Ionut Geageac1

Application Form
Section 1 Position
Position Applied for SECOND ENGINEER
Lowest Position Acceptable -
Date of Availability 20 / 03 / 2016 MUST Enter a date and in dd/mm/yyyy
Section 2 Personal Details
Family name / Surname GEAGEAC
First Name / Given Name IONUT
Date & Place of Birth Date - 28/06/1969 Place- CONSTANTA –ROMANIA
Nationality ROMANIAN
Permanent Address BULEVARDUL 1 DECEMBRIE 1918 NR.35,BLOC
L20,SC.B,AP.74 CONSTANTA /ROMANIA
Present Address
PPE information SAFETY SHOES SIZE 44 COVERALL SIZE L-XL
Blood Group Information B III
Present Contact Number
Mobile Number +40752626531
SKYPE ADDRESS
Email Address ionutgeageac2000@yahoo.com
Nearest Airport (and Distance) OTOPENI (HENRY COANDA)- BUCHAREST
Section 3 Passport and VISA details
Country of Issue ROMANIA USA Visa - Type
Date Issued 10/12/2008 USA VISA Expires
Place Issued CONSTANTA USA Visa - Type
Passport Number 14854766 USA VISA Expires
Passport –Expires 10/12/2018 Other Country Visa
Secondary passport or Dual nationality Visa Expiry
Section 4 ( hi-light as required ) Seaman book / Discharge book / Seaman Record Book / CDC
Issuing Country & Place
ROMANIA/CONSTANTA
Date Issued 01/10/2013
Number 3761 CT/48437 Expiry Date (if any) 19/08/2016
Section 5 Next of Kin – this is important information we require- Don’t ignore it
Full Name / Relationship GEAGEAC EMANUELA ALIS
Any dependents / Children (incl age ) GEAGEAC CRISTIAN
WPIF – M/01 23rd
FEB 2015 Rev - 06

Address BULEVARDUL 1 DECEMBRIE 1918 NR.35,BLOC L20,SC.B,AP.74
CONSTANTA /ROMANIA
Contact Numbers +40743075062
Page 1 of 7
Section 6 STCW95 Highest Certificate of Competency / Licence Held ( also list Flag State Endorsements)
Class /
Grade/Capacity
Issuing Country Certificate No. Date Issued Expiry Details of Limitations
SECOND
ENGINEER
ROMANIA 45630 01/10/2013 31/12/2016 -
SECOND
ENGINEER
ITALY 227/2015 26/03/2015 31/12/2016 -
ALSO ENTER ABOVE DETAILS OF ANY OTHER FLAG STATE CERTIFICATES HELD
Section 7 STCW95 Dangerous Cargo Endorsements
Petroleum…………….
Liquefied Gas……….
Liquid Chemicals…….
Certificate No. Date Issued Expires Details of Limitations/ Grade
Section 8 STCW95 related Courses Attended and Certificates Obtained
Name of Course / Certificate STCW Code Place Issue Date Cert No Expiry Date
Basic Safety Training A-VI/1
Basic Sea Survival / Personal Survival
Techniques
A- VI/1-1 CONSTANTA 05/11/2014 6225 05/11/2019
Fire Prevention & Fire Fighting A-VI/1-2
Elementary First Aid A-VI/1-3
Personal Safety & Social Responsibility A-VI/ 1-4 CONSTANTA 24/02/2015 6249 24/02/2020
Proficiency in Survival Craft & Rescue
Boats
A-VI/ 2-1 CONSTANTA 17/03/2015 1552 16/03/2020
Proficiency in RESCUE CRAFTS
Proficiency in FAST RESCUE BOATS A-VI/ 2
Advanced Fire Fighting A-VI/ 3 CONSTANTA 20/03/2015 1454 19/03/2020
Medical & First Aid A-VI/ 4-1 CONSTANTA 24/10/2014 91 -
Medical Care
( Ship Captains Medical Course )
A-VI/4-2
Radar & ARPA Simulator Trg-
Management level
A-II/ 1-2
Electronic chart Display and
Information System course (ECDIS)
A-II / 1
GMDSS + ENDORSEMENT A-IV/ 2
SAFETY OFFICERS COURSE (SO)
Ship Security Officers Course (SSO)
Issued under STCW95
A-VI/ 5
Proficiency in Security Awareness A-VI/6 CONSTANTA 08/11/2013 7422 -
Proficiency in Designated Security
Duties
A-VI
Medical Certificate / HEALTH
Certificate
MLC
Compliant
CONSTANTA 19/08/2015 3406 19/08/2016
Drug and Alcohol test certificate CONSTANTA 31/08/2015 10279 31/08/2016
YELLOW FEVER CONSTANTA 27/11/2014 369746 27/11/2024
Bridge Team Management A-II/2
Bridge Resources Management B-VIII/2
ISM Code A.1441 (18)
Engine Room Resources Management
( Operational Level / Management level )
A-III/1, A-III/2,
A-III/3,A-VIII/2
CONSTANTA 21/03/2014 774 21/03/2019
HELM
(leadership and management skills )
A-II/2,
A-III/2
CONSTANTA 14/08/2015 853 -
WPIF – M/01 23rd
FEB 2015 Rev - 06

