Eastern Pacific Shipping Pte Ltd.

EMPLOYMENT APPLICATION FORM

RECENT PASSPORT SIZE

COLOUR PHOTOGRAPH
STAFF CODE: RANK: Third Officer
Office use only

VESSEL:
DATE AVAILABLE: 5/1/2021
Office use only

SURNAME: Özdamar FIRST NAME: Mustafa OTHER NAME:

DATE OF BIRTH: 9/26/1994 PLACE OF BIRT Isparta NATIONALITY: Turkish

PASSPORT NO. U 23058193 ISSUED ON: Turkey EXPIRY DATE: 1/24/2030

S/BOOK NO. S00323424 ISSUED ON: Turkey EXPIRY DATE: 4/12/2026

SID NO: (Seafarer's Identity Document) ISSUED ON: EXPIRY DATE:

PERMANENT
Işıkkent Mah. 5616 Sok. No :13 Isparta / Merkez / Turkey
ADDRESS:

PHONES: (90) 5308679132 FAX: E-MAIL: ozdamarmustafa32@gmail.com

NEXT OF KIN: Father NAME: Selahattin Ozdamar

p

ADDRESS: Işıkkent Mah. 5616 Sok. No :13 Isparta / Merkez / Turkey

PHONES: 90 5375948831 FAX: E-MAIL:

NEAREST For officers - Please specify the nearest domestic

Isparta Suleyman Demirel Airport
AIRPORT: airport. For all ratings - the nearest international airport.

MARITAL STATUS: Single SPOUSE NAME: N/A

MARRIAGE DATE: N/A

CHILDREN

SON / DAUGHTER NAME DATE OF BIRTH

N/A N/A N/A N/A

PRE-SEA TRAINING / MARITIME SCHOOL / HIGHEST ACADEMIC QUALIFICATION (Specify School Name / Country, and Year attended)

Course Name Institude Name From Date - To Date

İstanbul Technical University Maritime Transportation and Management 2015 / 2020

PAGE 1 OF 7 OFC06- 02/21

 Eastern Pacific Shipping Pte Ltd.

DOCUMENT STATUS

LICENSES GRADE REGULATION NUMBER ISSUE EXPIRY PLACE Authenticated

NATIONAL LICENSE (LIC) (Please refer to Note below) N/A N/A 10561165 1/22/2020 1/22/2025 TURKEY N/A

NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - OIL N/A N/A N/A N/A N/A N/A N/A

NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - CHEM N/A N/A N/A N/A N/A N/A N/A

NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - GAS N/A N/A N/A N/A N/A N/A N/A

REVALIDATION OF NATIONAL LICENSE (REV) N/A N/A N/A N/A N/A N/A N/A

S T C W COURSES Mark / Delete GRADE REGULATION NUMBER ISSUE EXPIRY PLACE Authenticated
SURVIVAL AT SEA / PERSONAL SURV. TECH. (SAS / PSST) N/A STCW 11599240 4/12/2021 4/12/2026 TURKEY N/A

FIRE PREV. AND FIGHTING N/A STCW 11599244 4/12/2021 4/12/2026 TURKEY N/A

ELEMENTARY FIRST AID / MEDICAL FIRST AID / MEDICAL CARE N/A STCW 11599243 4/12/2021 4/12/2026 TURKEY N/A

PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES (PSSR) N/A STCW 11599241 4/12/2021 4/12/2026 TURKEY N/A

TANKER FAMILIARIZATION COURSE - OIL N/A STCW 11599242 4/12/2021 4/12/2026 TURKEY N/A

TANKER FAMILIARIZATION COURSE - CHEM N/A STCW 11599242 4/12/2021 4/12/2026 TURKEY N/A

TANKER FAMILIARIZATION COURSE - LPG N/A STCW 10898546 12/21/2017 6/19/2022 TURKEY N/A

ADVANCED TANKER COURSE - OIL N/A N/A 11370103 1/23/2020 1/16/2025 TURKEY N/A

ADVANCED TANKER COURSE - CHEM N/A N/A N/A N/A N/A TURKEY N/A

ADVANCED TANKER COURSE - LPG N/A N/A N/A N/A N/A TURKEY N/A

PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOAT (PSCRB) N/A STCW 11599239 4/12/2021 4/12/2026 TURKEY N/A

