SEAMAN’S EMPLOYMENT APPLICATION FORM

Position applied for: Second choice (if any): Available from:

Family name: First name:
Foto
Personal particulars
Date of birth: Place of birth: Nationality:
Marital status: Color of hair: Color of eyes:
Height (cm): Weight (kg): Size: Shoes:
Name of father:_____________ Name of mother:_____________ Name of spouse:_______
Children under 18 (name/date of birth):______________________________________________________________________
Home address:
Telephones:
Next of Kin: Surname________Name_____________ Relationship__________
Address/Telephones
The same
E-mail:

Documents and certificates

Documents No Place of issue Date of issue Valid until
Seaman’s passport
Civil travel passport
Civil passport ID №

Certificates of Grade No Place of issue Date of issue Endorsement

Competency valid until
National
Malta
Liberia
Name of Marine School (Academy):_____________________________________________________ Graduated on _______

STCW Certificates No Date of issue Valid until

Basic safety/survival at sea
GMDSS
ROPS, ARPA
Advanced fire-fighting
Proficiency in survival craft
Medical care / First aid
Dangerous cargo (Hazmat)
Security officer
Safety officer
Yellow fever
US VISA
Sea Service during last five years (count backwards)
Rank Vessel’s Main engine Ship-owner/Manager From To
(mm.yy) (mm.yy)
Name Flag Type DWT Type HP

Наличие справок о плавании и отзывов о работе приветствуется

Notes:

Special Remarks (to be filled by office only)

English: ______ PS Test: _____ Other: -
___________________________________________________________________

Signature _____________________________ Date __________________