NORTRANSSM AFFIX HERE

OCS Services (India) Pvt.ltd YOUR

Tel: +91-22-66409000 RECENT
Fax:91-22-26743300 PASSPORT
E-mail: marineoperations@oilfieldcs.com SIZE
RPSL-MUM-038 – Expiry date – 17-Oct-2021 PHOTOGRAPH
APPLICATION FORM
Form no: 501 rev: 08 Date : 30 - 09 - 16

Post applied for : Willing to accept lower rank? Yes / Available From: / /

1. Personal Details
First Name: Middle Name : Last Name / Surname :

Nationality: Date of Birth: Place Of Birth:

Permanent Address Present / Temporary Address Until

City Pin City Pin

Tel: Mobile: Tel: Mobile:
E mail: E mail:
Nearest Airport : Mumbai / New Delhi / Chennai / Kolkata

Document Country No. Issued Place Valid Until

Passport
Seamen’s Book National
Seamen’s Book Liberian
Seamen’s Book Marshall islands
Seamen’s Book Panamanian
Seamen’s Book Other:
US visa – “C1” / “D” Yes/No
INDoS No. ECNR : Yes /No .

Name of Nominee Relation:

In case of fatality :
Address :
City City : Pin : Tel:
Family Details
Relationship First Name Last Name Date of Birth Passport No. Issued Place Valid Until
Wife
Child M/F
Child M/F
Child M/F
Child M/F

Indicate the type of valid visa* USA C1/D CANADA BRAZIL UK OTHERS
 Height ( In cms ) Weight (In Kgs) Shoe Size : Boiler Suit Size :

2. Certificates / Courses
A. Academic Qualification Year of Passing Highest Qualification attained Class
School / College

B. Training / Apprenticeship From To Institution / University

C.Highest Competency Certificate Held

Issuing Authority : Grade Certification No. Date Issued Place Issued Valid Until
National (Country :)
Liberian
Panamanian
Marshall Island
Cayman Island
Hong Kong
Cyprus

D. Dangerous Cargo Certification

1. Endorsement on NATIONAL Certificate Number Level Date Issued Place Issued Valid Until
Petroleum
Liquid Chemicals

E. Dangerous Cargo Endorsement ( Issued by Countries other than in Section 2D)

Country Type @ Capacity # Certificate No. Date Issued Valid Until

(#) Use following nomenclature: “Tankerman person in charge”, “ Tankerman assistant” @- Petroleum / Chemical

F. Watch Keeping Certificate: (For Ratings Only) (Include Liberian Special Qualification) :
Certificate to work as ( e .g. AB/ Oiler) Certificate No. Date Issued Place Issued Valid Until

G. Courses Attended and Certificates Obtained

Course / Certificates Certificate Number Date Issued Institution / Place Issued Valid Until
 Fire Fighting ( Advanced/Basic)
Medical Care / MFA / EFA
Proficiency in Survival Craft (PSCRB)
Personal Survival Techniques
Personal Safety & Social Responsibility
Specialized Training Prog. (Petroleum)
Specialized Training Prog. (Chemical)
Oil /Chem / Gas Tanker Familiarization
DCE (Oil / Chem / Gas) Advanced / Basic
Ship Security Officer/ STSDSD
Radar Observer
ARPA / RANSCO
Electro Tech. Officer (ETO)
Engine Simulator (Oper / Mang level )
Ship Handling Simulator/LVHS
Liquid Cargo Handling Simulator
GMDSS Endorsement
GMDSS GOC
AMOS-D/P.M. S
BTM-Collision Avoidance
Maritime Resource Management
Ship Safety Officer
Risk Management
ECDIS Generic
ECDIS Type Specific
Hydraulics & Pneumatics
PMEW/BEFT
Automation
NABCO
Tanker Vetting
ISM-Awareness
ISPS-Awareness
AB Course / Motorman Course
COP / Watch-keeping
Yellow Fever

3. General:
A. Have you ever been denied a foreign Visa? YES / NO.
If yes, state which Country and reason ( If known ) :
B. Have you been the subject to court of enquiry or involved in a maritime accident ? YES / NO.
(If yes, pl attach the details)
C. Do you have any Medical History/ Undergone surgery? YES / NO
(If yes, please attach details)
D. References: (Please give references from 2 recent employers who we may contact for references.)

Name of Company
Name of Person to Contact
Telephone

For Office Use Only

 4. Record of Sea Service (Please give a full record starting with the last vessel on which you served)
DWT / Main Engine Type * Date from Date To Period
Company Vessel / Type* BHP Rank Chkd
GRT Only Engineers Dd/mm/yy dd/mm/yy M D

*Use only following abbreviations for Vessel types:

GC – General Cargo B/C – Bulk Carrier CN – Cellular Container MP – Multi Purposer LV – Live Stocl OBO – Ore/Bulk/Oil Carrier
TNC – Tanker(Crude) TNP – Tanker(Product) TNV – VLCC/ULCC GAS – LPG/LNG Carriers RF – Reefer CH – Chemical Tanker
PAS – Passenger Ships R/R – Ro-Ro Vessels OSV – Offshore Vessels PCC – Car Carriers FSO/FPSO OT – Others

I HEREBY DECLARE THAT ALL INFORMATION FURNISHED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
I FURTHER DECLARE THAT PRIOR JOINING YOUR COMPANY; I WILL STAND RELEASED FROM MY PREVIOUS EMPLOYMENT.
I CONFIRM THAT I HAVE RECEIVED ACKNOWLEDGEMENT FOR MY APPLICATION

Date: ________________ Place: ___________________ ____________________

Signature of Applicant: