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PERSONNELBIODATA CRANE OPERATOR
- 1. ----------------------------------------------------------------------------------------------------------------------------------------------------------- PERSONNEL APPLICATION FORM CRANEOPERATOR TRAVEL DOCUMENT INFORMATION Passport No K3016840 Date of Expiry 11/03/2022 Seaman Book No Mum102928 Date of Expiry 30/09/2022 Yellow fever . 1929 Date of Expiry 27/01/2018 U.S Visa No. H2454891 Date of Expiry 23/04/2018 CERTIFICATE OF COMPETENCY & OTHER COMPETENCY CERTIFICATE Watch keeping Certificate Date of Issue 09/08/2006 Date of Expiry unlimited Issuing Authority Mmd,chennai Crane operator certificate Date of Issue 04/12/2015 Date of Expiry 04/12/2016/renewal in progress Issuing Authority ICS,Tirunelveli COC for cook Date of Issue Date of Expiry Issuing Authority INDOS 02DL4920 Date of Expiry Issuing Authority LBS-mumbai Others Date of Expiry Issuing Authority Limitation AFFIX YOUR PHOTO 35 mm x 45 mm Position Applied Crane operator Vessel Type JACK UP BARGE,RIG BARGES Lowest Position Acceptable no Place of Birth alanthalai Name T.Horjin Derose Date of Birth 29/04/1972 Availability Date 02/10/2015 Nearest Airport tuticorin Address 131c-north street,alanthalai(p.o) Pin-628206,thoothukudi district, Tamilnadu-india. Age 44 Religion Roman catholic Weight (kg) 80 Marital status married Height (cm) 176 Nationality Indian Email Address horjinderose@mail.com Home Tel +91-9790524420 HP No +91 9004556361 Coverall size XXL Skype ID Horjin derose Shoe size 44 WhatsApp +91-9004556361
- 2. CERTIFICATES Certificates Institution / Place Issued Number Dateof Issue Date of Expiry S.T.S.D.S.D MOTA/PONDICHE RY 08/184/14 15/02/2014 UNLIMITED P.S.T SSMA/COIMBATO RE 005/08 25/03/2013 24/03/2018 F.P.F.F SSMA/COIMBATO RE RPFF/005/0 8 25/03/2013 24/03/2018 P.S.S.R SSMA/COIMBATO RE PSS/015/08 28/03/2013 UNLIMITED E.F.A YAK/MUMBAI 12/24/11/14 24/1/2014 23/12/2019 P.S.C.R.B(F.R.B) YAK/MUMBAI 12/19/11/14 19/12/2014 18/1/2019 P.S.T/SAFETY AWARENESS SIMS/MUMBAI 13890 18/02/2008 UNLIMITED Marline English test Risk management & Assessment/ISM SIMS/MUMBAI 13901 19/02/2008 UNLIMITED FRC course Helicopter Landing Crew course OPITO - H2S ( Hydrogen Sulfide) EIMA-DUBAI 1033901412 11150003 12/11/2015 11/11/2017 OPITO - HUET OPITO - BOSIET EIMA-DUBAI 1033570012 11150009 12/11/2015 11/11/2019 Last medical examination : - Date of Issue Date of Expiry Remarks on health condition FIT Vaccinations Yellow Fever Date of Issue 28/01/2008 Date of Expiry 27/01/2018 Cholera Date of Issue Date of Expiry Others Date of Issue Date of Expiry EDUCATION & PRE-SEA TRAINING DETAILS From To Schools/Institutions/Universities attended Qualifications Obtained 1991 1993 ITI MOTOR MECHANIC 1986 1987 ST.XAVIER HIGH SCHOOL SSLC PASS MEDICAL CERTIFICATES
- 3. RECORD OF SEASERVICE No Ship’s Name Type DWT Kw Rank Client / Charterer TON DP Time if any Trading Area Sign On Date Sign Off Date Sea Time Year / Month 1 TERRAS CONQUEST7 JACK UP RIG 5750 CRANE OP ARAMCO 200ton SAUDI 18/06/2016 07/12/2016 6MONTHS 2 RISING PHOENIX JACKU P RIG 6625 CRANE OP ARAMCO 225ton SAUDI 18/11/2015 12/05/2016 6MONTHS 3 DEEP CLEANER WSV 1915 CR.OP/B OSUN DANA OIL 80ton IRAN 10/01/2015 01/07/2015 6 MONTHS 4 ZAMIL601 DSV 2415 CR.OP ARAMCO 75ton SAUDI 24/04/2014 17/10/2014 6MONTHS 5 FLANDERS HARMONY STS 47587 BSN/CR. OP 60ton OMAN 13/05/2013 18/01/2014 8MONTHS 6 TUTICORIN PORT CRAN E 50T CR.OP 50ton INDIA 03/01/2013 08/05/2013 4MONTHS 7 ATLANTIC MUSE PROD 29733 BSN/CR. OP 50ton ASIA 01/04/2012 29/12/2012 9MONTHS 8 BRITISH EMISSARY STS 23270 