach dobrowolnie i zostałem poinformowany o
możliwości wycofania zgody w każdym czasie.

3
 Triton Marine Poland
Niecala 9 Street, Szczecin 71-027
Phone: +48 692 433 881
NIP 852 215 9459

PROCESSING CONSENT OF: APPLICANT FOR A SEAFARER POSITION IN RELATION TO THE APPLICANTS PERSONAL INFORMATION INCLUDING
THE PROCESSING OF ANY SPECIAL CATEGORY OF PERSONAL INFORMATION

IMPORTANT NOTICE: WE ACKNOWLEDGE RECEIPT OF YOUR APPLICATION.

HOWEVER BEFORE WE CAN CONSIDER IT FURTHER WE REQUIRE YOUR SIGNED CONSENT IN RELATION TO ANY PROCESSING WE MAY
CARRYOUT IN RELATION TO YOUR PERSONAL INFORMATION UNDER REGULATION (EU) 2016/679 OF THE EUROPEAN PARLIAMENT AND OF
THE COUNCIL of 27 April 2016 The General Data Protection Regulation (GDPR) on the protection of natural persons with regard to the
processing of personal data and on the free movement of such data.

PLEASE READ AND SIGN THE BELOW LETTER AND SUBMIT IT TOGETHER WITH YOUR RESUME / CV.

Dear Sir,

In order to progress my application for employment as a seafarer (as defined by Article II, paragraph 1 (f), MLC, 2006) by the Seven Seas
Maritime Services. (further referred to as “the Company”) I hereby give my explicit consent for the Company to collect, hold, process, store,
transfer, and use my personal information, including any special category of personal information as relevant, required and appropriate to my
request for employment.

In order to review / process my request for employment and in order to comply with any mandatory requirements of any law my personal
details may be provided to Ship-owners, Crew Managers, Issuing Authorities and other third parties where there is a legitimate reason to do
so. Such information shall include (but is not limited to) identification documents, professional qualifications / trainings, sea service, previous
experience and recruitment information such as interviews and test results.

It is my responsibility to provide any updated information to the Company in relation to my application. I accept that should I be offered
employment by the Company that the Company will then keep a record of any of my personal information including any special category of
personal information for the performance of my employment contract. I understand that until the Company has received a notification of any
changes to any of my personal information, the Company shall act on the basis that all my personal information that the Company hold are in
order, and correct.

I acknowledge that I have a legal right under the data protection law to see any personal information on me that is kept by the Company and
that I also have the right to rectify such information where I can provide evidence that it is incorrect. I also acknowledge my entitlement at
any time to withdraw my consent to any further processing of my personal information held by the Company in accordance with my rights
under the law.

I understand that all personal data on me will be kept only as long as necessary and processed in a manner that ensures appropriate security
against unauthorized or unlawful processing, accidental loss, destruction or damage using appropriate technical or organizational measures.

I hereby confirm that I have read and understood, and agree to the processing of my personal or any special category of personal information
for reasons as outlined above for the performance of my Seafarer Employment Agreement and notwithstanding that my explicit consent may
not be required by virtue of Article 6 (a) to (e) and Articles 9 and 10 of the GDPR.

For any GDPR enquires please contact: biuro@7seas.pl

________________________________ (please sign here)

..........................................................................................(please enter your first name and family name here)

__________________________________ (please enter the date here)