OPN101 REV.9/10-01-11
Republic of Panama
Capital Plaza Building, 8th floor, Roberto Motta y Costa del
Este Avenue, Costa del Este, Panama, Republic of Panama.
Date:
Position to Apply for:
2/O,3/O,C/O
Surname
URKMEZ
Date of Birth
18/09/1981
Address
CellPhone No. 00905446601496
SSS Number
Father’s Name HUSEYIN
Highest Educational Attainment
A. SEAMAN’S APPLICATION FORM
Vessel
First Name
VOLKAN
Middle Name
Place of Birth
BANDIRMA
Nationality
Landline No.
--
PhilHealth No.
Email Address:
TURKISH
volkan_urkmez@hotmail.co
m
Tin No.
HURIYE
KOCAELI UNV/ISTANBUL Year Grad
1999/2004
UNIV.
Marital Status SINGLE
Children
Yes
No
No. of Children below 18 yrs. old
Name of Beneficiary
Relation
Address
Contacts
12.6.2014 Date Valid
12.6.2019
Seaman’s Book No.
S00103469
Placed Issued
ANKARA
Date Issued
Passport no.
U02215919
Placed Issued
BANDIRMA
Date Issued
16.05.20
Date Valid
16.05.2021
11
SRC No.
G18707
Rank
UNLIMITED CHIEF
Date Issued
11.09.2013
Date Valid
31.12.2016
MATE
TESDA Certificate No.
Date Issued
Date Valid
PRC Certificates No.
Date Issued
Date Valid
MCV
Date Issued
Date Valid
USA VISA
Type:
C1/D
Date Issued
11.07.2011
Date Valid
06.07.2016
English Ability
Very Good
X Good
Fair
Poor
Distinct Mark
Height (ft)
174
Weight (kg)
88
B. DOCUMENTATION
Documents
Number
Placed Issued
Date Issued
Date Expire
001 Contract of Employment
002 Physical Examination/Status
003 Drug & Alcohol (Company Specific)
004 Yellow Fever Vaccination
U02215919
ISKENDERUN
08.03.2008
08.03.2018
005 Extra Medical Test (Company Specific)
11.9.2013
31.12.2016
006 Certificate of Competency ( COC )
G18707
ANKARA
007 Endorsement Attesting Issue
1.11.2012
2012-43-80055
31.12.2016
008 Deck/Engine Watch keeping
ANKARA
009 Basic Safety Training
12.6.2014
10255526
31.12.2016
010 Proficiency in Survival Craft & RB
ANKARA
1.11.2013
2013-43-83672
31.12.2016
011 Fast Rescue Boat
ANKARA
1.11.2012
2012-43-80058
31.12.2016
012 Medical First Aid (A-V/I 1-3)
ANKARA
1.11.2012
2012-43-80059
31.12.2016
013 Medical Care ( A-VI/4 4-6)
ANKARA
30.11.2012
2012-43-92024
31.12.2016
014 Advanced Fire Fighting
ANKARA
10030203
15.7.2014
31.12.2016
015 General Operator Certificates
ANKARA
1.11.2012
2012-43-80057)
31.12.2016
016 ARPA (management level)
ANKARA
1.11.2012
2012-43-80056
31.12.2016
017 RADAR Observation & Plotting
ANKARA
1.11.2012
2012-43-80061
018 BRM/ERM
ANKARA
UNLIMITED
019 INMARSAT
020 HAZMAT (company specific)
021 MARPOL 1&2
1.11.2012
2012-43-80060
31.12.2016
022 ECDIS (company specific)
ANKARA
023 SSBT/ERS (company specific)
024 Messman/Catering Course
12.6.2014
10255544
31.12.2016
025 Tanker Familiarization AV (1-7)
ANKARA
12.6.2014
10255552
31.12.2016
026 Specialized Training in Oil Tanker AV/I
ANKARA
027 C.O.W / I.G.S
12.6.2014
0255551
31.12.2016
028 Specialized Training in Chemical Tanker
ANKARA
23.6.2014
10262047
31.12.2016
029 Specialized Training in Liquefied Gas
ANKARA
12.6.2014
10255532
31.12.2016
030 Training for Passenger Vessels
ANKARA
Mother’s Name
School
031 Anti-Piracy Awareness
032 Ship Security Officer (SSO)/SSA
033 Steering Course
034 SETS 4000
B.
