APPLICATION FORM FOR NEW EMPLOYEE
DATE
FOR
RANK
PHOTO
SURNAME :
NAME :
PHONE :
DATE OF BIRTH :
PLACE OF BIRTH :
ADDRESS :
NEXT OF KIN :
PASSPORT No / PLACE OF ISSUE :
DATE OF ISSUE / VALIDITY :
No / DATE OF LAST MEDICAL VISIT
SEAMAN BOOK No :
DATE / PLACE OF ISSUE :
VALIDITY :
STCW ENDORSEMENT / VALIDITY :
OTHER FLAG DOCUMENTS :
FTK
STK OIL
STK CHEMICAL
LICENSED :
LICENCE No / SINCE :
FLAG MEDICAL REPORT :
IMO COURSES :
PERSONAL SURVIVAL TECHNIQUES
TANKER FAMILIARIZATION REFRESHMENT
MEDICAL CARE
MEDICAL / ELEMENTARY FIRST AID
SPECIALIZED TRAINING FOR OIL TANKERS REFRESHMENT
ADVANCED / BASIC FIRE FIGHTING
SPECIALIZED TRAINING CHEMICAL TKS REFRESHMENT
PERSONAL SAFETY AND SOCIAL RESPONSABILITIES ON BOARD SHIPS
SHIP HANDLING AND MANEUVERING SIMULATION
PREVENTION OF POLLUTION OF THE MARINE ENVIROMENT - MARPOL 75/78
B.T. AND RESOURCE MANAGEMENT REFRESHMENT
HANDLING AND TRANSPORT OF DANGEROUS, HAZARDOUS AND HARMFUL CARGOES
SHIP SECURITY OFFICER
MARITIME ENGLISH
ELECTRONIC CHARTS DISPLAY AND INFORMATION SYSTEM
PROFICIENCY IN SURVIVAL CRAFTS OTHER THAN FAST BOATS
ENGINE ROOM SIMULATOR
ARPA, BRIDGE TEAMWORK AND SEARCH AND RESCUE-MANAGEMENT LEVEL
ENGINE TEAM MANAGEMENT
RADAR NAVIGATION, RADAR PLOTTING, AND USE OF ARPA-OPERATIONAL LEVEL
G.M.D.S.S./GOC
PREVIOUS SEA SERVICE (LAST 5 EMPLOYMENTS)
TYPE/NAME OF VESSEL
DWT
SIGN ON
SIGN OFF
RANK
OWNER
ENGINE
1
2
3
4
5
U.S.A. VISA :
AVAILABILITY DATE :
YELLOW FEVER CERTIFICATE :
HEPATITIS A, B CERTIFICATE :
OVERALL/SAFETY SHOES :