"K" LINE SHIP MANAGEMENT (INDIA) PVT LTD.

SEAMAN EMPLOYMENT APPLICATION FORM

LAST UPDATED
Personal Particulars Date of Availability 1-Oct-16
First Name: Rajamani Middle Name - Last Name: Mohan
Name (as in Passport) Rajamani Mohan Blood Group B+
Position Applied For C/E Sex MALE Marital Status MARRIED
Nationality INDIA Height 167 Date of Marriage 10-Nov-83
Date of Birth 6-Jan-54 Weight 78 No. of Children 2
Age 65 Shoe Size 41 Hair Color & Eye Color Black,Black
Place of Birth Karappattu(TN) Boiler suit size 52 Birth Mark

Nearest Domestic Airport Chennai Nearest Intl. Airport Chennai

Education (Final Academic only) Training and Apprenticeship

Institute Coimbatore Institute of Technology Institute Garden Reach Ship building

Course B.E.Mechanical Engineering Course Apprenticeship
Year of Completion 1977 Year of completion 1979

Permanent Address Present Address Bank A/C No.

Bank Name
Old No.40A, New No.127, Aanaikatti street Old No.40A, New No.127, Aanaikatti street
Branch Name

City Tiruvannamalai City Tiruvannamalai Bank Address : City

Landline Number 9443234821 Landline Number 9443234821

Mobile Number 9487734821 Mobile Number 9487734821

E-Mail Address rajmanimohan@yahoo.com Next of Kin - Name Vijayamohan Relationship Wife

Previous Employer Synergy Oceanic Private ltd Next ofKin-Address Old No.40A, New No.127, Aanaikatti street, Tiruvannamalai-606601, India

Family Details

Relationship Sex Name Surname DOB

Wife F Vijayamohan Mohan 26-Mar-58

Child ( M/ F) F Aarthiemohan Mohan 31-Oct-88
Child ( M/ F) M Suryakeerthimohan Mohan 2-Aug-91

Date of Issue (dd- Date of Expiry

Travel Documents Type Number Place of Issue
mm-yy) (dd-mm-yy)
Seaman Book No. CL 41951
Passport No.

U.S.A. Visa Details

Yellow Fever

INDOS NO

AUSTRALIA MCV VISA DETAILS

OTHER VISA DETAILS IF ANY

Date of Issue (dd- Date of Expiry

Highest Certificate held NAT Grade Number Place of Issue
mm-yy) (dd-mm-yy)
COC - Indian/UK/AUS/SIN/BAN

COC - REVALIDATION

GMDSS Indian/ UK/AUS/SIN/BAN

GMDSS Endorsement

DCE Oil Endorsement (Level)

DCE Chemical Endorsement (Level)

DCE GAS Endorsement (Level)

Others :

Form # 07-5/1(09/06) Sheet 1 of 3

 Date of Issue
STCW & Other Certificates/Endorsements Number Place of Issue Grade Issued By
(dd-mm-yy))

Elementary First Aid

Medical First Aid / MEDICARE

Personal Survival Techniques

Proficiency in Survival Craft & Rescue Boat

Fire Prev. & Fire Fighting

Advanced Fire Fighting

Personal Safety and Social Responsibilities

Oil Tanker Familiaraization

Spec Training Prog on Oil tanker Operation

Liquified Gas Tanker Familiaraization

Spec Training Prog on Liquified Gas Tnker Operation

Chemical Tanker Familiaraization

Spec Training Prog on Chemical tnker Operation

Revalidation Course Deck/ Engine

Refresher & Upgrading – COC/PSC/FPFF/MFA

Radar,Arpa and Navigation Simulator (RANSCO)

Radar Observer

Automatic Radar Plotting Aids

Ship Security Officer Course / ISPS

Liquid Cargo Handling Simulator

Ship Manoeuvring Simulator

Bridge Team Management (BTRM / BRM)

Bridge Simulator

Engine Room Simulator(BASIC/ ADVANCED)

ECDIS

NABCO

Hydraulic And Pneumatics

Automation and Controls

Reefer Container Maintenance

Pre-Sea Training for GP (Deck/Engine) / Saloon

Watchkeeping (Deck/Engine) for Ratings

Date of Issue Date of Expiry

Flag Endorsements for National Certificates Number Place of Issue Issued By
(dd-mm-yy)) (dd-mm-yy))

Japan Licence

Japan GMDSS

Liberian CDC

Liberian COC

Panama CDC

Panama COC

Panama GMDSS

Singapore DCE Endorsement

Hongkong Licence

Please specify below any other certificates held

Form # 07-5/1(09/06) Sheet 2 of 3

Sea Service Career. (PLEASE FILL IN AS LAST VESSEL FIRST)

ONBOARD PERIOD
TOTAL MAIN ENGINE MAKE & UMS
NAME OF PRINCIPALS VESSEL'S NAME RANK GRT VSL TYPE TEU / DWT BHP Reason for Sign Off Verified By
FROM (dd- TO (dd- Y/ M/D TYPE Y/N
mm-yy)) mm-yy)

0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0
0/0/0

Signature : …………………………
……………..

Form # 07-5/1(09/06) Sheet 3 of 3