2013-43-83673
1.11.2013
ANKARA
31.12.2016
as
C.
Flag
Rank
UNLIMITED CHIEF MATE
TURKISH
Rank
Years
With Operator
Years In Rank
Type Of Tanker
All Types of Tanker
FLAG LICENSE DOCUMENTS
Number
Date Issue
G18707
11/09/2013
D. PREVIOUS SEA SERVICE FOR TANKERS
C/O
2/O
3/O
C/E
Master
2
Date of Expire
31/12/2016
2/E
3/E
4/E
6
6
6
6
PARAGRAPH D WILL BE COMPLETED BY THE CREW OPERATOR BEFORE SENDING FOR APPROVAL TO SPECIFIC TANKER PRINCIPALS, THE YEARS WILL BE THE AGGREGATE OF
BOTH PAIRS OF OFFICERS INDICATED (MASTER & C/O, C/E & 2/E, ETC
E.
Company
MELTON
COMMERCIAL
TERSAN
TANKER
GEDEN LINES
GEDEN LINES
K TANKERING
CHEMFLEET
AYDER
TANKERS
AYDER
TANKERS
EFEMAY
SHIPPING
GEMDEN
CHEMICAL
Vessel Name
& Flag
LPG/C GAS
MAGICPANAMA
MT CESTENIMALTA
MT ROCKETMALTA
MT ROCKETMALTA
MT GUNES KMALTA
MT SAKARYAMALTA
MT CT CORKMALTA
MT CT
WICKLOWMALTA
MV MERT ETURKISH
MT ALIZEMALTA
SULZER
PREVIOUS SEA SERVICE (Start with the latest)
Ex- Crew
New Crew
DWT
Vessel Type &
Rank
Date
Date
Year Built
Embarked
Disembarked
(mm/dd/yy)
(mm/dd/yy)
30000
LPG/C
2/0
13/08/2014 17/01/2015
MAN BW
10700
OIL&CHEM.
2/0
10/12/2013
18/04/2014
MAN BW
37000
OIL&CHEM.
2/0
11/06/2011
14/02/2012
MAN BW
37000
OIL&CHEM.
2/0
9/08/2010
07/02/2011
MAN BW
20000
OIL&CHEM.
2/0
01/03/2010
07/07/2010
MAN BW
11700
OIL&CHEM.
2/0
10/10/2009
05/02/2010
MAN BW
11700
OIL&CHEM.
2/0
19/04/2009
21/08/2009
MAN BW
3500
OIL&CHEM.
2/0
01/10/2008
19/03/2008
MAN BW
25000
BULK/C
2/0
16/01/2008
21/07/2008
MAN BW
3542
OIL&CHEM.
2/0
19/04/2007
15/10/2007
Engine
Type & BHP
Remarks:
PREVIOUS EMPLOYER
Employer’s Name
Date Appointed
Allowance, if any
TRANSAL TANKER
17/01/2015
4500 USD
EOC
Reason for leaving:
Does your employer know your leaving? YES
When would you able to enter our company?
Any previous ILLNESS?
NO
Position
2/O
I WANT TO JOIN INTERNATIONAL COMPANY FOR MY FUTURE
If YES, State the illness:
CHARACTER REFERENCE FROM PREVIOUS COMPANY:
Two persons other that relatives to whom we can refer regarding yourself.
Cause of
Discharge
Name:
Company
Address
Tel/Cell No.
Period known:
SEMIH SEMIZ
SHELL DEVOLOPMENT NIGERIA
CANAKKALE TURKEY
00905434992472
5 YEARS
Name:
Company
Address
Tel/Cell no.
Period Known:
SERKAN SEZGIN
MITSUI OSK LINES TURKEY
ISTANBUL TURKEY
00905302316147
14 YEARS
CERTIFICATION
I certify that I am not blacklisted at the Philippines Overseas Employment Administration (POEA) nor in any Company where I was
previously employed; I have not been dismissed by my Employer for cause that all the statement and data above contained are all true
and correct of knowledge and that misrepresentation here is sufficient for my disqualification for my employment.
ISTANBUL,TURKEY
02/10 ,2015
Month – Day Year
________________________
Signature