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    Application Form

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    Novak Bakic
    This document is an application for sea staff employment submitted by [Name] to Scandinavian Ship Services SIA. It includes sections for personal details, certifications and training, sea service history, a signature, and space for company notes. The applicant provides information such as their position applying for, citizenship, address, education, passport and certificate details, medical fitness, training courses, sea service dates and details on vessels, and a signature affirming the truth of the information provided.

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    Application Form

    Uploaded by

    Novak Bakic
    20 views1 page
    This document is an application for sea staff employment submitted by [Name] to Scandinavian Ship Services SIA. It includes sections for personal details, certifications and training, sea service history, a signature, and space for company notes. The applicant provides information such as their position applying for, citizenship, address, education, passport and certificate details, medical fitness, training courses, sea service dates and details on vessels, and a signature affirming the truth of the information provided.

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    Application Form

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    This document is an application for sea staff employment submitted by [Name] to Scandinavian Ship Services SIA. It includes sections for personal details, certifications and training, sea service history, a signature, and space for company notes. The applicant provides information such as their position applying for, citizenship, address, education, passport and certificate details, medical fitness, training courses, sea service dates and details on vessels, and a signature affirming the truth of the information provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    20 views1 page

    Application Form

    Uploaded by

    Novak Bakic
    This document is an application for sea staff employment submitted by [Name] to Scandinavian Ship Services SIA. It includes sections for personal details, certifications and training, sea service history, a signature, and space for company notes. The applicant provides information such as their position applying for, citizenship, address, education, passport and certificate details, medical fitness, training courses, sea service dates and details on vessels, and a signature affirming the truth of the information provided.

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    Scandinavian Ship Services SIA

    Reg. No 52103025341. Fr.Brivzemnieka str. 52, Liepaja, LV-3401, Latvia. Tel.+371 63426052, fax +371 63480784, Web-page: www.scandinavianship.lv; Email: info@scandinavianship.lv APPLICATION FOR SEA STAFF EMPLOYMENT 1. Personal Data

    Forma SSS1/02.2012

    Position applied for: for Surname: Surname Date of Birth: Birth Citizenship: Citizenship Address (ZIP incl.): Residence / mobile tel.: tel Marital status: status Next of Kin / Relationship / Address, tel.: tel Maritime or other education (From - To):
    No Certificate Name Rank

    Date: Date First Name: Place of birth: birth Departure airport: airport

    ID number:

    Email or fax number: number Number of children under the age of 18: 18

    2.The Summary of Personal Certification and Training Courses attended


    Validity Number Grade Issue Place Issue Date Exp.Date

    1.1. 1.2. 2. 3.

    Travel passport Seamans Discharging Book Certificate of Competency Certificate of Competency National Endorsement of Certificate Norway/Bahamas Endorsement of Certificate of Competency

    All Crew All Crew

    Unlim. Unlim. M,Off,Eng 5 years M,Off,Eng 2 years

    4. Basic Safety Training (Basic SOLAS) All Crew 5 years All Crew 2 years 5. Medical Fitness All Crew 5 years 6. Proficiency in Survival Craft. M,Off,Eng 5 years 7. Advanced Fire Fighting 5 years 8. Onboard Medical Care (First Aid) M,Off Deck Off 5 years 9. ARPA Deck Off 5 years 10. Radar observation Deck Off 5 years 11. GMDSS 12. GMDSS National Endorsement 13. Norway/Bahamas GMDSS Endors. 14. Yellow fever Deck Off 15. Ship Security Course (A-VI/5) 16. Visa for travel 17. English Language Skills Spoken: fluent / good / average / poor Written: fluent / good / average / poor 18. Other Foreign Languages Boiler suit / Shoes size: 3. Sea Service (Please use the European date format DD.MM.YY.)
    From (S/On Date) To (S/Off Date) Onboard M./ Days Rank Vessels Name / Flag Ship Type GRT Main Eng. Type / kW Employer (company to contact for reference)

    Signature:

    I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge. Note: This form can be returned per email without signature- please ensure however to send a signed printout for our records per ordinary mail (e.g. with passport photo and photo copies of Certificates listed above are required)

    4.Company notes: References: YES Have been checked in NMA: YES


    NO NO

    Marlines English test in %

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