ADVANCED FIRE FIGHTING N/A STCW 11370102 1/23/2020 1/23/2025 TURKEY N/A

MEDICAL FIRST AID AND MEDICAL CARE N/A STCW 11370099 1/23/2020 NO EXPIRY TURKEY N/A

GMDSS N/A N/A 10479985 4/12/2021 4/12/2026 TURKEY N/A

BRIDGE TEAM AND RESOURCE MANAGEMENT (BTRM) N/A N/A ITU 3/11/2020 NO EXPIRY TURKEY N/A

ENGINE TEAM RESOURCE MANAGEMENT (ETRM) / ERM N/A N/A N/A N/A N/A TURKEY N/A

ELECTRONIC CHART DISPLAY AND INFORMATION SYSTEM (ECDIS)

N/A N/A ITU 3/11/2020 NO EXPIRY TURKEY N/A
as per IMO 1.27

RISK MANAGEMENT AND INCIDENT INVESTIGATION COURSE (RMI) N/A N/A N/A N/A N/A TURKEY N/A

SAFETY OFFICER COURSE (SOT) N/A N/A TURKEY N/A

SHIP SECURITY OFFICER (SSO) N/A N/A 11392916 2/28/2020 2/6/2025 TURKEY N/A

SDSD-Designated Security Duties = YES N/A N/A 10609327 7/26/2016 NO EXPIRY TURKEY N/A

HIGH VOLTAGE TRAINING COURSE (C/E, 1/AE, 2/AE, 3/AE, E/E) N/A N/A N/A N/A N/A TURKEY N/A

ENVIRONMENTAL OFFICER TRAINING COURSE N/A N/A N/A N/A N/A TURKEY N/A

RADAR OBSERVER (ROC) N/A N/A ITU 12/27/2019 NO EXPIRY TURKEY N/A

ARPA / RADAR SIMULATOR N/A N/A ITU 12/27/2019 NO EXPIRY TURKEY N/A

OTHER COURSES GRADE REGULATION NUMBER ISSUE EXPIRY PLACE

SHIP HANDLING SIMULATOR (SHS)

LIQUID CARGO HANDLING SIMULATOR (LCH) N/A N/A N/A N/A N/A N/A N/A

ENGINE SIMULATOR COURSE N/A N/A N/A N/A N/A N/A N/A

U.S. VISA C1/D STATUS N/A N/A 20200653040002/ C1-D

3/9/2020 3/4/2025 Istanbul, Turkey N/A

YELLOW FEVER N/A N/A 283524 12/20/2017

LIFE OF PERSONTurkey N/A

ELECTRONIC MAIN ENGINE COURSE N/A N/A N/A N/A N/A N/A N/A

ME-GI ELECTRONIC ENGINE EXPERIENCE N/A N/A N/A N/A N/A N/A N/A

NABCO (AUTOCHIEF) N/A N/A N/A N/A N/A N/A N/A

HIMSEN GENERATOR COURSE N/A N/A N/A N/A N/A N/A N/A

REEFER CONTAINER & MAINTENANCE COURSE N/A N/A N/A N/A N/A N/A N/A

HYDRAULIC COURSE N/A N/A N/A N/A N/A N/A N/A

LNG BUNKERING COURSE N/A N/A N/A N/A N/A N/A N/A

Note: For Deck Officer, the COC should be valid for Navigational Watch on ships 500 gross tonnage or more.

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 Eastern Pacific Shipping Pte. Ltd.

DETAILS OF PREVIOUS SEA SERVICE

LAST VESSEL ON TOP

PERIOD OF SERVICE
Vessel Details
(For Engine Staff : Vessel Type / Engine
YEAR details : Example : Container Carrier / DWT NAME OF OWNERS / MANAGERS
NAME OF VESSEL
BUILT
FLAG
B&W - 12K98MC-C) H.P.*
RANK
AND THEIR CONTACT DETAILS Period in Months
FROM TO
(For Deck Officers : Vessel Type / ECDIS. (DD/MM/YYYY) (DD/MM/YYYY)
Example: Container, JRC 201C)

Can Yücel 1995 Turkish Bulk 38852 D/Cadet 1/18/2016 2/19/2016 Statu Shipping 1.1

Southport 2008 Mars.Islands Oil Tanker 115.396 D/Cadet 2/23/2018 9/28/2018 Thome Ship Management PTE LTD. 7.2

Pacific Sky 2008 Mars.Islands Oil Tanker 115.396 3rd Officer 7/14/2020 3/14/2021 Thome Ship Management PTE LTD. 8.1

