o

o CREW MANAGEMENT & TRAINING

o [Link]
o APPLICATION FORM
o Position Holding Valid Higher Licence Availability Vessel
o Applied for for the position of: Date Name Hire Status
o MAIN INFORMATION OF SEAMAN
o Surname FALSIS First Name PAROCEL Middle Name ABELLA
o Date of Birth 8-Dec-76 Age 47 Marital Status MARRIED Gender MALE
o Place of Birth DUMALAG, CAPIZ
ASSOCIATE MARINE Home Address
o Educational Attainment TRANSPORTATION School AKLAN POLYTECHNIC INSTITUTE Year Completed 16-Oct-98
o Height 167.64CMWeight 76.5KG Religion ROMAN CATHOLIC English Proficiency
o Contact Nos. 9073461954 E mail
o Father ARSENIO C. FALSIS Mother LEAH A. FALSIS
o Spouse NORMA M. FALSIS Contact Nos. 9480253733
o Next of Kin / Beneficiary NORMA M. FALSIS Relation Contact No.
o NATIONAL INFORMATION & TRAVEL DOCUMENTS
o SSS No. 07-3180554-5 HDMF(Pag-ibig) No. * MCR([Link]) No. *
o SRC No. * ILO9724-97 Issue Date Yellow Fever- Expiry
o Seaman's Book No. C1350960 Issue Date Expiry Date
o Passport No. P7662446B Issue Date Expiry Date
o US Visa No. N/A Issue Date Expiry Date
o Schengen Visa No. N/A Issue Date Expiry Date
o MCV No. N/A Issue Date Expiry Date
o Travel Passport ** YES Issue Date Expiry Date
o CERTIFICATES
o DESCRIPTION NUMBER ISSUE DATE EXPIRY DATE ISSUING AUTHORITY
Certificate of Competency 25-69326 2-Dec-14 NONE MAXIMO Q MEJIA JR. PhD
Endorsement Attesting the Issue
Certificate of Competency Higher License
Basic Training A-VI/1-1 to 1-4
Proficiency in survival craft and rescue boats - A-VI/2-1
GOC IV/2
Endorsement of GMDSS G.O.
Medical First Aid A-VI/4-1
Medical Care A-VI/4-2
Advanced Fire Fighting A-VI/3-1
Ship Security Officer ( SSO) A-VI/5
Seafarer with Design. Sec. Duties & Sec. Awareness Training A-VI/6-1 & 6-2
Basic Training For Oil and Chemical Tanker Cargo Operations
Basic Training for LPG Tanker Cargo Operations
Advanced Training for Oil Tanker Cargo Operations
Advanced Training for Chemical Tanker Cargo Operations
Advanced Training for LPG Tanker Cargo Operations
Proficiency in Fast Rescue Boat
ECDIS generic IMO Model Course 1.27
Training for Passenger Ships other than RO/RO Passenger Ships
Training forRO/RO Passenger Ships
FLAG CERTIFICATES
DESCRIPTION NUMBER ISSUE DATE EXPIRY DATE ISSUING AUTHORITY
Marshall Islands Endorsement
Marshall Islands Seaman's Book MH 659758 29-May-19 26-Jul-21
Liberian Endorsement
Liberian Seaman's Book
Panama Endorsement
Panama Carnet
OTHER CERTIFICATES
DESCRIPTION NUMBER ISSUE DATE EXPIRY DATE ISSUING AUTHORITY
ECDIS Specific JRC JAN 7201/9201
ECDIS Specific JRC JAN 701/901
ECDIS Specific FURUNO FEA
ECDIS Specific FURUNO FMD
ECDIS Specific TRANSAS
Bridge Resource Team Management (BRM)
Bridge Team Management (BTM)
Cargo Handling
Ship Safety Officer
Risk Assessment and Incident Investigation
Ship's Handling and Maneuvering
Engine Room Management (ERM)
HAZMAT (Hazardous Materials)

* For Filipino applicants only.

** For Russian applicants only.
 CREW MANAGEMENT & TRAINING
[Link]

APPLICATION FORM
Position Availability Vessel
Applied for Date Name
MAIN INFORMATION OF SEAMAN
Surname First Name Middle Name
Date of Birth Age Marital Status
PREVIOUS SEA SERVICE
S/ON S/OFF MOS. CAUSE OF VESSEL YEAR MAIN AUX
RANK VESSEL GRT DWT BHP PRINCIPAL AGENCY
DATE DATE ONB DISCHARGE TYPE BUILT ENGINE ENGINE

PREVIOUS SEA SERVICE FOR TANKERS

RANK
Years With Operator
Years In Rank
Years in thisType of Tanker
Years in All types of Tanker

I
am willing and I voluntarily allow all personnel of the Company and its counterparts to view, review, process and share this information as an integral part of an application and recruitment
procedure. Consequently, I also relieve the Company from any administrative, civil and criminal liabilities associated with relevant data protection acts.

SIGNATURE OVER PRINTED NAME DATE