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    Smms Application Form

    Uploaded by

    Soyel Fernandes
    This document is an application for employment as a Chief Officer. It requests basic personal information such as name, date of birth, address, education and training details. It also asks for sea service history, medical details, and an attached document checklist of required licenses and certifications. The purpose is to collect all necessary information to evaluate the applicant for employment as a ship's Chief Officer.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd

    Smms Application Form

    Uploaded by

    Soyel Fernandes
    15 views8 pages
    This document is an application for employment as a Chief Officer. It requests basic personal information such as name, date of birth, address, education and training details. It also asks for sea service history, medical details, and an attached document checklist of required licenses and certifications. The purpose is to collect all necessary information to evaluate the applicant for employment as a ship's Chief Officer.

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    This document is an application for employment as a Chief Officer. It requests basic personal information such as name, date of birth, address, education and training details. It also asks for sea service history, medical details, and an attached document checklist of required licenses and certifications. The purpose is to collect all necessary information to evaluate the applicant for employment as a ship's Chief Officer.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    15 views8 pages

    Smms Application Form

    Uploaded by

    Soyel Fernandes
    This document is an application for employment as a Chief Officer. It requests basic personal information such as name, date of birth, address, education and training details. It also asks for sea service history, medical details, and an attached document checklist of required licenses and certifications. The purpose is to collect all necessary information to evaluate the applicant for employment as a ship's Chief Officer.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Download as xls, pdf, or txt
    of 8

    Template Version :- 1.

    04 Revision :- 2

    APPLICATION FOR EMPLOYMENT

    Note: Fields with * sign are required fields in SMMS and should not be left blank.
    Gender* Male
    Crew Type* On Contract Crew Status* Available Rank* Chief Officer
    Surname Date Of Birth
    First Name* Height
    Middle Name Weight

    Home Address Other Addr

    Address Address

    Phone 1 Phone 2 Phone 1 Phone 2


    Place of Birth Religion Cloth Size (EU) Cloth Size (
    Marital Status Nationality Shoe Size
    E-Mail
    Basic Education Maritime Educ
    Institute From Date To Date Particulars Institute* From Date To Date

    Bank Detail
    Bank Name Branch Beneficiary Name A/c Type

    City Country State Zip Code Routing

    Next Of Kin's Detail


    Relation* Name* Date of Birth Address Relation* Name* Date of B

    Sea Service
    Note: Sequence for entering sea service records: Latest service should be entered at row no. 1 and then older services downward.
    Vessel Name* From Date* Ship Type GRT Manager
    No Period (Y/M/D) Rank
    Flag To Date Engine Type BHP Manning Compan

    10

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    Has the applicant has ever signed off from a vessel on Medical Grounds. If yes, please furnish details.

    Name of Vessel Date signed off Reason / Brief Description of Illnes

    Have you visited the doctor in the last 12 months for any surgery / Illness. If yes, please furnish details

    Date of Illness / Surgery Details of Illness and Treatment received


    hief Officer
    ###
    Photo
    CM
    KG

    Other Address

    Phone 2 ###
    Cloth Size (US) ###

    itime Education
    To Date Particulars* ###

    ###

    A/c Type A/c No.

    Date of Birth Address

    ###

    ###
    rd.
    anager Sign Off Reason Cargo Crane
    ng Company Remarks
    `
    on of Illness / Injury / Accident
    DOCUMENT CHECK LIST
    Guidelines for filling data
    1. If any data entered against Training then that record will be saved in SMMS.
    2. Country is required to save License record in SMMS.
    Documents Clinic Name Issue
    VACCINATION 1
    VACCINATION 2
    MEDICAL CHECKUP 1
    MEDICAL CHECKUP 2
    Documents Number* Issue
    NATIONAL SEAMAN BOOK/ Seaman's Discharge Book (SDB) / Continuous Discharge Cert (CDC)
    Seaman Book (Other)
    INDOS
    Seafarers Identification and Record Book (SIRB)
    FLAG STATE SEAMAN BOOK (I.D BOOK)
    PASSPORT
    VISA - USA
    VISA - Shengen
    VISA - MCV
    VISA - Other
    Licenses Number Issue
    Cert Of Competency - National
    Cert Of Competency - Other
    Cert of Endorsement - Panama
    Cert of Endorsement - Singapore
    GMDSS COC - National
    GMDSS COC - Other
    GMDSS COE - Panama
    GMDSS COE - Singapore
    ST

    Expiry Remarks

    Expiry Remarks

    Expiry Remarks

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