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0
1. APPLICANTS TO ENSURE THAT COMPLETE SEA SERVICE FROM THE BEGINNING OF SEA CARRIER IS GIVEN. IF THIS PAGE IS INSUFFICIENT, PLEASE MAKE A PHOTOCOPY OF THIS PAGE AND WRITE THE SEA SERVICE.
2. ENGINE DEPARTMENT APPLICANTS ESPECIALLY ENGINEERS TO ENSURE THAT HORSE POWER & DEAD WEIGHT IS WRITTEN UNDER COLUMN (TYPE OF VESSEL/MAN ENGINE DETAILS).
3. MANNING OFFICE TO VERIFY AND ENSURE THE ABOVE SEA-SERVICE IS TALLYING AGAINST CANDIDATE'S NATIONAL SEAMAN BOOK.
4. CANDIDATES APPLYING FOR LPG FLEET PLEASE SPECIFY WHICH SHIPS WERE FULLY PRESURIZED, SEMI-REFRIGERATED AND FULLY REFRIGERATED UNDER COLUMN (TYPE OF VESSEL/MAN ENGINE DETAILS).
5. PLEASE DO NOT CHANGE THE PAGE LAYOUT AND MARGINS.
Example : BSN, A/B x 3, O/S x 2, PMN 7
Manning Info of last vessel : Please specify ranks and number onboard Count
Deck Officers : MST, C/O, 2/O, 3/O
Deck Ratings : BSN, A/B, O/S, PMN
Engineers : C/E, 1A/E, 2A/E, 3A/E,E/E,G/E) Was last vessel running in UMS ?
Engine Ratings : OLR, WPR, FTR) _______
Catering : (Cook, STW, MSB/CBY)
Cadets : (DCT, ECD. ELC)
Total 0

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 Eastern Pacific Shipping Pte Ltd.

SUMMARY OF OFFICER'S EXPERIENCE In years and months

Product Chemical LPG
EXPERIENCE AS Crude Oil Tanker Bulk Geared Bulk Container Car Carrier TOTAL
Tanker Tanker Tanker

MASTER C/E

C/O 1/AE

2/O 2/AE

3/O 3/AE 0.8 0.8

G/E E/E

TOTAL

ENGINE APPLICANT DECK APPLICANT

TYPE OF AUXILIARIES Please mention MODEL & TYPE TYPE OF ECDIS Please mention MODEL & TYPE

GENERATORS JRC JRC 701B - 901B

BOILERS FURUNO

PURIFIERS TRANSAS

COMPRESSOR TOKYO KEIKI

ELECTRONIC MAIN ENGINE EXPERIENCE PAPERLESS NAVIGATION EXPERIENCE:

ME-GI ELECTRONIC ENGINE EXPERIENCE

EXPERIENCE WITH MULTINATIONAL CREW: CROTIAN,

YES / NO UKRAINAN,RUSSIAN
NATIONALITY: , INDIAN, FLIPPO,TURKISH
YEARS / MONTHS: 1Y4M

REASON FOR LEAVING LAST COMPANY: YES / NO IS APPLICANT 18 YEARS OR ABOVE? YES

AGREEABLE TO ACCEPT ONE RANK LOWER : YES / NO YES AGREEABLE TO JOIN VSL PLYING IN WAR ZONE HIGH RISK AREA: YES

Blood Type: A RH + Height 191 CM Safety Shoes 45

Eye Sight with Glasses: 0 Weight 91 KG Boiler Suits XXL

Eye Sight without Glasses: 0 BMI Parka XXL

APPLICANT'S DECLARATION: (Answers to questions A, B, C & D has to be either 'Yes' or 'No')

A. HAVE YOU BEEN THE SUBJECT OF A COURT OF ENQUIRY OR INVOLVED IN A MARITIME ACCIDENT?
NO _________
YES
B. I CONFIRM THAT I AM WILLING TO WORK ONBOARD EPS VESSELS WITH ZERO ALCOHOL POLICY

MEDICAL HISTORY:
ALL PREVIOUS ILLNESSES OTHER THAN MINOR ILLNESSES SHOULD BE STATED BELOW OR UPDATED. IF NOT PREVIOUSLY DISCLOSED, THE COMPANY IS ENTITLED
TO REFUSE ANY REIMBURSEMENT OF MEIDCAL COSTS, CLAIM FOR TREATMENT OR FOR ANY OTHER INSURED BENEFITS.
C. HAVE YOU EVER SIGNED OFF A SHIP DUE TO MEDICAL REASONS?NO
IF YES, PLEASE PROVIDE FOLLOWING DETAILS (IF SPACE IS INSUFFICIENT, ATTACH ADDITIONAL SHEETS) :
NAME OF VESSEL DATE OF OCCURRENCE PLACE OF OCCURRENCE
N/A N/A N/A
BRIEF DESCRIPTION OF ILLNESS / INJURY / ACCIDENT N/A

