COMPANY WORK FORM Form No. F.6.

2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised MD
By

DATE AVAILABLE:      August

POSITION APPLIED FOR:      Oiler/Wiper with OIC-EW
FULL NAME:      Enrique T. Ventolero ATTACH
SURNAME:     Ventolero PHOTO
FIRST NAME:      Enrique HERE
MIDDLE NAME(S)      Tanio
PERSONAL DETAILS
DATE OF  29/01/1990 PLACE OF BIRTH NATIONALITY HEIGHT  172.72
BIRTH Bacong Negros Oriental Filipino
WEIGHT  83kg HAIR COLOUR Black EYE COLOUR Black
MARITAL  Single SPOUSE’S NAME  N/A No. of N/A
STATUS Children
FATHER’S  Julito Ventolero MOTHER’S NAME  Narcisa NEXT OF KIN      
NAME Ventolero
HOME ADDRESS       TEL. No.      
(PERMANENT) Brgy Calangag Bacong Negros Oriental
OTHER ADDRESS       TEL. No.      

E-MAIL: SKYPE:       HOMEPORT:       Mob No.

enriqueventolero5@gma Dumaguete 09176073725
il.com
LICENCES / DOCUMENTS HELD
ITEM No. I S S U E D EXPIRING GRAD
DATE PLACE BY DATE E
NATIONAL LICENCE                                    
STCW ENDORSEMENT                                    
MARSHALLS ISL. ENDORSEMENT                                    
LIBERIAN ENDORSEMENT                                    
OTHER LICENCE                                    
PASSPORT P0685168B  15/02/2019   DFA       14/02/2029        
  Dumaguete  
NATIONAL SEAMAN’S BOOK/CDC C1485952  27/05/2019 Manila       27/05/2029       
OTHER SEAMAN’S BOOK / CDC                                    
U.S.VISA 20143189510002 17/11/2014  Manila        13/11/2019        
     
YELLOW FEVER VACCINATION QJ 090359 16/10/2014   Manila                  
P.R.C. No. (Filipino Crew only)                                    
National data base of seafarers                                    
INDOS Certificate No. (Indian
personnel only)
CERTIFICATES HELD
ITEM No. ISSUED EXPIRIN ISSUED BY
BASIC SAFETY TRAINING (*IF ONE CERTIFICATE) 24-392340   15/07/2015 15/07/2020 MARINA
 
PERSONAL SAFETY & SOCIAL RESPONSIBILITIES*                        
PERSONAL SURVIVAL*                        
SURVIVAL CRAFT HANDLING*                        
FIRST AID AT SEA (ELEMENTARY LEVEL)*                        
PROFICIENCY IN SURV.CRAFT/ RESCUE BOAT (PSCRB) 15-482112 08/11/2016    08/11/2021 MARINA  
ADVANCED / SHORE-BASED FIREFIGHTING                        
PETROLEUM TKR SAFETY – BASIC/ GEN OIL TKR FAM.                        
MEDICAL FIRST AID                        

Rev. 3 dated 30/09/15

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 COMPANY WORK FORM Form No. F.6.2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised MD
By

SHIP MASTERS MEDICARE/ADVANCED MEFA                        

PETROLEUM TKR SAFETY – ADVANCED/SPECIALISED                        
COW / IGS                        
DANGEROUS CARGO ENDORSEMENT - OIL                        
CHEMICAL TANKER SAFETY                        
LIQUIFIED GAS FAMILIARISATION                        
LIQUIFIED GAS SPECIALISED/ADVANCED COURSE                        
DANGEROUS CARGO ENDORSEMENT - LIQUIFIED GAS                        
LICOS (FOR LIQUIFIED GAS – PLS SPECIFY)                        
LIQUIFIED GAS-SPECIFIC FIRE FIGHTING – PLS SPECIFY                        
SIGTTO                        
STCW ENDORSEMENT                        
ARPA                        
R.O.C. / RANSCO / RADAR SIMULATOR                        
SATCOM                        
\\\

APPLICANTS NAME:      ____Enrique Ventolero_____________________________________________________

CERTIFICATES HELD (CONTINUED)