TANKERS FAMILIARISATION A-V/1
Advanced Tanker Operations (Chem.) A-V/1-2
Advanced Tanker Operations (Oil) A-V/1
Advanced Tanker Operations (LPG) A-V/1
REFRESHER & UPDATING I/II & III/2
Page 2 of 7
Section 9 OFFSHORE INDUSTRY COURSES
Please enter below any other certificates held or courses done, ie offshore, DP certs etc or Any other not already mentioned
Name of Course / Certificate APPROVALS Place Issue Date Cert No Expiry
BOSIET
HUET
FOET
OFFSHORE MEDICALS
( UK, NORWAY or NETHERLAND )
Re-Breather training
Initial Standby vessel crews training ( ITSO )
CAA (Civil Aviation Authorities – Helicopter)
Advanced Medical Aider ( AMA )
HLO
HLA
MARLIN’s English Test Score: %
IELTS-English TEST http://www.ielts.org/test_centre_search/search_results.aspx SCORE
PMS maintenance system – Confirm that you are Familiar with its use ( YES / NO )
DEEP WATER ANCHOR HANDLING EXPERIENCE ENTER DEPTH IN METERS ???????
DP Maintenance Courses IMCA CONSTANTA 21/01/2016 20 /
DP Maintenance Courses
HIGH VOLTAGE COURSE
Dynamic Positioning Induction Course
Dynamic Positioning Simulator Course
Dynamic Positioning Operators
CERTIFICATE
Full or
Limited
Dynamic Positioning Log book Details IMCA CONSTANTA 21/01/2016 45808
Section 10 Hours done with various DP system
SYSTEM DETAILS Approx Hours as SDPO / Approx Days
in case of Senior ETO / Senior Engineer
Approx Hours as DPO / Approx Days
in case of Junior ETO / Junior Engineer
APPROXIMATE Total DP Hours in Various Operations
SAT DIVING CABLE LAYING
AIR DIVING SURVEY
ROV PIPE LAYING
WELL STIMULATION / INTERVENTION /
ACTIVATION
DRILL SHIP / SEMI SUB
AHTS 1000 PSV 1000
L
I
S
T
A
L
L
O
T
H
E
R
C
O
U
R
S
E
S
WPIF – M/01 23rd
FEB 2015 Rev - 06

FPSO SHUTTLE TANKER
CONSTRUCTION ROCK DUMPING / MATTRESSING
CORING TRENCHING
HEAVY LIFT ACCOMMODATION / GANGWAY
Page 3 of 7
Section 11 Medical History
YES NO
Have you ever signed off a ship due medical reason ? NO
Have you undergone any medical operations in past ? NO
Have you consulted a doctor during the past 12 months for an illness / Accident NO
Do you have any health or disability problem now ?? NO
If answer to any of above is YES then give further details below or on a separate sheet
NOTE : All our clients have STRICT Alcohol and Drug Policy, Which
means ZERO TOLERENCE for alcohol and drugs
Section 12 General
Yes No
Have you ever been involved in a maritime accident, ie grounding, fire, Explosion,
Collision, etc
NO
Have you ever been the subject of a court of enquiry or involved in a maritime accident NO
Have you ever had a professional licence suspended or revoked NO
Have you ever been convicted of any criminal offence? NO
Have you ever been dismissed NO
If yes to any of above then please full details below or on separate sheet of paper
Section 13 PROVIDE DETAILS OF YOUR LAST TWO EMPLOYERS, IN
ORDER TO OBTAIN CONFIRMATION ON YOUR SEA SERVICES
Name of company GRUP SERVICII PETROLIERE ROMANIA- MICOPERI SPA.
ITALY
Name Person to be contacted SERBAN ADRIAN- GRUP SERVICII PETROLIERE ROMANIA
Address
Tel No +40769296613 Fax
Email
Name of company
Name Person to be contacted
Address
Tel No Fax
Email
Section 14 Any other information, you wish to add in support of your application
Section 15 Declaration – MUST BE SIGNED BY ALL APPLICANTS
I hereby declare that the above particulars are true and I authorize you to contact the referees listed above
And confirm that All my certificates / Licences are Authentic / SEASERVICE RECORD is ACCURATE / And I
confirm accepting Companies DRUG & ALCOHOL Policy
WPIF – M/01 23rd
FEB 2015 Rev - 06

Signed GEAGEAC IONUT…………………………
Date…25/01/2016………………..
Page 4 of 7
WPIF – M/01 23rd
FEB 2015 Rev - 06