D. HAVE YOU UNDERGONE ANY OPERATION IN THE PANO IF YES, PLEASE PROVIDE FOLLOWING DETAILS :
DETAILS OF OPERATION DATE PERIOD OF DISABILITY PRESENT CONDITION
N/A N/A N/A N/A

E. FOR WHAT ILLNESSES OR ACCIDENTS HAVE YOU CONSULTED A DOCTOR DURING THE LAST 12 MONTHS?
DETAILS OF ILLNESS / ACCIDENT DATE THERAPY / TREATMENT
N/A N/A N/A

F. PLEASE GIVE DETAILS OF ANY HEALTH, ALLERGY OR DISABILITY PROBLEM

DETAILS: N/A

I hereby confirm that all my certificates [Certificate of Competency, STCW certificates and other qualifications] are genuine and authentic. I confirm that I am NOT holding any fake
certificates.

I declare that all information provided herein is to the best of my knowledge is true and correct. I am fully aware that witholding or providing wrong information will lead to termination of
employment and commencement of criminal proceedings.
I have read and understood the Recruitment Privacy Notice.

4/16/2021
Signature Date of application

I have confirmed the applicant is holding the certificates require as per QSP0912/0913 applicable for his position.

EPS Representative / Agent Date

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 Eastern Pacific Shipping Pte Ltd.

EVALUATIONS
(For All Ranks)

Date :
Manning office :
Applicant’s name :
Rank :
Biodata Number :

Reference Check - 1 (Last Employer)

Employer’s Name and contact details

THOME SHIP MANAGEMENT PTE LTD

Reference check date :

Name of Person Giving this reference:
Detailed references (To be listed point by point)
1 Capt. BEGONJA IVO (Master of Pacific Sky) + 385 98 192 0012
2 Devinder Pal Singh (Previous Company's Senior Manager ) +65 62 207 291
3
4
5
6
7
8 Name of person taking reference
9
10

Reference Check - 2 (Previous Last Employer)

Employer’s Name and contact details

Reference check date :

Name of Person Giving this reference:
Detailed references (To be listed point by point)
1
2
3
4
5
6
7
8 Name of person taking reference
9
10

Special Remarks / Comments

Recommendation from any Ex EPS staff or Reliable known persons.

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 Eastern Pacific Shipping Pte Ltd.

CARGO INFORMATION SHEET

NOTE: Tick appropriate box for cargoes carried, and comment in the space provided.

Fleet A – GAS TANKERS Fleet A – PRODUCT / CRUDE TANKERS

Acetaldehyde JET A1
Anhydrous Ammonia NAPTHA
Butadiene PREMIUM UNLEADED PETROL (UNDYED)
Butane PREMIUM UNLEADED PETROL (DYED)
Butane / Propane Mixture UNLEADED PETROL / MOGAS
Butene LEADED PETROL / MOGAS
Butylenes AUTOMOTIVE GAS OIL
Diethyl Ether VGO
Dimethylamine CAT CRACKED GASOLINE
Ethyl Chloride CRACKER FEED
Ethane LIGHT CYCLE OIL
Ethylene Oxide / Propylene Oxide Mixtures REFORMATE
Isoprene FUEL OIL 380 CST
Isopropylamine FUEL OIL BLEND COMPONENT
Methyl Acetylene – Propadiene Mixture HIGH SULPHUR FUEL OIL
Methyl Chloride LOW SULFUR WAXY RESIDUE
Monoethylamine CUTBACK BITUMEN
Propane BITUMEN FEEDSTOCK
Propylene CRUDE OIL x
Vinyl Chloride Monomer CONDENSATE
Vinyl Ethyl Ether HIGH POUR POINT CRUDE
Vinylidene Chloride CLOUD POUR POINT CRUDE
Crude C4 CRUDE WITH HIGH VAPOUR PRESSURE
Methane HEATED CARGO
Fully Pressurized Ships WTI MIDLAND CRUDE OIL x
Semi Pressurized / Refrigerated Ships
Fully Refrigerated Ships
Special Cleaning After Prop OX (Give Details)
Special Cleaning After Butadiene (Give Details)
LPG

