1. Personal Details

1. Position

2. Second Choice
3. Date Available for Joining
 
4. Name
 		5. Surname
 		6. Middle Name
7. Height, cm

 8. Weight, kg

 9. Color of Eyes
10. Date of Birth
 11. Place of Birth
 12. Nationality
13. Phone
 14. Mobile Phone
15. E-mail
16. Address

 17. City
 18. Country

2. Details of Previous Sea-Service (Last Vessel On Top)
Name of Ship Type of Ship, DWT Type of Engine, bhp Rank Period Company

3. Notes
Requested wages, USD

4. Previous Employers
Employer’s Name Contact Details (Phone/Fax)
1.
2.
3.

5. Documents
  Number Date of Issue
1. Seaman's Book
2. Passport
3. Travel Passport
4. Medical Certificate
5. D&A Test Report
6. Yellow Fever Vac.
7. Diploma
8. Certificate of Compenetcy
9. National Endorsement
10. G.M.D.S.S.
11. R.T. Operator
12. Radar Ob. & Plotting
13. A.R.P.A.
14. Basic Safety Training (VI/1.1-1.4)
15. Proficiency In Survival Craft (VI/2)
16. Advanced Fire Fighting (VI/3)
17. First Aid (VI/4.1)
18. Medical Care (VI/4.2)
19. I.D.G. (V/4, V/5)
20. Oil Tanker Training (V/1)
21. Ch. Tanker Training (V/1)
22. L.Gas Tanker Training (V/1)
23. Other
24. Other
25. Other

6. Family
Marital Status
 
Next of Kin, Name

Next of Kin, Relationship
Next of Kin, Address
   		Next of Kin, Phone
  

 
 
 
 
 
 
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Last modified: 26-11-2003