Application Form

Application Form



 

Readiness

 

Rank

 

Expected salary (min)

 

 

Surname

 

Name

 

Father name

 

Date of Birth

Place of Birth
 

English Level 

 

Next of kin

 

Marital status

 

Children under 18yrs

 

Nationality

Height  

Weight

Eyes

Boot size

 

 

Address:

Phone:

Mobile:

 

Next of kin Address:

Seaman's passport  

Issued / valid date  

Travel passport        

Issued / valid date   

National passport

Issued

 

Education:

 

CERTIFICATES

NUMBER

ISSUING PLACE

ISS / VALID DATE

Certificate of competency

 

 

 

 

Endorsement

 

 

 

GMDSS

 

 

 

Endorsement of GMDSS

 

 

 

Radar, ARPA Certificate

 

 

 

STCW-95 BASIC

 

 

 

Medical First Aid

 

 

 

Medical Care

 

 

 

Advanced Fire Fighting

 

 

 

Survival Crafts

 

 

 

Bridge Team Management

 

 

 

Ship Security Officer

 

 

 

Ship Safety Officer

 

 

 

Oil Tanker Familiarization

 

 

 

Oil Tanker Advanced

 

 

 

Chemical Tanker Safety

 

 

 

Liquefied Gas Tanker

 

 

 

Crude Oil Washing

 

 

 

Inert Gas System

 

 

 

Dangerous Cargo

 

 

 

USA - Visa

 

 

 

Yellow Fever

 

 

 

PREVIOUSSEA SERVICE

RANK

Vessel's name

Type of Vessel/DWT

Type of ME/BHP

Company

Flag

From

Till

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last modified on Friday, 03 May 2019 23:53