ITEM No. ISSUED EXPIRING ISSUED BY
GOC / GMDSS                        
ECDIS                        
SHIP MANOEUVERING/SHIP HANDLING                        
SIMULATOR
SHIP SECURITY OFFICER                        
ISPS FAMILIARISATION                        
SHIPBOARD SAFETY OFFICER                        
ENGINE ROOM SIMULATOR                        
ENGINE ROOM RESOURCES MANAGEMENT                        
HUMAN RELATIONS                        
QUALITY AND SAFETY MANAGEMENT                        
RISK ASSESSMENT / RISK MANAGEMENT                        
MARINE ACCIDENT/INCIDENT INVESTIGATION                        
MANAGEMENT OF CHANGE                        
ENVIRONMENTAL COURSE / ISO 14001                        
MLC/LSC MARITIME LEADERSHIP COURSE                        
MARPOL I                        
MARPOL II                        
MARPOL VI                        
MARITIME ENGLISH                        
MLC 2006                        
BRIDGE TEAM MANAGEMENT                        
BRIDGE RESOURCES MANAGEMENT                        

RECORD OF PREVIOUS SERVICE (VERIFIED AGAINST SEAMAN’S BOOK ENTRIES)

COMPANY VESSEL TYPE DWT M/ENG’S UMS RANK FROM TO MONTH
S
’S / BHP/TYPE ( Y-N)
      CSCL 2005  50,794  B&W      WPR  26/04/2018  25/01/2019  9  
SEASPAN NEW 8K90MC-C          
YORK 

Rev. 3 dated 30/09/15

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 COMPANY WORK FORM Form No. F.6.2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised MD
By

NSC MARIN CCNI 2015  88,920.7 B&W      WPR  25/11/2016 20/07/2017 7
ANGOL       9G80ME-C     Mont
  9.2 hs,
25da
ys 
NSC MARIN MV 2010  41,974   MAN B&W      E/C  26/08/2015  07/09/2016 12   
PARTICI   7K90MC-C     
    
                                                             
    
                                                          
 
                                                          
 
                                                          
 
                                                          
 
                                                          
 
                                                          
 
                                                          
 
                                                                 
     
                                                          
 
                                                          
 
                                                          
 

Rev. 3 dated 30/09/15

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 COMPANY WORK FORM Form No. F.6.2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised MD
By

APPLICANT’S NAME: ___________________________________________________________________

ACTUAL TIME SERVED IN MONTHS
OBO / CHEM. / BULK
RANK LNG LPG CRUDE OIL PRODUCT CARRIER/
TANKER TANKER OTHER
MASTER OR CH. ENG.                              
C/OFF OR 1A/E                              
2/OFF OR 2A/E                              
3/OFF OR 3A/E                              
GAS/CARGO ENGINEER                              
CADET/JR.ENG                              
ETO / ELEC (PLS STATE)                              
PMN / FITTER                              
OTHER RANK                              

ALLOTMENT DETAILS
SURNAME      
NAME      
MIDDLE NAME      
DATE OF BIRTH      
RELATIONSHIP      
ADDRESS      
NAME OF BANK      
ACCOUNT No.      
SSS No. (Filipino crew only)      
TIN No. (Filipino crew only)      

WIFE & CHILDREN’S NAME S DOB POB PASSPORT DATE OF ISSUED AT

      NO. ISSUE EXPIRY
                                         
                                         
                                         
                                         
                                         
How long did you stay at your previous  Only 1 contract 
company?
Wages on last vessel?  850$
Trade route of vessels?  Worldwide   
Who referred you to the company?  Nothing
Any relatives with the company?  Nothing
If yes, who?      
ANY OTHER INFORMATION ABOUT YOURSELF:      

Rev. 3 dated 30/09/15

4 of 3
 COMPANY WORK FORM Form No. F.6.2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised MD
By

UNION MEMBERSHIP NO.:       DATE :      

DOE:      
ALL APPLICANTS
DATE APPLICATION FILLED OUT      24/06/2019

SIGNATURE OF APPLICANT      

FULL NAME IN BLOCK CAPITALS      ENRIQUE T. VENTOLERO

Rev. 3 dated 30/09/15

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