Application for Employment

Marine Personnel
Position:

Completed? Please send form to: crew.management@hlag.com

Personal Details
General
Surname:
First Name:

Middle Name:

Nationality:

Sex:

Birthday:

Birthplace:

Civil Status:

Picture

No.of Children / Dependent:

Address
Street:

Tel.: +

City/ZIP Code:

Mobile: +

Country:

Fax: +

Airport:

or:

Email:

Next of Kin
Name:

Tel.: +

Relation:

Mobile: +

Street:

Fax: +

City/Country:

Email:

Travel Documents
Passport No:

Issued:

Expired:

Place:

Seamansbook No:

Issued:

Expired:

Place:

German SB.No:

Issued:

Expired:

Place:

U.S.VISA No:

Issued:

Expired:

Place:

Other Visa No:

Issued:

Expired:

Place:

Other Visa No:

Issued:

Expired:

Place:

Languages
Mother Language:
Level of English (written):

Level of English (spoken):

Other Language:
Other Language:

Medical Fitness
National (Place):

Issued:

Expired:

German (Place):

Issued:

Expired:

Cholera:

Issued:

Expired:

Yellow Fever:

Issued:

Expired:

Other:

Issued:

Expired:

Other:

Issued:

Expired:

Vaccination

Application for Employment

Marine Personnel
Position:

Completed? Please send form to: crew.management@hlag.com

Qualification
1. Certificate of Competency (Nautical or Technical)
1.1. National
Competence:

Cert.No:

Issued:

Expired:

1.2. German
Competence:

Cert.No:

Issued:

Expired:

1.3. Watchkeeping (Deck/Engine)

Cert.No:

Issued:

2. GOC (General Operator's Certificate )

2.1. National
Cert.No:

Issued:

Expired:

Place:

2.2. German
Cert.No:

Issued:

Expired:

Place:

Expired:

Place:

3. BASIC SAFETY TRAINING STCW

3.1. Basic Safety Bundle
Cert.No:

Issued:

3.2. Certificate of Proficiency in Survival Craft

Cert.No:
Issued:

Place:

3.3. Certificate of Proficiency in Fast Rescue Boat

Cert.No:
Issued:

Place:

3.4. Medical Care

Cert.No:

Issued:

3.5. Medical First Aid

Cert.No:

Issued:

Place:

3.6. Advanced Fire Fighting

Cert.No:

Issued:

Place:

3.7. ISPS Ships Security Officer

Cert.No:

Issued:

Place:

3.8. Dangerous, hazardous & harmful cargoes (HAZMAT)

Cert.No:
Issued:

4. Other Certificates/ Courses

4.1. High Voltage
Cert.No:

Issued:

4.2. Automatic Radar Plotting (ARPA)

Cert.No:
Issued:
4.3. ME Electronic Engine
Cert.No:

Issued:

5. Any Other Additional Qualification

Expired:

Expired:

Place:

Place:

Application for Employment

Marine Personnel
Position:

Completed? Please send form to: crew.management@hlag.com

Experience
1. Training Courses
Training Course / Seminar

Location

Duration

Date

2. Graduated From:

3. Form of Education:

4. Sea Service (For last five years or last 10 ships served)

Name of vessel

Type
Gross tonnage

Engine
kW

5. Availability for Serivce:

Date:

6. Notes and Remarks:

Remarks:

Company

Rank

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to