Section 16 Record of Sea Service (All Dates to be entered as dd/mm/yy)
Please give full record of sea service STARTING FROM LAST VESSEL FIRST
VESSEL COMPANY Type of Vessel
And Type of
operation in case
of DP vessels
DWT or GRT
(please delete as reqd)
Type of Engines
Or DP System
BHP RANK Sign on
DATE
Sign off
DATE
dd / mm / yy dd / mm / yy
BUCCANEER MICOPERI AHTS S/V DP1 1671 WARTSILA 2X3000 SECOND
ENGINEER
02/09/2015 10/12/2015
ENGINEER
01/04/2015 24/06/2015
ENGINEER
21/11/2014 04/02/2015
SNIPE MICOPERI S/V 973 MACK 2X1700 SECOND
ENGINEER
06/08/2014 08/10/2014
GSP KING GRUP
SERVICII
PETROLIERE
AHTS/DP2 2690 WARTSILA 2X5000 SECOND
ENGINEER
02/06/014 02/07/2014
GSP KING GRUP
SERVICII
PETROLIERE
ENGINEER
04/04/2014 03/05/2014
GSP KING GRUP
SERVICII
PETROLIERE
ENGINEER
03/10/2013 05/03/2014
GSP KING GRUP
SERVICII
PETROLIERE
AHTS/DP2 2690 WARTSILA 2X5000 ENGINEER
OFFICER
04/10/2013 03/11/2013
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
14/07/2013 02/09/2013
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
01/06/2013 10/07/2013
GSP QUEEN GRUP
SERVICII
PETROLIERE
OFFICER
04/05/2013 31/05/2013
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
01/04/2013 01/05/2013
WPIF – M/01 23rd
FEB 2015 Rev - 06

GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
28/01/2013 15/03/2013
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
23/11/2012 28/12/2012
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
12/09/2012 14/10/2012
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
09/05/2012 11/08/2012
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
01/03/2012 03/04/2012
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
28/12/2011 30/01/2012
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
03/10/2011 15/11/2011
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
02/07/2011 30/08/2011
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
28/03/2011 30/05/2011
GSP KING GRUP
SERVICII
PETROLIERE
OFFICER
27/11/2011 26/02/2011
GSP PERSEU GRUP
SERVICII
PETROLIERE
OSV 1289 ALCO 2X3500 ENGINEER
OFFICER
07/10/2010 24/01/2011
GSP LICORN GRUP
SERVICII
PETROLIERE
OFFICER
30/09/2010 07/10/2010
GSP LICORN GRUP
SERVICII
PETROLIERE
OFFICER
20/09/2010 30/09/2010
WPIF – M/01 23rd
FEB 2015 Rev - 06

Type of Engines :: for engineers only, DPOs to Mark DP System BHP : for Engineers and AHTS / TUG Masters & Officers Page 5 + 6 of 7
WPIF – M/01 23rd
FEB 2015 Rev - 06

ADDITIONAL INFORMATION SHEET
VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority)
1. AHTS
2. DSV
3. ACCOMMODATION / GANGWAY
4. PSV
5.DRILL SHIP/SEMI SUB
MAXIMUM ACCEPTABLE CONTRACT PERIOD (Please indicate below)
Please Quote –Consolidated MINIMUM MONTHLY SALARY ( no leave pay ) payable for
time onboard only or Working DAY RATE EXPECTATION ( no leave pay)
( please quote below in US$ -preferred or Euro or GBP£ )
7500 $
250 $ / day
Languages Spoken / Written / Understood (1-poor 5-Fluent)
Spoken Written Understood
ENGLISH GOOD GOOD GOOD
ITALIAN GOOD GOOD GOOD
DRUG & ALCOHOL POLICY
ALL Our Clients have very strict NO DRUG and ALCOHOL POLICY, Which is required to be
complied with at all times, which means “””ZERO TOLERENCE on ALCOHOL & DRUG”””
Your body must NOT have any ALCOHOL or DRUG substances from the time you board your flight
or commence your travel to join vessel, and Must remain so Until you have completed full contract
and returned to your home Airport / Town
If during the said period you are found under the influence of DRUG or ALCOHOL then ALL
EXPENCES incurred which will include all your travel and recruiting costs, And your relief’s
Travel and recruiting costs, And Any other costs whatsoever incurred due to your NON-
COMPLIANCE will be deducted from your salary, Which will include but not limited to “damage to
vessel her equipments and machineries, loss of charter, and any other costs Directly or indirectly
connected with your NON-COMPLIANCE
Sign & CONFIRM ACCEPTANCE OF ABOVE POLICY………………………………………
FOLLOWING DOCUMENTS COPIES MUST BE SENT TO US- send to us In separate Email
All Certificates / Courses Listed in this form + Licence or Certificate of competency, Any tanker
endorsements, GMDSS showing expiry date in case of Deck Officers, Medical Fitness / Examination
Certificate, Passport Main page, Seaman book or Discharge book Main pages, In case of DPO – DPO Cert,
DP LOG Pages
FOLLOWING ADDITIONAL DOCUMENTS will ALSO BE REQUIRED – Send to us in separate email
All short courses certificates ( STCW95 ), SSO certificate, Last 3-5 years ships entries in Discharge book or
Seaman book, Certificate of Equivelant Competency from other flag states
PAGE 7 of 7
WPIF – M/01 23rd
FEB 2015 Rev - 06

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