BSN/CR. OP BP 50ton USA 10/07/2011 14/12/2011 5MON4DAY A 9 BRITISH LAUREL STS 79100 BSN/CR. OP BP 50ton USA 03/09/2010 23/04/2011 8MONTHS 10 BRITISH VINE STS 58070 BSN/CR. OP BP 50ton ASIA 02/02/2010 05/05/2010 3 MONTHS 11 BRITISH ENSIGN TANKE R 23000 BSN/CR. OP BP 40ton EUROPE 07/02/2009 08/10/20098 MONTHS 8MONTHS 12 BRITISH SECURITY PROD 22550 AB BP 40ton SINGAPO RE 17/04/2008 05/10/2008 6MONTHS 13 GRAND EXPLORER VLCC 15334 7 AB 6n0t ASIA 02/06/2007 12/12/2007 6MONTHS1 5DAYS 14 TRIWATI TANK 77387 AB IOC 60ton ASIA 22/08/2006 23/11/2006 3MONTHS 15 TRIWATI TANK 77387 AB IOC 60ton ASIA 21/08/2005 26/05/2006 9MONTHS 16 CEC ASIA CONT 4600 AB/CR.O P CMA CGM 60ton USA/EUR OPE 13/06/2004 21/05/2005 13MONTHS 17 OCEAN MONARCH BARG E 4500 AB/CR.O P 80ton EUROPE 06/02/2003 20/10/2003 8MONTHS 18 PACIFIC TITAN CABLE SHIP 2875 BSN/CR. OP CGM 50ton IRAN 09/05/2000 24/10/2000 6MONTHS
- 4. 19 MARLIN CABLE3850 BSN/CR OP GULF 31/03/1998 19/04/1999 13 MONTHS 20 SEA LION CABLE 3950 BSN/CR. OP GULF 16/11/1997 10/03/1998 4 MONTHS 21 MERCUREZ CABLE 3891 AB GULF 28/06/1997 16/11/1997 5MONTHS 22 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 01/09/1996 18/10/1996 6WEEKS 23 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 25/05/1996 13/07/1996 6WEEKS 24 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 27/01/1996 30/03/1996 6WEEKS 25 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 08/10/1995 02/12/1995 6WEEKS 26 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 24/06/1995 05/08/1995 6WEEKS 27 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 01/04/1995 13/05/1995 6WEEKS 28 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 28/01/1995 04/03/1995 6WEEKS 29 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 23/09/1994 03/12/1994 6WEEKS 30 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 18/06/1994 30/07/1994 6WEEKS 31 SAMUDRA SARVEKSHAK GTV 3444 AB ONGC BOMBAY HIGH 31/03/1994 12/05/1994 6WEEKS
- 5. EXPERIENCE; TELESCOPIC BOOM CRANE,KNUCKLEBOOM CRANE,PEDASTEL CRANE 250TONNES, RIGHT NOW WORKING IN JACK UO BARGE WITH 250 TONNES CRANE NEXT OF KIN (Emergency Contact person) Name H.PREMILA Relationship WIFE Residential Address 131C-NORTH ST, ALANTHALAI-628206 THOOTHUKUDI(DIST) Email Address premilahorjin@gmail.com Home Telephone Contact No. 09790524420 Family Particulars (Please include Parents, Spouse, Siblings and Children) Name Relationship Age Occupation Employer Father T.HELEN SILVEURA Mother 68 RETIRED TEACHER H.PREMILA Wife 40 HOUSE WIFE H.HEMILAN Children (M/F) 13 STUDYING H.HARRISON Children (M/F) 3 STUDYING Children (M/F) SELF DECLARATION I hereby certify that the above information provided by me is true and complete.. T.Horjin Derose 08 jan 2017 __________________________ _____________ Signature Date
- 6. EXPERIENCE; TELESCOPIC BOOM CRANE,KNUCKLEBOOM CRANE,PEDASTEL CRANE 250TONNES, RIGHT NOW WORKING IN JACK UO BARGE WITH 250 TONNES CRANE NEXT OF KIN (Emergency Contact person) Name H.PREMILA Relationship WIFE Residential Address 131C-NORTH ST, ALANTHALAI-628206 THOOTHUKUDI(DIST) Email Address premilahorjin@gmail.com Home Telephone Contact No. 09790524420 Family Particulars (Please include Parents, Spouse, Siblings and Children) Name Relationship Age Occupation Employer Father T.HELEN SILVEURA Mother 68 RETIRED TEACHER H.PREMILA Wife 40 HOUSE WIFE H.HEMILAN Children (M/F) 13 STUDYING H.HARRISON Children (M/F) 3 STUDYING Children (M/F) SELF DECLARATION I hereby certify that the above information provided by me is true and complete.. T.Horjin Derose 08 jan 2017 __________________________ _____________ Signature Date