Escolar Documentos
Profissional Documentos
Cultura Documentos
Please complete the form by hand or electronically (you can type directly in the fields provided).
Please send the completed application to resume@reliancems.com, or fax it to +40 241 510 409
CFR Medical Certificate expiry date: Other Visa: Type: Valid until:
Yellow fever vaccination expiry date: Other Visa: Type: Valid until:
Professional Qualifications
Licenses Grade of license Number Date issued Place issued / Expiry Date
Revalidated
National
Romanian
Other
Other
Other
Seaman’s book Place & date Expiry date Passport Place & date Expiry date
number / issued nationality / issued
Nationality Number
Referees: 1) 2)
company,contact
person, phone no
Doc No: PP02 / F01
Application Form and Valid from: 01/01/2011
Record of Personal Information Author: Reliance
and Past Experience Maritime Services
Ltd
2nd
Last
3rd
Last
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Last
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Last
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Last
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Last
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9th
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I certify that the above information are true and correct. I fully understand and agree that any false
declaration herein above shall result in instant dismissal without any responsibility or liability
whatsoever on the part of the company.
Date: Signature:
Reliance Maritime Services Ltd has been registered to the A.N.S.P.D.C.P. (National Survey Authority of
Personal Data Processing) with the evidence number '18456' - to protect individuals from the point of view
of personal data processing and with the freedom of using the data on each document through which
personal data are collected, stocked and revealed only in recruitment and employment purposes.