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Maritime Job Application Form

The document contains details for a job application, including personal information such as name, date of birth, address, nationality, and next of kin. It also lists the applicant's certifications such as Seaman's Book, Certificate of Competency, STCW95 endorsement, and IMO certificates for courses in areas like firefighting, survival craft, and ship security. Previous sea experience is outlined including details of vessels served on like type, flag, tonnage, and rank. Specialized cargo training and previous employers are also included.

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Ramona Elisa
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© Attribution Non-Commercial (BY-NC)
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116 views2 pages

Maritime Job Application Form

The document contains details for a job application, including personal information such as name, date of birth, address, nationality, and next of kin. It also lists the applicant's certifications such as Seaman's Book, Certificate of Competency, STCW95 endorsement, and IMO certificates for courses in areas like firefighting, survival craft, and ship security. Previous sea experience is outlined including details of vessels served on like type, flag, tonnage, and rank. Specialized cargo training and previous employers are also included.

Uploaded by

Ramona Elisa
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

1.

Position applied for:

2. Personal Data:
Surname: Name: Fathers Name: Permanent address: Nationality:

Date of birth:

Place of birth:

Marital status:

Next Of Kin

Phone: Mobile: Email:

Document
PASSPORT US Visa

No.

Issued

Place

Date of expire

3. Certificates
Issuing authority
NATIONAL SEAMANS BOOK NATIONAL CERTIFICATE OF COMPETENCY NATIONAL ENDORSMENT/STCW 95 STCW95 ENDORSMENT ( Foreign Flag State ) SEAMANS BOOK ( Foreign Flag State 1 )

Grade

Certificate No

Date issued

Date of expire

4. Previous Sea Experience:


Company Vessel's Name Flag DWT(teus) M.E. power Type of M.E. Type of Vessel Rank served Service From Service Till

5. Special cargo certification


Courses/Certificate
OIL TANKER FAMILIARIZATION SPECIALIZED TRAINING FOR OIL TANKERS SPECIALIZED TRAINING FOR CHEMICALS TANKERS SPECIALIZED TRAINING FOR LIQUIFIED GAS TANKERS INERT GAS SYSTEM OPERATION

Number

Date issued

Date of expire

6. IMO Certificates
Courses/Certificate
GMDSS GOC FIRE FIGHTING ADVANCED FIRE - FIGHTING PERSONAL SURVIVAL TECHNIQUES
PROFIENCY IN SURVIVAL CRAFTS AND RESCUE BOATS

Number

Date issued

Date of expire

PSSR MARITIME ENGLISH PREVENTION OF POLLUTION - MARPOLL TRANSPORT OF DANGEROUS GOODS RADAR ARPA, BRIDGE TEAMWORK MEDICAL CARE FIRST AID SHIP SECURITY OFFICER RO-RO / PASSENGER FAST RESCUE CRAFT BRIDGE TEAM MANAGEMENT ENGINE MANAGEMENT

7. Previous Employers.
Employer Name: Address : Telephone : Fax: E-mail: Employer Name: Address: Telephone: Fax: E-mail:

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