To be filled in as per seaman’s Passport

APPLICATION FORM

POSITION APPLIED FOR

2.

Date:

TO BE FILLED IN AS PER SEAMAN’S PASSPORT

Surname

Name

Father’s name

Mother’s name

Date of Birth

Place of Birth

Nationality

Address

Height/Weight

Private Phone

Contact Phone

Eyes color

Next of Kin name/Relationship/Address

Nos. Of children under 18

Education

Name of Maritime College or Academy

From

Till

DOCUMENTS

NUMBER

ISSUED: Date / Place

Valid Till

Seaman’s passport

Tourists Passport

National (Citizen) Passport

Visa USA

CERTIFICATES

GRADE / CLASS

NUMBER

ISSUED: Date / Place

Valid Till

Certificate of Competency

Endorsement

Radar Observing Certificate

ARPA Certificate

GMDSS Certificate

GMDSS Endorsement

Bridge Team Management

Engine Team Management

Ship Safety Officer

Ship Security Officer

Foreign Licenses

STCW-CODE’95 CERTIFICATES

CERTIFICATES

NUMBER

ISSUED: Date / Place

Valid Till

1. Basic Safety Training

2. Proficiency in Survival Craft

3. Advanced FFT

4. Hazardous Cargoes

5. Medical First Aid

6. Medical Care on Board

7. Oil Tanker Familiarization

8. Crude Oil Washing Technology

9. Inert Gas System

10. Advanced Training on Oil Tankers

11. Chemical Tankers

12. Liquefied Gas Tankers

13. Ro-Ro Passenger Ships

SEA SERVICE (Last 5 Years)

Rank	Vessel’s Name	Type / dwt	M. E. Type / Mark	BHP	Flag	From	To	Owners	Crew Agency

English Level: ___________

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Дата добавления: 2015-08-27