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TIDEMARINE LTD.
12/2, Ave. Shevchenko, office 3, P.O. 65058, Odessa, Ukraine
Telephone: +380-48-7065516 / +380-68-7458413 / +380-93-4618307 / +380-95-2516243
Email: crew@tidemarine.net, Website: www.tidemarine.net

Application form
Minimum acceptable
Application for employment as: salary
Passports
Family name: Father’s name: Type Nationality Number Issued Expire
First name: Mother’s name: Travel Passport UKR

Date of Birth: Place of Birth: Seaman’s book UKR

Citizenship: Marital Status Schengen Visa

Height : Weight : Shoes : Hair color : / Eyes color : US Visa
Permanent address: Names of Children up to 18: -- Next of Kin Name/Address : Telephone/ Mob./ E-mail/ Skype :

Knowledge of language: -English- (Fluent , Good, Satisfactory, Poor) Results of testing, % : : CES 4.1 : Marlins :

DETAILS OF PREVIOUS 5 YEARS SEA SERVICE ( STARTING FROM LAST VESSEL FIRST )

Type of Vessel Type of

NAME of VESSEL GRT FLAG RANK Period of Service NAME OF OWNERS / OPERATORS
DP System ME/BHP

Form: CREW-002-Merchant Fleet Staff Created by OS

Application Approved by OY & VM
 TIDEMARINE LTD.
12/2, Ave. Shevchenko, office 3, P.O. 65058, Odessa, Ukraine
Telephone: +380-48-7065516 / +380-68-7458413 / +380-93-4618307 / +380-95-2516243
Email: crew@tidemarine.net, Website: www.tidemarine.net

Form: CREW-002-Merchant Fleet Staff Created by OS

Application Approved by OY & VM
 TIDEMARINE LTD.
12/2, Ave. Shevchenko, office 3, P.O. 65058, Odessa, Ukraine
Telephone: +380-48-7065516 / +380-68-7458413 / +380-93-4618307 / +380-95-2516243
Email: crew@tidemarine.net, Website: www.tidemarine.net

Maritime education
Q Please advise the complete information with regard to your maritime education and qualifications.
U
Professional Qualifications (Nautical College/Institute, Diploma/License) Studied from - to
A
L
I License particulars and S.T.C.W. courses
F
I Type and Class Serial No Date / Place of Issue Validity
C National Certificate of competence Grade/Capacity:
A
T
Endorsement of National Certificate of competence /
I
O
Capacity:
N Basic Safety Training and Instructions Reg. VI/1
S Survival craft, rescue boats Reg. VI/2-1
Advanced fire fighting Reg VI/3
L Medical first aid Reg. VI/4-1
I
Medical Care Reg. VI/4-2
C
E GMDSS / GOC Reg. IV/2
N ARPA/RADAR Resol. A.482,483 (XII)
S ECDIS
E Dangerous cargo
Ship’s security officer
C
O Ship’s safety officer
U Ship handling arrangements
R Bridge Team Management
S Tanker familiarization
E Chem TNK specialize training

Form: CREW-002-Merchant Fleet Staff Created by OS

Application Approved by OY & VM
 TIDEMARINE LTD.
12/2, Ave. Shevchenko, office 3, P.O. 65058, Odessa, Ukraine
Telephone: +380-48-7065516 / +380-68-7458413 / +380-93-4618307 / +380-95-2516243
Email: crew@tidemarine.net, Website: www.tidemarine.net

S Oil TNK specialize training

Liquiefied Gas TNK specialize training
Inert gas system
Crude oil washing
Ship Security Awareness Training
High Voltage (for ETO only)
Designated Ship Security Duties Training
Health Certificate Reg. I/9
Yellow Fever Certificate
Name of Owners Address / phones / email / www PIC

CARGO OPERATION EXPERIENCE DETAILS:

Container Cargo Experience (e.g. reefer cont.
Stowage, charters names, trading areas,
Over-stack info if available)

Form: CREW-002-Merchant Fleet Staff Created by OS

Application Approved by OY & VM
 TIDEMARINE LTD.
12/2, Ave. Shevchenko, office 3, P.O. 65058, Odessa, Ukraine
Telephone: +380-48-7065516 / +380-68-7458413 / +380-93-4618307 / +380-95-2516243
Email: crew@tidemarine.net, Website: www.tidemarine.net

Bulk Cargo info (e.g. draft survey info, charter,

Trading and etc.)

Tankers info (e.g. vetting passed, type of fuels/

Oils/chemicals carried, trading info)

SELF DECLARATION

Answer Yes or No to the following questions. If Yes, give details below Yes No
1 Has any previous employer dismissed you for misconduct?
2 Have you had any serious illness, injury or operation affection your work
3 Do you have any physical handicap including eyesight or hearing
4 Have you ever being convicted in a court of law in any country

I hereby certify that the above information provided by me is true and complete.
__________________________ _____________
Signature Date

Form: CREW-002-Merchant Fleet Staff Created by OS

Application Approved by OY & VM