A.Z.

SHIPPING SERVICES
(MLC-2006 Certified, No: CHG0/SUM/20130818091605)
Ship Manning Agent
Head office: City Shopping Complex (2nd Floor), Bepari Para, Agrabad, Chittagong, Tel: +880 31 2524486 , +880 31 2528581
E-mail: info@azshipping.net , crew@azshipping.net
PERSONAL DETAILS/OFFICER'S APPLICATION FORM
APPLIED FOR DATE
FIRST NAME MIDDLE NAME LAST/SUR NAME

DATE OF BIRTH PLACE OF BIRTH NATIONALITY PHOTO

BANGLADESHI

ADDRESS

E-MAIL PHONE MOBILE :

HEIGHT BOILER SUIT SIZE BLOOD GROUP MARITAL STATUS
WEIGHT S. SHOE SIZE COLOR OF EYE AVAILABILY
NEXT OF KIN/NAME RELATION DOB MOBILE/TEL
EMERGENCY CONTACT RELATION DOB MOBILE/TEL
FULL ADDRESS
BANK A/C DETAILS
ACADEMIC QUALIFICATION
TRAINING INST. NAME FROM TO CERTIFICATE OBTAINED GRADE / MARKS YEAR

RECORD OF SEA SERVICE

SERVED(MM/DD/YY) DURATION
OWNER / MANAGER SHIP'S NAME RANK GRT VESSEL TYPE FLAG Reason for Leaving
FROM TO MONTH/D%

DOCUMENT DETAILS
DOCUMENT NUMBER DATE OF ISSUE DATE OF EXPIRY PLACE OF ISSUE ISSUING AUTHORITY/REMARKS
PASSPORT
SEAMAN BOOK
COC: Class (Deck/Motor)
GMDSS (N/A for Engineer)
Seafarer's ID Card
VISA US- C1/D
US- B1/B2
SINGAPORE

MANDATORY COURSES AS PER STCW/SOLAS/ISPS

CERTIFICATE NAME CERT. NO. DATE OF ISSUE PLACE OF ISSUE ISSUING AUTHORITY VALIDITY
Elementary First Aid
Medical Care/Medical First Aid
PSSR
Fire Prevention and Fire Fighting
Advance Fire Fighting
PSCRB
Radar Observers Course (ROC)
Automatic Radar Plotting Aids (ARPA)
Bridge Team Management (BTM)
ISPS Familiarisation (ISPS FAM)
Pro. Ship Security Officer (PSSO)
Elect Chart display and info (ECDIS))
Tanker Familiarization (Oil, Chem & Gas)
Adv. Oil tanker Program.
Adv. Chem tank Program.
National License (COC N)
Flag State License (COC F)

DCE (Oil, Chem & Gas)

ADDITIONAL COURSES
Safety Management System (SMS)
Planned Maintenance System (PMS)
Risk Assessment and Management (RAM)
Energy Conservation
Accident Investigation
Environmental Awareness
Bridge Resource Management (BRM)
Bridge Engine Resource MGT (BERM)
Ship Board Safety Officer (SBSO)
OPA 90-VRP & VGP (OPA 90)
H Press Hydrs/Framo (HPS)
Vapour Emission Control System( VEC)
Officer of Watch (See note 08)
PSC and Vetting Inspections(INSPXN)

Life Boat on Load Release Gear (LBRG)