Preliminary application for employment cmo 02 sheet 1

PRELIMINARY APPLICATION FOR EMPLOYMENT CMO 02 Sheet 1

AFFIX HERE YOUR RECENT PASSPORT SIZE PHOTOGRAPH Personnel Data
First name	Middle name	Last name/Surname
Nationality	Date of birth (dd/mm/yy)	Place of birth

Post Applied for
Willing to accept lower rank Yes No	Available from / /

Contact Address	Documents	Issued on	Valid Until
	Passport: (Country)
	Seaman’s Book: National
City	Liberian:
Phone:	Panamanian:
Eye Colour:		Hair Colour:		Height:		Weight:

Highest Competency Certificate Held	Dangerous Cargo Endorsement (**)
Issuing Authority	Grade (*)	Valid until	Petroleum	Chemical	Gas
National (Country:)
Liberian
Panamanian
Bahamian
Others

(*) Specify whether: (**) Specify whether:

Dk Class 1 = Master FG Eng Class 1 = 1^st Class (M), (S), (M+S) R/O Class 1 In charge: Highest Grade

2 = 1^st Mate FG 2 = 2^nd Class (M), (S), (M+S) R/O Class 2 Assistant: Watch keeper at cargo watch

3 = 2^nd Mate FG 3&4 = Class 4(M) R/O R/T only

4 = NWKO

STCW & Specialised Courses Attended – Including Special Qualifications (***)
Pers Sea Survival	Prof in Surv Craft	Basic First Aid	Medicare	Basic F-Fighting	Adv. F-Fighting
Radar Observer	Radar Simulator	ARPA	Ship Simulator	Marine Comm	GMDSS
Nav Command & Control	Liq. Cargo Simulator	E/R Simulator	Revalidation	A/B
Tkr Safety (Pet)	Tkr Safety (Chm)	Tkr Safety (LPG)	Tkr Fam (Pet))	Tkr Fam (Chm)	Tkr Fam (LPG)
Liberian SCC	Liberian A.B.	Liberian Oir	Liberian GMDSS	Others: (Please specify)

(***) Tick for course done and still valid

Sea Experience
Company	Vessel	Flag	Type (****)	DWT	M/Engine	BHP	Rank	From (dd/mm/yy)	To (dd/mm/yy)

(****) Use only following abbreviations for vessel type:

GCD - General Cargo B/C - Bulk Carrier CON - Cellular Container MLP- Multi-Purpose O/O - Ore Oil

OBO - Ore/Bulk/Oil NC - Tanker Crude TNP - Tanker Product TNS - Tanker Storage INV - VLCC/ULCC

GAS - LPG/LNG Carrier CHM - Chem Carrier PAS - Passenger Ships R/O - Ro/Ro Carriers LSH - Lash

OSV- Offshore Supply Vessel DRG - Dredgers SRV - Survey vessels LOG - Log/Timber VL - Naval Ships

Please give reference from 2 recent employers who we may contact for references
Name of Company
Name of person to contact
Address
Telephone

I hereby declare that the above is true

Place ________________________________ Date ______________________________ Signature __________________________

Дата добавления: 2015-11-04