Photo

4
SSS No. 04-1988945-6 Pag-Ibig No. 1210-4379-5785
PhilHealth No. 01-025378216-7 Tin No. 269-547-722-000

PHYSICAL DETAILS
Height: 165 cm Weight 65 kg Cover all Size (S, M, L, XL, XXL): Shoe Size (6,7,8,9,10,11): 8
Eye Color black Hair Color black Distinguishing Mark: Waistline: 30

EDUCATION
SCHOOL PERIOD (dd/mm/yy) Certificate/Diploma/Course
HIGH SCHOOL Pulo National Highschool From: 2004 To: 2008 Highschool Diploma
VOCATIONAL SCHOOL From: To:
COLLEGE St. Therese-MTC Colleges Lapaz, Iloilo City From: To:

LICENSES AND OTHER REQUIRED DOCUMENTS

DOCUMENT CERTIFICATE NUMBER RANK Issue Date(dd/mm/yy) Expiry Date(dd/mm/yy)
Philippine Seaman book
S.R.C. / E-Registration
Philippine Passport
Phil. License
COC issued by MARINA
Endorsement issued by MARINA
GOC License
Deck / Engine COC
Full DP License
Basic DP
Advance DP
DPM Certificate
Pilot Exemption Certificate (PEC)
Yellow Fever ###

VISA / LOGBOOK
DOCUMENT Number Expiry Date(dd/mm/yy) DOCUMENT Issue Date (dd/mm/yy)
U.S. Visa None DP Logbook none
Schengen Visa None IMCA Logbook none
Brunei Visa None Crane Optr.Logbook none
Nigerian Visa None NIS Booklet none

FAMILY BACKGROUND
Family Name Date of Birth PPT. No. Date of Issue Date of Expiry Place of Issue
None
Wife
Christina Jhoie Deleon Jul;y 8,1990
M Dwayne Christopher Recuenco ###
Child
F ###
M None
Child
F Sabrina Zuleica Jhoie Recuenco Sept. 3 ,2010
M None
Child
F
M None
Child
F

Form No. CSI-01-F Issue Date: 31.05.13 Revision No.: 11 Revision Date: 13.07.20 Approved by: MAC
 TRAINING CERTIFICATES
Issue Date Validity Date
COURSE NAME Certificate Number COP Number (DD-MM-YY) (DD-MM-YY)

Basic Training
PSCRB
ATFF
PFRB
MEFA
MECA
SSO
SDSD
BTOC
ATOT
ATLGT
BTLGT
ATCT

OTHER REQUIRED CERTIFICATES

Course Name Certificate Number Issue Date Course Name Certificate Number Issue Date
(DD-MM-YY) (DD-MM-YY)

ECDIS HSE / MEDIC CERTIFICATES

ECDIS Furuno
ECDIS World Chart
Bridge Resource Mgmt.
Bridge Team Mgmt.
Engine Room Simulator
Engine Resource Mgmt. SKILLED CERTS
RADAR/ARPA
MLC
High Voltage Certificate
OLC
Consolidated MARPOL OTHER CERTIFICATES
Marlins Test
TOR (Preferably)
OFFSHORE CERTIFICATES
BOSIET
FOET
HUET
Rigging and Slinging
Basic H2S/Hydrogen Sulphide
TESDA
NC I
NC II
NC III
CRANE OPERATOR
G5 Certificate / Sparrow
Crane Operator Course

Form No. CSI-01-F Issue Date: 31.05.13 Revision No.: 11 Revision Date: 13.07.20 Approved by: MAC
 SERVICE RECORD
(Please arrange in chronological order starting from present to past service)
Nationality of FROM TO REASON FOR TRADING
S/N PRINCIPAL VESSEL NAME FLAG AGENCY RANK VESSEL TYPE GRT ENGINE MAKE KW TOTAL MOS/ DAYS SALARY
Master / CE (DD-MM-YY) (DD-MM-YY) DISCHARGE ROUTE

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

PAST EMPLOYMENT
PREVIOUS EMPLOYER / PRINCIPAL DETAILS
Philippine Manning Agency Employer's Name: Roble Shipping Inc Name of Foreign Principal
Address: #7 E.S. Baclig Ave., North Reclamation Area Cebu City Address:
Contact Person: -- Contact Person
Landline/Mobile number: (032) 419-1190-95 | 416-6352 Landline/Mobile number:
Email Address [email protected] Email Address

Philippine Manning Agency Employer's Name: Name of Foreign Principal

Address: Address:
Contact Person: Contact Person
Landline/Mobile number: Landline/Mobile number:
Email Address Email Address

Form No. CSI-01-F Issue Date: 31.05.13 Revision No.: 11 Revision Date: 13.07.20 Approved by: MAC
 SEA SERVICE SPECIFICATION FOR OFFSHORE
(For Offshore Only)

DP DP Engine No. of days of this operation

S/N 1/ BHP Propulsion Type of Installation Served Character
2 /3 Make Model Make Model Supply AHTS Towing Dive Support ROV Floatel

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
MEDICAL HISTORY
Any previous Surgery No Yes , please describe briefly ________________________________________
Any previous illness No Yes , please describe briefly ________________________________________
Any previous handicap No Yes , please describe briefly ________________________________________
Any drug/alcohol problem No Yes , please describe briefly ________________________________________
Any scar in the lungs No Yes , please describe briefly ________________________________________
Any previous hepatitis No Yes , please describe briefly ________________________________________
SEAFARER'S DECLARATION
I hereby confirm that the information given by me is true and correct to the best of my knowledge and belief. I have not withheld any information that may affect my appication unfavorably, any false data herein constitutes ground for my disqualification or
non-acceptance of my application. I also understand that strict medical examination inclusive of a Drug and Alcohol Test is a company prerequisite for my employment. I am will to be examined and to provide this company's accredited medical clinic a
complete and detailed personal medical history. I also agree that the findings and results of the examination are final. I am not presently employed with any company and if my application is accepted, i will be available to report starting on (dd-mm-yy)
Please, paki justify po/salamat

Signature of Seafarer ____________________________________________________________________ Date Signed _______________________________________________________________________

Form No. CSI-01-F Issue Date: 31.05.13 Revision No.: 11 Revision Date: 13.07.20 Approved by: MAC