1. .01
APPLICATION FOR EMPLOYMENT
RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE
Ran
k
3/E First Name UMBERTO
Last
Name
ŠTEFANINI Nationality CROATIAN
Date & Place
of Birth:
26.03.1975 Marital Status: Married
Present
Address:
Duplančića dvori 21 Next of Kin: Marijana Štefanini
Home phone: +38521507892 Name / Relationship: Wife
cell phone: +385981858320
Address: Mostarska 44
Fax:
Email: umberto0stefanini@gmail.com Next of kin Cell Phone :
Father’s name Tonči Mother’s name: Cvita
Nearest
Airport:
Split
Km from
Airport:
25
Present
Employer:
Tidewater
Languages: English Tel + email:
Medical Certificate
issued:
18.12.2014 Expired: 18.12.2016
Previous
Employer:
K-LINE/LNG
Any visa issued: Expired: Tel + email:
Weight(kg
)
90 Height(cm) 178 Coverall Size: 54 Shoes Size: 45 Hair: Eyes:
Position Applied: 3rd
engineer Date of availability:
Education: high/secondary school (4 years) ,
college (2-3 years) ; university (4-5 years):
: high/secondary school (4
years
Last wage (inclusive of leave pay):
Licence (Certificate of Competency)
Licence Country Grade of Licence Number Place & Date Issued Date Expired
Officer in charge of
an engineering
watch on a ship
powered by the
main propulsion
machinery of 750
kw propulsion
power or more
III/1 400176499 Split 08.03.2013 31.12.2016
Passports – If several passports write them all.
Number Place Issued Date Issued Date Expired
098898887 Split 06.02.2013 06.02.2023
Seaman’s Book - If several seaman’s books write them all (even if expired)
Country Place Issued Date Issued Number Date Expired
Croatia Split 21.05.2013 00077921 21.05.2023
DP Log Book
Country Place Issued Date Issued Number Date Expired
DP Certificates
Certificates Place Issued Date Issued Number Date Expired
DP Basic (induction)
DP Advanced
DP Limited
DP unlimited
Application Form Page 1 of 4

2. .01
APPLICATION FOR EMPLOYMENT
RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE
Certificate
Certificates STCW Date Issued Place Issued Expiration date License Number
Yellow Fever certificate 18.12.2006 Split 18.12.2016
Helicopter Underwater Escape Training
Helicopter Landing Officer
MEDICAL (First Aid) VI/4 04.03.2011 Split 04.03.2016
MEDICAL (Care) VI/4
ARPA
GMDSS IV/2
Advanced Fire Fighting VI/3 04.03.2011 Split 04.03.2016
PSCRB (proficiency in survival craft) VI/2 04.03.2011 Split 04.03.2016
Basic Safety Training Certificate (or Items from 1
to 4 below MANDATORY) VI/1
04.03.2011 Split 04.03.2016
1 - Personal Security and Social Responsibilities 04.03.2011 Split 04.03.2016
2 - Personal Survival Technique 04.03.2011 Split 04.03.2016
3 - First Aid at sea 04.03.2011 Split 04.03.2016
4 - Fire fighting 04.03.2011 Split 04.03.2016
BOSIET
SSO (Ship Security Officer) VI/5
Seafarer with designated security duties 17.01.2014 Split Unlimited
Security Awareness 17.01.2014 Split Unlimited
Tanker familiarization certificate 04.03.2011 Split 04.03.2016
Advanced oil tanker operations 03.05.2010 Split 03.05.2015
Advanced liquefied gas tanker operations 18.01.2012 Split 31.12.2016
Second engineer officer on a ship powered by
the main propulsion machinery of less than to
3000 kw
16.01.2013 Split 31.12.2016
Application Form Page 2 of 4

3. .01
APPLICATION FOR EMPLOYMENT
RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE
Previous Sea Experience
Vessel’s Name Flag GRT
Vessel
Type
Eng Type &
KW
Company Name Rank
Period:
From
Period:
To
For Offshore Ships: Type of Job Performed (supply,
anchorhandling, towing…), Water Depth, Type of Rig or
Barge Work With, Area of Operation, Charterer-Client
Thornbury Bah. 56115 Oil Tanker Man&14050
kw
Lundquist 3/e 18.07.2008 01.11.2008
Thornbury Bah. 56115 Oil Tanker Man&14050
kw
Lundquist 3/e 28.02.2009 29.07.2009
Thornbury Bah. 56115 Oil Tanker Man&14050
kw
Lundquist 3/e 27.10.2009 28.02.2010
Thornbury Bah. 56115 Oil Tanker Man&14050
kw
Lundquist 3/e 28.06.2010 05.08.2010
Umm Al Amad Majur
o
13668
5
Lng Carrier Man&2x
16550Kw
K-Line 4/e 26.03.2011 22.06.2011
Umm Al Amad Majur
o
13668
5
Lng Carrier Man&2x
16550Kw
K-Line 4/e 09.09.2011 11.10.2011
Trinity Arrow Pan. 10108
0
Lng Carrier Steam
Turbine
29420kw
K-Line 3/e 12.10.2011 06.12.2011
Al Thakhira Bah. 95824 Lng Carrier Steam
Turbine
29420kw
K-Line 3/e 19.02.2012 31.03.2012
Al Thakhira Bah. 95824 Lng Carrier Steam
Turbine
29420kw
K-Line 3/e 23.06.2012 04.10.2012
Demarest Tide Vanu. 3943 Psv-Dp 2 Stx-
4x1761kw
Tidewater/Thromso 3/e 28.10.2013 26.11.2013
Demarest Tide Vanu. 3943 Psv-Dp 2 Stx
-4x1761kw
Tidewater/Thromso 3/e 18.12.2013 15.01.2014
Demarest Tide Vanu. 3943 Psv-Dp 2 Stx
-4x1761kw
Tidewater/Thromso 3/e 13.02.2014 12.3.2014
Demarest Tide Vanu. 3943 Psv-Dp2 Stx- Tidewater/Thromso 3/e 09.04.2014 07.05.2014
Application Form Page 3 of 4

4. .01
APPLICATION FOR EMPLOYMENT
RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE
4x1761kw
Demarest Tide Vanu. 3943 Psv-Dp 2 Stx
-4x1761kw
Tidewater/Thromso 3/e 04.06.2014 02.07.2014
Demarest Tide Vanu. 3943 Psv-Dp 2 Stx
-4x1761kw
Tidewater/Thromso 3/e 30.07.2014 28.08.2014
Demarest Tide Vanu. 3943 Psv-Dp 2 Stx
-4x1761kw
Tidewater/Thromso 3/e 24.09.2014 22.10.2014
Demarest Tide Vanu. 3943 Psv-Dp 2 Stx
-4x1761kw
Tidewater/Thromso 3/e 18.11.2014 12.12.2014
Application Form Page 4 of 4