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    Application Form

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    57f9bmfjf2
    This document appears to be an application form for a seaman position. It requests personal details of the applicant such as name, date of birth, passport information, qualifications, medical information, and records of previous sea service including vessel names, flags, positions held, and dates of employment. National and international certifications are also listed to verify the applicant's qualifications for the position.

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    Application Form

    Uploaded by

    57f9bmfjf2
    19 views1 page
    This document appears to be an application form for a seaman position. It requests personal details of the applicant such as name, date of birth, passport information, qualifications, medical information, and records of previous sea service including vessel names, flags, positions held, and dates of employment. National and international certifications are also listed to verify the applicant's qualifications for the position.

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    This document appears to be an application form for a seaman position. It requests personal details of the applicant such as name, date of birth, passport information, qualifications, medical information, and records of previous sea service including vessel names, flags, positions held, and dates of employment. National and international certifications are also listed to verify the applicant's qualifications for the position.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    19 views1 page

    Application Form

    Uploaded by

    57f9bmfjf2
    This document appears to be an application form for a seaman position. It requests personal details of the applicant such as name, date of birth, passport information, qualifications, medical information, and records of previous sea service including vessel names, flags, positions held, and dates of employment. National and international certifications are also listed to verify the applicant's qualifications for the position.

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    © All Rights Reserved
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    SEAMAN's APPLICATION FORM

    FOTO A. SEAMAN'S PERSONAL DETAILS

    POSITION TO APPLY FOR CERTIFIED FOR


    NAME / SURNAME
    FATHER'S NAME MOTHER'S NAME
    D.O.B./P.O.B. NATIONALITY UKRAINE
    Height (in cm): Weight (Kg): Shoes size: Parka size:
    ADDRESS
    MOBILE No.: SKYPE ADDRESS:
    e-mail:
    PHONE No.:
    MARITAL STATUS MARRIED CHILDREN HOW MANY UNDER
    YES NO YES NO 18 YRS OLD
    NEXT OF KIN RELATION
    SEAMAN'S PASSP NO. ISS / VALID DATE
    TRAVEL PASSP NO. ISS / VALID DATE
    GRADUATED FROM
    ENGLISH ABILITY FLUENT VERY GOOD GOOD FAIR

    B. NATIONAL CERTIFICATION
    CERTIFICATE NUMBER ISSUING - VALIDATION ISSUING PLACE
    DATE
    CERTIFICATE OF COMPETENCY
    ENDORSEMENT OF CERTIFICATE
    GMDSS CERTIFICATE
    ENDORSEMENT OF GMDSS
    SHIP SECURITY OFFICER
    BASIC SAFETY
    PROFICIENCY IN SURV CRAFT
    MEDICAL FIRST AID
    ADVANCED FIRE FIGHTING
    BRIDGE/ENGINE - TEAM MNGMNT
    SECURITY RELATED TRAINING
    DESIGNATED SECURITY DUTIES
    SAFETY FAMILIARIZATION

    ECDIS
    RADAR, ARPA (DECK OFF.)
    DANGEROUS SUBSTANCES
    LAST MEDICAL
    USA VISA
    VACCINATIONS YELLOW FEVER : DOI DOE
    CHOLERA : DOI………………………. DOE ……………………….

    C. FLAG CERTIFICATION
    Based on NATIONAL
    FLAG TYPE / No. RANK ISSUED VALID ENDORSEMENT
    (S.BOOK/ENDORS/STICKER) NUMBER

    D. PREVIOUS SEA SERVICE


    VESSEL FLAG TYPE/DWT ENG/HP RANK S/ON S/OFF OWNERS

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