1. PHOTO
DATE APPLIED: 7-Jun-22 IRIS No.:
POSITION APPLYING FOR: 2nd Eng'r
AVAILABILITY: July 2022
SEAFARER APPLICATION FORM
PART I - PERSONAL DATA
LAST NAME: FIRST NAME: MIDDLE NAME: CIVIL STATUS:
Saladaga Edwin Bontuyan Married
PERMANENT ADDRESS: TEL. NO. CELLPHONE NO.
Balintawak Aurora Zamboanga Del Sur 9499161676
CONTACT ADDRESS: E-MAIL ADDRESS: RELIGION:
Balintawak Aurora Zamboanga Del sur edwinsaladaga29@gmail.com catholic
DATE OF BIRTH: AGE: PLACE OF BIRTH: HEIGHT: WEIGHT: LANGUAGES SPOKEN: NATIVE FOREIGN
29-Apr-72 50 Dumalinao Zamboanga Del sur 5 10 " 83 Lbs. English English
BLOOD TYPE:TIN No.: SSS No.: PHIL HEALTH NO: PAG-IBIG No.: POEA SRC No.:
O 161-025-182 06-1248631-3 19-090357859-2 1210-0948-2397 2021113387694
WIFE'S FULL MAIDEN NAME: Number of Sons / Daughters: CELLPHONE NO. / E-MAIL ADDRESS:
Analyn M. Saladaga 1 2 9478765719
1st CHILD GIVEN NAME: AGE: 2nd CHILD GIVEN NAME: AGE: 3rd CHILD GIVEN NAME: AGE: 4th CHILD GIVEN NAME: AGE:
Rhaven Rose M. Saladaga 18 Janna Angela M. Saladaga 15 Jhon Manuel M. Saladaga 9
FATHER'S FULL NAME: MOTHER'S FULL MAIDEN NAME: NEXT OF KIN: ADDRESS & CONTACT NUMBER:
Manuel C. Saladaga Nena B. Saladaga Rhaven Rose Balintawak Aurora zambo sur/ 09478765719
PART II - EDUCATION
LEVEL NAME OF SCHOOL CITY / PROVINCE FROM TO
College University of Cebu Course: AME. Cebu city 1989 1991
High School Navalan National High School Tukuran Zambo sur 1985 1989
Elementary Balintawak Elementary School Aurora Zambo sur 1979 1985
PART III - LICENSES
CCE200000776120 DATE ISSUED: August 19 2020 VALID UNTIL: August 19 2025
GOC LICENSE No. ECE200000772120 DATE ISSUED: August 19 2020 VALID UNTIL: August 19 2025
TESDA NCI/NCIII No. DATE ISSUED: VALID UNTIL:
PART IV - TRAVEL DOCUMENTS
DOCUMENT TYPE NUMBER DATE ISSUED VALID UNTIL DOCUMENT TYPE NUMBER DATE ISSUED VALID UNTIL
PASSPORT P46886366B Feb 05 2020 4-Feb-30 AUSTRALIAN MCV
SEAMAN BOOK C1221074 6-Aug-18 3-Aug-28 YELLOW FEVER VACC. G5410-1 20-Jul-12 1-Jul-22
U.S.A. VISA CHOLERA VACC.
PART V - FOREIGN FLAGSHIP DOCUMENTS
DOCUMENT TYPE NUMBER DATE ISSUED VALID UNTIL DOCUMENT TYPE NUMBER DATE ISSUED VALID UNTIL
Panama SIRB Marshall Island End.
2. Panama GOC Marshall Island Book
Liberia End. Bahamas Endorsement
Liberia Book 1648382 1-Dec-21 Bahamas Book
Cyprus End. Malta Endorsement
Cyprus Book Malta Book
PART VI - TRAINING CERTIFICATES
COP CERTIFICATES NUMBER DATE ISSUED TRAINING CENTER CERTIFICATES NUMBER DATE ISSUED
Basic Training 200027016620 19-Aug-20 Engine Room Simulator ERSC 0810-461-04027 Aug 26 2010
Prof. In Survival Craft & Rescue Boat 200014283720 19-Aug-20 Auxiliary Machinery System
Advanced Fire Fighting 20007505120 Aug 19 2020 Control Engineering
Medical Emergency First Aid 18-220871 Nov 05 2015 Hydraulics and Pneumatics
Medical Care Dangerous & Hazardous Materials
Ship Security Officer SSO0614-595-5541 June 11 2014 MARPOL (CONSOLIDATED)
BTOC TESDA (NC1)
ATCT TESDA (NC3)
ATOT Deck / Engine Watchkeeping
Fast Rescue Boat (FRB) Welding Course
SDSD Lathe Machine Course
TRAINING CENTER CERTIFICATES NUMBER DATE ISSUED Practical Assessment
Safety Officer Course Culinary / Catering Course
Risk Assessment Messman Course
Incident Investigation CROWD AND CRISIS MGT.
ECDIS GENERIC Shore-based Fire Fighting
ECDIS SPECIFIC Crude Oil Washing
Bridge Resourse/Team Mgmnt. Inert Gas System
SSBT FRAMO Course
Ship Handling Course Free-Fall Lifeboat Familiarization
INMARSAT/SATCOM Environmental Management
GMDSS Human Relationship
ROC/ROP Bilge Water Waste Management
ARPA Tank Atmospher & Gas Measurement
RSC Automatic identification System
SRROC BTLGT
