1. PERSONAL DETAILS. 2. ADDRESS. 3. NEXT OF KIN. 4. CHILDREN. 5. TRAVEL DOCUMENTS. 6. BANK ACCOUNT INFORMATION. IBAN NUMBER. CURRENCY. 7. EDUCATION. 8. PROFESSIONAL QUALIFICATION / CERTIFICATE OF COMPETENCY /WATCH KEEPING /COP. 9. LANGUAGES. 10. MEDICAL C

PRESENT PHOTO

APPLICATION FOR EMPLOYMENT

APPLICATION FOR POSITION AS

OTHER POSITION (IF ANY)

1. PERSONAL DETAILS

TITLE MR/MRS/MISS

SEX

SURNAME

FIRST NAME

MIDDEL NAME

DATE OF BIRTH

PLACE OF BIRTH

NATIONALITY

MARITAL STATUS

COLOUR OF EYES

COLOUR OF HAIR

MOTHER’S NAME

FATHER’S NAME

SHOESIZE

BOILER SUIT SIZE (US)

HEIGHT (CM)

WEIGHT (KG)

NEAREST INTERNATIONALAIRPORT:

INDOS NUMBER

2. ADDRESS

NO & STREET

CITY

POST CODE

COUNTRY

TEL. NO.

MOBILE

E-MAIL

Skype ID

3. NEXT OF KIN

FULL NAME

RELATIONSHIP

ADDRESS

CITY

COUNTRY

TEL. NO.

MOBILE

4. CHILDREN

FULL NAME OF CHILD

DATE OF BIRTH

SEX

5. TRAVEL DOCUMENTS

TYPE

DOCUMENT NO.

ISS. DATE

EXP. DATE

ISS. BY (AUTHORITY)

PLACE OF ISSUE

PASSPORT

SEAMAN BOOK

OTHER SEAMAN BOOK

US C1/D VISA

OTHER VISAS

6. BANK ACCOUNT INFORMATION

BANK NAME

BRANCH

BANK ADDRESS

BANK SWIFT CODE

BANK COUNTRY

IBAN NUMBER

BENEFICIARY

ACCOUNT NUMBER

CURRENCY

CARD NUMBER/ACCOUNT PASSPORT

7. EDUCATION

INSTITUTE NAME

FROM

INSTITUTE NAME

FROM

8. PROFESSIONAL QUALIFICATION / CERTIFICATE OF COMPETENCY /WATCH KEEPING /COP

CERTIFICATE NAME

NUMBER

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

TANKER VESSEL CERTIFICATES

NUMBER

ISSUE DATE

EXPIRY DATE

OIL

CHEMICAL

GAS

9. LANGUAGES

ENGLISH

FLUENT

GOOD

FAIR

POOR

MARLIN’S TEST / LEVEL

ISSUED DATE

RESULT %

ISSUED BY(AUTHORITY)

ISSUED AT

10. MEDICAL CERTIFICATES & VACCINATIONS

MEDICAL CERTIFICATES

NUMBER

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

INTERNATIONAL/ILO

PANAMANIAN

YELLOW FEVER

11. COURSES

COURSE NAME

NUMBER

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

PERSONAL SURVIVAL/PST

PERSONAL SAFETY AND SOCIAL RESPONSIBILITY

FIRE PREVENTION AND FIRE FIGHTING

ADV. FIRE FIGHTING

ELEMENTARY FIRST AID

MEDICAL FIRST AID

MEDICAL CARE

PERS. SAFETY & SOC. RESP.

PROF. IN SURVIVAL CRAFT & RESCUE BOATS

FAST RESCUE CRAFT

PREVIOUSE DOCUMENTRY EVALUATION

SECURITY TRAINING FOR SEAFARERS WITH DESIGNATED SECURITY DUTIES

SHIP SECURITY OFFICER

G. M. D. S. S.

GENERIC ECDIS COURSE

TYPE SPECIFIC ECDIS COURSE

ROC & ARPA

RADAR OBSERVATION

HAZMAT

BASIC OIL TANKER

ADVANCE OIL TANKER

BASIC CHEMICAL TANKER

ADVANCE OIL TANKER

BASIC GAS TANKER

ADVANCE GAS TANKER

BRIDGE TEAM MANAGEMENT

Guidance on value added training MATRIX (Company specific courses)

SHIP MANOUVERING SIMULATOR

ENGINE ROOM SIMULATOR

CARGO HANDLING SIMULATOR COURSE

RISK ASSESSMENT

ISM AWARENESS

BRIDGE AND ENGINE ROOM RESOURCE MANAGEMENT

ACCIDENT /INCIDENT INVESTIGATION¹

SAFETY OFFICER

MARPOL

VAPOUR EMISSION

ENERGY EFFICIENCY

FRAMO³

VETTING⁴

MARITIME ENGLISH

12. ENDORSEMENT

ENDORSEMENT NAME

NUMBER

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

COMPLETE SEA – SERVICE DETAILS

(LAST VESSELS FIRST )

NAME:

RANK:

AVALIABILITY DATE:

COMPANY NAME

RANK

VESSEL NAME

SIGNED

SIGNED OFF

PERIOD IN MONTHS

TYPE OF VESSEL

D. W. T. / GRT

ENGINE TYPE ( ENGINEERS ONLY)

BHP

SECURITY& REFERENCE CHECK CONTACT DETAILS

COMPANY NAME

ADDRESS

PHONE NO.

FAX/E-MAIL

CONTACT PERSON

I declare that the information I have given is, to the best of my knowledge, true and complete. I also declare that the documents submitted are genuine and have been signed by the person whose name appears on them.

DATE

SIGNATURE