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Crew Application Form 3

This document is a seafarer application form containing personal and professional details. Section 1 requests personal details like name, date of birth, nationality, and contact information. Section 2 asks for current and temporary addresses. Section 3 is for next of kin contact information. Sections 4-6 cover travel documents, bank account, and education history. Sections 7-11 request professional qualifications, language skills, vaccinations, marine training courses, and health certificates. The final section is for sea service details including vessel names, types, dates served, and engine details. The applicant agrees to share this data with potential foreign employers for recruitment purposes.

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Mati Bzdury
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182 views4 pages

Crew Application Form 3

This document is a seafarer application form containing personal and professional details. Section 1 requests personal details like name, date of birth, nationality, and contact information. Section 2 asks for current and temporary addresses. Section 3 is for next of kin contact information. Sections 4-6 cover travel documents, bank account, and education history. Sections 7-11 request professional qualifications, language skills, vaccinations, marine training courses, and health certificates. The final section is for sea service details including vessel names, types, dates served, and engine details. The applicant agrees to share this data with potential foreign employers for recruitment purposes.

Uploaded by

Mati Bzdury
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Seafarer Application Form - 3

APPLICATION FOR OTHER POSITION (IF


POSITION AS ANY)

1
1. PERSONAL DETAILS
SURNAME
FIRST NAME OTHER NAMES
DATE OF BIRTH PLACE OF BIRTH
NATIONALITY MARITAL STATUS
NEAREST INTERNATIONAL AIRPORT:
2. ADDRESS ADDRESS (TEMP.) FROM/TO:
NO & STREET NO & STREET
CITY CITY
POST CODE POST CODE
COUNTRY COUNTRY
TEL. NO. TEL. NO.
MOBILE MOBILE
E-MAIL E-MAIL
3. NEXT OF KIN
FULL NAME RELATIONSHIP
ADDRESS
CITY COUNTRY
TEL. NO. MOBILE EMAIL
4. TRAVEL DOCUMENTS
TYPE DOCUMENT NO. ISS.DATE EXP. DATE ISS. BY (AUTHORITY) PLACE OF ISSUE
PASSPORT
SEAMAN’S BOOK
US C1/D VISA
5. BANK ACCOUNT INFORMATION
BANK NAME BRANCH
BANK ADDRESS
CITY SWIFT CODE
ACCOUNT NUMBER
ACCOUNT OWNER’S NAME
AND ADDRESS
6. EDUCATION
SCHOOL NAME FROM TO

SCHOOL NAME FROM TO

2
7. PROFESSIONAL QUALIFICATION / CERTIFICATE OF COMPETENCY
EXPIRY ISSUED BY ISSUED AT
CERTIFICATE NAME NUMBER ISSUE DATE
DATE (AUTHORITY) (PLACE)

8. LANGUAGES
ENGLISH FLUENT GOOD FAIR POOR

MARLIN’S TEST / LEVEL ISSUED DATE RESULT % ISSUED BY (AUTHORITY) ISSUED AT

9. VACCINATIONS
NAME ISSUE DATE EXPIRY DATE ISSUED BY (AUTHORITY) ISSUED AT
YELLOW FEVER
TYPHOID
TETANUS
10. MARINE COURSES
ISSUE EXPIRY ISSUED BY ISSUED AT
COURSE NAME NUMBER
DATE DATE (AUTHORITY) (PLACE)
PERSONAL SURVIVAL
BASIC FIRE FIGHTING
ADVANCED FIRE FIGHTING
ELEMENTARY FIRST AID
MEDICAL FIRST AID
MEDICAL CARE
PERS. SAFETY & SOC. RESP.
PROF. IN SURVIVAL CRAFT &
RESCUE BOATS
FAST RESCUE BOATS
G.M.D.S.S.
A.R.P.A.
RADAR OBSERVATION
HAZMAT
BASIC OIL TANKERS
ADVANCED OIL TANKERS
BASIC CHEMICAL TANKERS
ADVANCED CHEM. TANKERS
SHIP SECURITY OFFICER
BRIDGE TEAM MANAGEMENT
ECDIS
SHIP HANDLING COURSE
SECURITY AWARNESS VI/6.1
DESIGNATED DUTIES VI/6.4

11. HEALTH CERTIFICATE


ISSUE EXPIRY ISSUED BY ISSUED AT
FLAGE STATE NUMBER
DATE DATE (AUTHORITY) (PLACE)
INTERNATIONAL
DANISH
NORWEGIAN
PANAMANIAN

3
SEA – SERVICE DETAILS

AVALIABILITY
NAME: RANK:
DATE:
SIGNED SIGNED
COMPANY NAME RANK VESSEL NAME VESSEL TYPE G.R.T. D.W.T. ENGINE TYPE BHP KW
ON OFF

"I hereby authorize Alba Tankers Poland to process my personal data included in my job application for the needs of the recruitment process in accordance with the Personal Data Protection Act dated 29.08.1997
(uniform text: Journal of Laws of the Republic of Poland 2002 No 101, item 926 with further amendments)" I also agree to sharing the above mentioned data with foreign employers using crew consulting service offered
by Alba Tankers Poland for job recruitment purpose. I accept that my personal data can be made available to other parties offering recruitment services for individual applying for the job on board the vessel. I declare I
have been informed that I have right to view and correct my personal data. I also declare that the above information I given is, to the best of my knowledge true and complete.

Date & Signature :_________________________

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