Scribd Logo
Upload

Welcome to Scribd!

  • Rank Applied:: Tel Document No. E Mail Issue Date Web Revision Sns Page No

    Uploaded by

    Rian Alben
    12 views3 pages
    This document contains a job application form for a seafarer position. It requests personal information such as name, date of birth, education history, certifications, medical information, passport details, emergency contacts, sea service history and shore service history. Documentation of qualifications like STCW certificates, medical exams, and documents like passports and visas are also required. Physical attributes like height, weight, and clothing sizes are requested. References from previous employers in the form of sea service on vessels and shore side jobs are also part of the application process.

    Original Description:

    formulir

    Original Title

    form

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document contains a job application form for a seafarer position. It requests personal information such as name, date of birth, education history, certifications, medical information, passport details, emergency contacts, sea service history and shore service history. Documentation of qualifications like STCW certificates, medical exams, and documents like passports and visas are also required. Physical attributes like height, weight, and clothing sizes are requested. References from previous employers in the form of sea service on vessels and shore side jobs are also part of the application process.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    12 views3 pages

    Rank Applied:: Tel Document No. E Mail Issue Date Web Revision Sns Page No

    Uploaded by

    Rian Alben
    This document contains a job application form for a seafarer position. It requests personal information such as name, date of birth, education history, certifications, medical information, passport details, emergency contacts, sea service history and shore service history. Documentation of qualifications like STCW certificates, medical exams, and documents like passports and visas are also required. Physical attributes like height, weight, and clothing sizes are requested. References from previous employers in the form of sea service on vessels and shore side jobs are also part of the application process.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    Tel +62-21-4585-0568/0569 Document No.

    BIF-CR-010

    E mail bsmid@bsmid.net Issue date 01 Apr 2018

    Web www.bsmid.net Revision 0

    Sns facebook.com/bsicrewing/ Page no 1 of 3

    RANK APPLIED :
    Personal information
    Name
    Place of birth
    Nationality Indonesia
    Date of birth
    Marital Status Married Single Divorced Widower
    PHOTO
    Religion
    Email

    Phone
    Mob
    Skype
    Address
    Family name Father: Mother: Wife : Yenyen

    The highest level of education & Knowledge of language


    School name Major Date of graduation
    Knowledge of English language Very good Good Satisfactory Fair Poor
    Knowledge of other language

    Body condition
    Height Weight Blood type
    Waist size Shoes size Boiler suit size
    Shirt size Parka size

    Detail of emergency contact


    Name Tel Mob
    Relationship Address

    Travel document
    Name of document Number Place of issue Date of issue Date of expiry
    Passport no
    Seaman book
    Citizenship
    UAE visa
    US visa
    Other visa

    Certificates of STCW
    Name of certification Number Date of issue Date of expiry
    Basic Safety Training
    Advanced Fire Fighting
    Proficiency in Survival Craft and Rescue
    Boats
    Security awareness training
    Ships Safety Officer
    Designated Security Duties
    Medical First Aid
    Personal Survival Techniques
    VI /1 A- VI /1-1.
    Document no BIF-CR-010 Issue date 01 Apr 2018
    Revision 0 Page no 2 of 3

    Certificates of STCW
    Name of certification Number Date of issue Date of expiry
    Fire Prevention and Fire Fighting
    VI /1 A- VI /1-2
    Personal Safety And Social
    Responsibilities VI /I A-VI/1-4
    Medical exam
    Drug & alcohol
    Yellow fever
    Cholera

    Sea service record


    Name of Flag of Period service Name of Company
    Grt Trading Duration
    No vessel Rank vessel (Reason of
    Hp Area From To (month) Disembarkation)
    / Type
    1

    Shore service record


    Type of Period service Duration
    No Name of company Position Main duty
    company From To (month)
    1

    *Reason of disembarkation : disembarkation : end of contract, will, dismissal, sickness, ship sold, ship total loss
    *Name of company : write name of ship owner or ship management company(Do not write name of manning company)

    Date Name & Signature :


    :

    You might also like