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Application form


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Position applied for:

2nd choice:

Min wage:

Family Name

First name

Fathers name

Date of Birth

Place of Birth

Nationality

Home address
Home phone nr.

Contact/mobile phone number

E-mail

LICENSES, PASSPORTS, CERTIFICATES, etc.

Passports Number Date of Issue Place Valid Until
Seaman’s Identification Card
Foreign Civil Passport
National Passport  
Main Certificates
 
 
 
Other Certificates
Sec.A-VI/1 STCW-95 (Social responsibilities)
Sec.A-VI/2 STCW-95 (Proficiency in survival craft)
Sec.A-VI/3 STCW-95 (Advanced fire fighting)
Sec.B-V/4 & B-V/5 STCW-95 (Hazardous Cargoes)
Sec.A-VI/4-1 STCW95 (Medical first aid)
Sec.A-VI/4 STCW-95 (Medical Care)
Reg.V/1, 1.1,1.2; Sec.A-V/1, 1.7(Oil Tankers Famil.)
Res.10 Sec.A-V/1, 9.14 (Adv.training Oil Tankers)
Reg.V/1, 1.STCW-95 (Breathing apparatus)
Res.11.12&16.34 Sec.A-V/1 (Chem Tank)
Res.11.12&16.34 Sec.A-V/1 (Liq Tank)
Res.11.12&16.34 Sec.A-V/1 (Gas Tank)
MARPOL 73/78 (Crude Oil Washing Certificate)
Reg.I/11, I/14 (Safety Officer Certificate)
Sec.II/2 STCW-95(Cert. revalidation Course)
Radar Observing Certificate
ARPA Certificate
Ship Security Officer Certificate
Foreign licences, seamen’s books and endorsements

Last 5 Employments

  Vsl Name Owner Flag Rank From To Vsl Type Engine DWT/BHP
1
2
3
4
5

Last 3 Employers Full Style

  Owner / Operator Telephone Fax E-mail
1
2
3

 

   

 

 

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