SEAMAN'S APPLICATION FORM
*
- required fields
dd.mm.yy
- date entering format
SEAMAN'S PERSONAL DETAILS
Surname:
*
Name:
*
Father name:
*
Mother name:
*
Date of birthday:
*
Place of birthday:
*
Next of kin:
Marital status-married:
No of children
under 18 yrs:
Heigh:
*
cm
Weight:
*
kg
Nationality:
*
Relation:
Adress:
*
Phone:
.
Seaman's passport No:
*
Iss/valid date:
*
Civil passport No:
*
Iss/valid date:
*
English:
GOOD
V.GOOD
Just_enough_for_his_Rank
NEGATIVE
DOCUMENTS
No.
CERTIFICATES
NUMBER
ISSUING
PLACE
ISSUING-VALIDATION
DATE
1.
Endorsement of certificate
2.
STCW 95 BASIC
STCW 95 ADVANCED
3.
Medical first AID
4.
Fire fighting
5.
Survival crafts&rescue boat
6.
Fast rescue boats
7.
GMDSS (desk off)
8.
ARPA (desk off)
9.
RADAR (desk off)
10.
Oil tanker safety
11.
C.O.W.
12.
Chemical tanker safety
13.
Last medical
PREVIOUS SEA SERVICE
1
Vessel's name
Company
Type
Tank
Chem
Cont
Bulk
Reef
Cable
Pass
Sail
Dcgo
Ro-Ro
Ro-Lo
LASH
Fish
LPG
LNG
Multi
L-stock
Tug
Research
Supply
Salv.tug
Other
DWT
Engine/HP
Slz
Man
B&W
Man+B&W
Makita
Stork
Mitsub
Deutz
Akasaka
Daihatsu
Pielst
Burm
Werks
RusDiesel
SKL
NVD
Doxford
Kelvin
Hanshin
MAK
Mits-B&W
Hitachi
Caterpillar
Fiat
Wartsila
Other
Rank:
Master
C/O
2/O
3/O
C/E
2/E
3/E
4/E
R/E
E/E
Bosun
Cook
M/B
Oiler
Oiler/Fitter
Oiler/E
AB
OS
Fitter
Welder
BSN/PMP
Steward
PUMPMAN
R/off
Technician
Wiper
Other
S/On:
S/Off:
Reason:
Sick-ss
End_C-t
Vsl_sold
Family
Alk
ITF
Scrap
Other
2
Vessel's name
Company
Type
Tank
Chem
Cont
Bulk
Reef
Cable
Pass
Sail
Dcgo
Ro-Ro
Ro-Lo
LASH
Fish
LPG
LNG
Multi
L-stock
Tug
Research
Supply
Salv.tug
Other
DWT
Engine/HP
Slz
Man
B&W
Man+B&W
Makita
Stork
Mitsub
Deutz
Akasaka
Daihatsu
Pielst
Burm
Werks
RusDiesel
SKL
NVD
Doxford
Kelvin
Hanshin
MAK
Mits-B&W
Hitachi
Caterpillar
Fiat
Wartsila
Other
Rank:
Master
C/O
2/O
3/O
C/E
2/E
3/E
4/E
R/E
E/E
Bosun
Cook
M/B
Oiler
Oiler/Fitter
Oiler/E
AB
OS
Fitter
Welder
BSN/PMP
Steward
PUMPMAN
R/off
Technician
Wiper
Other
S/On:
S/Off:
Reason:
Sick-ss
End_C-t
Vsl_sold
Family
Alk
ITF
Scrap
Other
3
Vessel's name
Company
Type
Tank
Chem
Cont
Bulk
Reef
Cable
Pass
Sail
Dcgo
Ro-Ro
Ro-Lo
LASH
Fish
LPG
LNG
Multi
L-stock
Tug
Research
Supply
Salv.tug
Other
DWT
Engine/HP
Slz
Man
B&W
Man+B&W
Makita
Stork
Mitsub
Deutz
Akasaka
Daihatsu
Pielst
Burm
Werks
RusDiesel
SKL
NVD
Doxford
Kelvin
Hanshin
MAK
Mits-B&W
Hitachi
Caterpillar
Fiat
Wartsila
Other
Rank:
Master
C/O
2/O
3/O
C/E
2/E
3/E
4/E
R/E
E/E
Bosun
Cook
M/B
Oiler
Oiler/Fitter
Oiler/E
AB
OS
Fitter
Welder
BSN/PMP
Steward
PUMPMAN
R/off
Technician
Wiper
Other
S/On:
S/Off:
Reason:
Sick-ss
End_C-t
Vsl_sold
Family
Alk
ITF
Scrap
Other
4
Vessel's name
Company
Type
Tank
Chem
Cont
Bulk
Reef
Cable
Pass
Sail
Dcgo
Ro-Ro
Ro-Lo
LASH
Fish
LPG
LNG
Multi
L-stock
Tug
Research
Supply
Salv.tug
Other
DWT
Engine/HP
Slz
Man
B&W
Man+B&W
Makita
Stork
Mitsub
Deutz
Akasaka
Daihatsu
Pielst
Burm
Werks
RusDiesel
SKL
NVD
Doxford
Kelvin
Hanshin
MAK
Mits-B&W
Hitachi
Caterpillar
Fiat
Wartsila
Other
Rank:
Master
C/O
2/O
3/O
C/E
2/E
3/E
4/E
R/E
E/E
Bosun
Cook
M/B
Oiler
Oiler/Fitter
Oiler/E
AB
OS
Fitter
Welder
BSN/PMP
Steward
PUMPMAN
R/off
Technician
Wiper
Other
S/On:
S/Off:
Reason:
Sick-ss
End_C-t
Vsl_sold
Family
Alk
ITF
Scrap
Other
5
Vessel's name
Company
Type
Tank
Chem
Cont
Bulk
Reef
Cable
Pass
Sail
Dcgo
Ro-Ro
Ro-Lo
LASH
Fish
LPG
LNG
Multi
L-stock
Tug
Research
Supply
Salv.tug
Other
DWT
Engine/HP
Slz
Man
B&W
Man+B&W
Makita
Stork
Mitsub
Deutz
Akasaka
Daihatsu
Pielst
Burm
Werks
RusDiesel
SKL
NVD
Doxford
Kelvin
Hanshin
MAK
Mits-B&W
Hitachi
Caterpillar
Fiat
Wartsila
Other
Rank:
Master
C/O
2/O
3/O
C/E
2/E
3/E
4/E
R/E
E/E
Bosun
Cook
M/B
Oiler
Oiler/Fitter
Oiler/E
AB
OS
Fitter
Welder
BSN/PMP
Steward
PUMPMAN
R/off
Technician
Wiper
Other
S/On:
S/Off:
Reason:
Sick-ss
End_C-t
Vsl_sold
Family
Alk
ITF
Scrap
Other
STATE FAX/TEL Nos OF PREVIOUS COMPANIES:
1.
2.
3.
EXPERIENCE WITH FOREIGN OFFICERS/CREW (State Nationalities):
