SEAMAN APPLICATION FORM

POSITION APPLIED : Chief Engineer DATE :

Name Date / Place of Birth Home Address Nationality Religion

Overall / Shoes Size Status Height / Weight Next of Kin / Contact Number
Relationship

Document Number Date of issued Date of Expiry

Passport
Seaman Book
CERTIFICATE OF SEAFARER ( IMO – STCW )

Certificate of Competency Certificate Number Place / Date of Issue

Certificate of Proficiency of Special Education and training for Seafarers

Name of Certificates Number Issue Date Place of Issue
Basic Safety Training
Proficiency In Survival Craft And Rescue Boats
Advance Fire Fighting
Medical First Aid
Medical Care On Board Ship
Tanker Familiarization
Oil Tanker Specialized Training Program
Ship Security Officer
SEA SERVICES

No Name of Type of Rank HP / Sign On Sign off Company Trading

Vessel Vessel Engine Area