Fleet A – CHEMICAL TANKERS

Aromatics: Chemical Products :
Benzene Caustic Soda
Epichlorohydrin (ECH) Chloroform
Molasses MDI / Diphenylmethane Diisocyanate/ TDI
Xylene Ethylene Dichloride (EDC) / Methylene Dichloride
Alcohols & Glykols Styrene Monomer
Styrene MethylTert-Butyl Ether (MTBE)
Toluene Butyl Acetate
Methanol Acetone
Ethanol Acrylonitrile
IPA - Iso-propyl Alcohol / NBA Vinyl Acetate Monomer (VAM)
Butyl/Isobutyl Alcohol Urea Ammonia Nitrate
2-Ethylhexanol (Octanol) Dowanol
Mono Ethylene Glycol (MEG) Dodecylbenzene (Lab)
Acids : Perchlorethylene
Sulfuric Acid Trichlorethylene
Nitric Acid Phenol
Acrylic Methyl Ethylene Glycol (MEG)
Acetic Lub Additives / Lubrizol
Phosphoric Acid Sodium Hydrosulphide
Hydrogen Peroxide Propylene Oxide / Ethylene Oxide
Paraffins :
Paraffin Wax Wall Wash Testing (HC / CL)
Slack Wax Passivating Stainless Steel Tanks
Cyclohexane Permangemate Testing (PTT)
Hexane N2 Padding
Veg Oils:
Crude Palm Oil, Rapeseed Oil, Soyabean Oil, Sunflower Oil
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 Eastern Pacific Shipping Pte Ltd.

CARGO INFORMATION SHEET

NOTE: Tick appropriate box for cargoes carried, and comment in the space provided.

Fleet B – BULK CARRIERS Fleet C - (CONTAINER AND CAR CARRIER)

Alumia Ore X DG Cargo

Sugar Iron X Reefer Containers Monitoring

Lime / Cement Sand & gravel Mediterranean Mooring

Understanding of the Regulation regarding Verification
Petcoke Copper
of the Gross Mass (VGM) of a packed Container
Grain Limestone Awareness of Synchronous & Parametric Rolling

Salt Silica Sands

Steel Products Pig Iron

Bagged Cargo Timber (UnderDeck)

Coals Machinery (Boxed)

Experience on geared bulk carrier / bulk carrier with cranes

(please advise numbers and types of the cranes)

OTHER INFORMATION / AREAS OF KNOWLEDGE

Oil Company Inspections / CDI (Please List) ENOC
Trade Areas (Please list in details last 2-3 vessels' trading areas) W.W
Deep Well Pumps Experience (Types of Pumps) N/A
Centrifugal Pumps Experience YES
Specialized Framo Pumps / Cargo System N/A
Working experience on Oil Tanker with Pumproom YES
Closed Loading / VECS. YES
Cargo Heating – Oil / Steam / Deck htr (Please List) YES
Tank Coating Type – Zn / SS / EPOXY (Please List) EPOXY
Cargo Cooling Systems N/A
Compressor Types N/A
Inert Gas System (IGS) YES
Inert Gas Generator (IGG) N/A
Knowledge of Day Signals and Display of Placard on Bridge for Deck N/A
Officers
Gas Freeing YES
Specialist Gas Training N/A
Experience of changeover of grade (Please give details about N/A
cargo grade changed over)

Bunker Management Procedure (Experience of changeover of bunker GULF OF MEXICO - EU

for SECA & ECA (Please give details on which vessel)

STS (Ship-To-Ship) experience YES

Lightering Experience - Please list in detail N/A
Transshipper Experience - Please list in detail N/A

Dry Dock Experience (Indicate shipyard and vessel name)

BESIKTAS SHIPYARD (YALOVA TURKEY) AND MT
SOUTHPORT
New Delivery Experience from Shipyard (Indicate shipyard, vessel name) N/A
Trading Area (Indicate areas) W.W
Ice Navigation Experience (Indicate areas) N/A
Scrubber experience (List vessel name where Scrubber was operational)

Type of Ballast Water Treatment Plant BWTS

SCR - Selective Catalytic Reduction N/A

Parcel Trade Experience N/A

Competencies for Fitters, Pumpman & Engine Ratings

Brazing skills (especially on refrigeration lines) Ability to perform Gas Welding

Welding skills – including gouging, grinding Ability to perform Grinding / drilling

Pipe fabrication including T-joints and Flange joints TIG Welding proficiency

Ability to carry inter-tank repairs & stainless steel repairs Ability to Repair & overhaul Machineries

Operational knowledge of engine overhaul & pump overhaul Other Skills - please mention in details

Gas cutting experience Plumbing Skills

Carpentery Skills

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