Application for Sea based employment Page 1 of 4

Rev. No. 1
(CRW Form 02) Effective: 21 May 2021

Picture

1x1

Date Applied: __________________

 Management Level  Operational Level  Support Level

Position Applied: License:

Last Name, First Name, Middle Name Nickname

Present Address Province City Landline No.

Permanent Address Province City Cellphone No.

Date of Birth Place of Birth Civil Status

Single Married Widower Separated
Religion Nationality Height Weight Blood Type

Name Birthdate Contact No Occupation

Father
Mother
Spouse
Children (21 years and below: / SIBLINGS (if single)

Special skills Email Address

SSS number TIN Number PAGIBIG Number PHILHEALTH Number

Are you related to any employee of HSTC, FPCI and ESHCORP of any of its affiliate companies?
 YES  NO
Were you recommended to this Company?
 YES  NO
 Application for Sea based employment Page 2 of 4
Rev. No. 1
(CRW Form 02) Effective: 21 May 2021

LEVEL NAME OF SCHOOL DEGREE EARNED YEARS ATTENDED

PRIMARY
SECONDARY
VOCATIONAL
COLLEGE
POSTGRADUATE
EMPLOYMENT HISTORY (Start with present employment / please use back of page if space is not enough)
NAME OF VESSEL POSITION TYPE OF GRT (Deck) FROM TO SALARY NAME OF
VESSEL HP (Engine) (MM/DD/YY) (MM/DD/YY) COMPANY

Have you been involved in any Yes (pls give particulars)

administrative, civil, or criminal cases?

No
Have you ever been dismissed, forced to Yes (pls give particulars)
resign, retired from any employment for
reason other than lack of funds or
dropped from the roll?
No
Have you had any physical or mental Yes (pls give particulars)
condition which limits your ability to
perform the job applied for or pose a
potential risk to other employees? No

CHARACTER REFERENCES: List down at least two who are not related to you.
COMPLETE NAME ADDRESS/CONTACT NUMBER OCCUPATION
 Application for Sea based employment Page 3 of 4
Rev. No. 1
(CRW Form 02) Effective: 21 May 2021

QUALIFICATION DOCUMENTS NO. VALIDITY

Marina License
Seamans Record Identification Book (SIRB)
Domestic Certificate of Competency (D-COC)
Domestic Certificate of Proficiency (DCOP)
General Operator Certificate (GOC)
Ship Restricted Radio Operator Certificate (SRROC)
Health Card (yellow card)

TRAINING / CERTIFICATE COP No. NO. VALIDITY

1. Basic Training (BT)

2. Advance Fire Fighting (AFF)

3. Medical Emergency First Aid (MEFA)

4. Proficiency in Survival Craft & Rescue Boat (PSCRB) – if fitted

5. Safe Nav & ColReg

6. Basic Training Oil and Chemical Tanker (BTOC)

7. Advance Training for Oil Tanker Cargo Operations (ATOT)

8. Advance Training for Chemical Tanker Cargo Operations (ATCT)-

if fitted

9. Consolidated MARPOL

10. Deck Watch Keeping in the Domestic Trade (DW)

11. Engine Watch Keeping in the Domestic Trade (EW)

12. Ship Security Awareness Training and Seafarers with Designated

Security Duties (SDSD)

13. Maritime Laws (below 500 GT)

14. Medical Care (MECA)

15. Marine Occupational Safety & Health (MOSH)

16. Ship Handling and Manuevering

17. Ship Safety Officer Course or Shipboard Safety Officer Course

(SSOC)
 Application for Sea based employment Page 4 of 4
Rev. No. 1
(CRW Form 02) Effective: 21 May 2021

18. Radar Navigation, Radar Plotting and use of ARPA (RNRPU ARPA)

19. Radar Simulator Course (RSC)

20. Radar Observer Plotting Course (ROPA) if fitted

21. Ship Simulator Bridge Teamwork (SSBT)

22. Bridge Resource Management or Bridge Team Management

(BRM or BTM)

23. Engine Room Simulator w/ Engine Resource Management (ERS

w ERM)

24. Ship Security Officer (SSO)

25. Global Maritime Distress and Safety System (GMDSS)

26. TESDA Training Certificate (NC - III)

I understand that any misrepresentation, falsification, or omission of facts of whatever nature that are required by this application ,
shall be considered sufficient cause for disqualification at any time during my employment from any of the Strategic Business Units
within the Herma Group.
I am authorizing and giving my consent to the Herma Shipping & Transport Corporation, Flagship Petroleum Carriers, Inc and
Esguerra Shipping Corporation and its accredited third-party partners to collect, store, share and process my information as required
by RA 10173 and other applicable laws and regulations.

____________________________________
Signature Over Printed Name / Date

Data Privacy Act COMPLIANT