JSM-02-R01

CHECKED BY

PERSONAL RECORD Manager G/Manager

( BIO DATA ) - ENGINE RATING

Jadeoriental Ship Management Co., Ltd.
Initial entry date Updated Date
Code No Rank Date employed Vessel :
Name :
Note : Myanmar people has no separation of Sur/Given/Middle Name, Above name is as per his passport.
Register Address Tel :
Current Address
Date of Birth Age 45 Nationality Myanmar Blood Pressure
Place of Birth Height (CM) Clothes size
Marital Status Weight (KG) Shoe size (MM)
BMI
Family Status Fill in below Yes(Y), No(N) or Nbr.
Father Mother Brother Sister Son Daughter
Next of Kin Relation

1. EDUCATIONAL ATTAINMENT
School /Address Majored in Course (From - To) Degree Graduation Date
-

2. SEAMAN BOOKS / PASSPORT / SID

Type Number Date Issued Expiry Date Issued By
Passport Myanmar MHA, Yangon
Panama N/A
Panama SSA N/A
Panama DSD N/A
Seaman Book Liberia N/A
Myanmar DMA, Yangon
Australian MCV Australia
Seafarers’ Identity Document DMA, Yangon

3. OTHER CERTIFICATES OF COMPETENCE

Kind of Certificate Number Regulation Date Issued Expiry Date Remarks
Other Certificates -

4. CERTIFICATES ( STCW 95 )
Kind of Certificate Number Date Issued Expiry Date

GENERAL
Basic Training (STCW 4 items)
PSC "Proficiency Survival Craft"
STCW-95 Watch-Keeping (Engine III/5)
Engine Cadet (MMU / IMT) N/A
SSA Certificate
DSD Certificate
SECD Pool Registered Date N/A

FOR TANKER
TFC Endorsement

5. MEDICAL INSPECTION / VACCINATIONS

Date Issued Expiry Date Remarks
Medical Examination -
Cholera -
Yellow Fever -
 JSM-02-R01

6. ON-BOARD SERVICE HISTORY FOR LAST 10 YEARS ( approx )

Vessel Name Type GRT Engine Type Tank Coating Manning Crew S/On date Sign off
Period
Flag Rank DWT Output (KW) Cargo Pump Co., Combination S/Off date Reason
Golden Unity
Panama
Golden Sky
Liberia
Golden Ace
Hongkong
Golden Resolution
Hongkong
Golden Resolution
Hongkong
Golden Taka
Panama
Golden Yosa
panama
Rong Yi
Panama
Sea Crystal
Panama
YC Lilac
Korea
Royal Aqua
Marshall Island
CS. Crane
Panama
Dong-A Selene
Korea
Mare Adriaticum
Antigua &Barbuda
Mare Lycium
Antigua Barbuda
Merkur Tide
Liberia
Merkur Beach
Liberia
Hong Hae Miyama
Korea
PK.Prosperity
Hondurs
Neptune Wind
Hondurs

7. SHORE CAREERS RELATING TO SHIP / MARITIME / TECHNICAL FIELD ( IF ANY )

Company Type of Job Position Service Duration Remark
N/A N/A N/A N/A N/A

8. SPECIAL COMMENTS

Health:
Experience ;

Trading Area ;

9. INTERVIEWER'S ASSESSMENT : INTERVIEWED BY LOCAL REPRESENTATIVE.

Family Smoking Drinking
A:Married/B:With parents/C:Alone A:None/B:Little/C:1 pack/day A:None/B:One can beer/C:Heavy

Any previous illness English level Eyes

A:None/C:With some remark A:Fluent/B:btwn A and C/C:Poor A:Clear,bright and positive C:Dark and negative

CES TEST Date Score

Job ability Motivation to be a seaman Why he wants to change Company.
A:Good/B:Normal/C:Poor A.Positive answer/C:Money purpose N/A

Crew Rank & Name

10-1). FILLED OUT AND CHECKED BY TEAM LEADER.

10-2). DOUBLE-CHECKED BY TEAM MANAGER.