APPLICATION FORM - MARINE PERSONNEL

POSITION APPLIED FOR :

Are you willing to accept a lower position ? PHOTO

Date available if selected ?

Surname :

First Name : Mid Name :

Marital Status : Nationality :

Date of Birth : Age: 122.50 Place :

Height (cms) : Weight (kgs) : Shoe Size : Blood Group :

UK / USA / Europe
Religion

Address (1) : Telephone :

(Present) Mobile :
E-mail :
Fax :

Address (2) : Telephone :

(Permanent) Mobile :
E-mail :
Fax :

Nearest Airport:
(International) (Domestic)

FAMILY DETAILS

Next of Kin : Relation :

Address : Telephone :
Mobile :
E-mail :

Date of Birth
Children : Name Sex
(dd/mmm/yy)

BW Maritime Pte. Ltd., 10, Pasir Panjang Rd, #18-01 Mapletree Business City, Singapore 117438
Tel: +65 6337 2133 Fax: +65 6337 1623 www.bwshipping.com, www.bwgroup.net 1/7
(IBO Form # 07-5/1 Rev 1)
 EDUCATION / TRAINING

Period (dd/mm/yy)
School / College / Institution Attended Certificate / Diploma obtained
From To

MEDICAL HISTORY

Have you ever signed off any ship due to medical reasons ?
Have you undergone any surgery in the past ?
Have you consulted a doctor during the last 12 months for any illness or accident ?
Have you ever been tested positive for any drug and alcohol test ?
(Please mention Yes, No or N/A if the form is being filled manually)
If the answer is YES to any of the above, please give full details below and attach a separate page if necessary

TRAVEL DOCUMENTS AND COMPETENCY CERTIFICATES (Date in dd/mm/yy)

Place of
Document Capacity / Grade Cert. No. Issued Date Expiry Date Remarks
Issue
Passport -
U.S visa (C1/D) -
U.S visa (B1/B2) -
Medical Certificate -
INDOS Number -
Yellow Fever -
National
Seaman's book

Panama
Liberia
NIS
Bahamas
Others
Enter GRADE of Certificate
National
Panama
Certificate of

Hong Kong
competency

Singapore
Liberia
NIS Enter :
Bahamas Level 1
Level 2
Others
National LPG
National OIL
National CHE
Dangerous Cargo
Endorsement

Panama
Hong Kong
Singapore
Liberia
NIS
Bahamas
Others
National
Panama
Hong Kong
GMDSS

Singapore
Liberia
NIS
Bahamas
Others

BW Maritime Pte. Ltd., 10, Pasir Panjang Rd, #18-01 Mapletree Business City, Singapore 117438
Tel: +65 6337 2133 Fax: +65 6337 1623 www.bwshipping.com, www.bwgroup.net 2/7
(IBO Form # 07-5/1 Rev 1)
 PROFESSIONAL COURSES (Date in dd/mm/yy)

Type Certificate Number Date Issued Institute / Remarks

Advanced Fire Fighting

Fire Prevention and Fire Fighting
Basic Fire Fighting (shore based)
Personal Survival Techniques
Proficiency in Survival Craft & Rescue Boat
Personal Safety & Social Responsibility
Ship Captain's Medicare
Medical First Aid
Radar Simulator
Radar Observer
Automatic Radar Plotting Aid
Basic Tanker Familiarization (Oil / Gas / Chemical) *
Specialised Tanker Safety Course (Oil) - TASCO
Specialised Tanker Safety Course (Gas) - GASCO
Specialised Tanker Safety Course (Chemical) - CHEMCO
Crude Oil Washing / Inert Gas
AMOS (or any other electronic Planned Maintenance System) *
Ship Security Officer
Ship Safety Officer
Watchkeeping for Engine Room Watches (E/R Ratings)
Watchkeeping for Navigational Watches (Deck Ratings)
Ship Manoeuvring Simulator & Bridge Teamwork
Engine Room Simulator *
NABCO M/E Manoeuvring & Control *
Radar Maintenance Course
Electronic Navigation Aids
Electronic Chart Display & Information Systems including INS
Collision Avoidance Course
Liquid Cargo/Ballast Handling Simulator *
Bridge Team Management
Bridge/Engine Resource Management
Dangerous, Hazardous and Harmful Cargoes (HAZMAT)
Internal Auditor's Course
Port State Control
Hydraulics and Pneumatics
Applied Electronics
Marine Electrical
Welding Course
Computer Knowledge
Catering or Cooking Course
Corrosion Protection & Painting Course
Others than above :

1) Please mention the level/category of course in remarks column if marked with an asterisk * Select :
DWT / GRT /
2) Details of any additional courses attended to be filled-up in the blank spaces Cu Metres

BW Maritime Pte. Ltd., 10, Pasir Panjang Rd, #18-01 Mapletree Business City, Singapore 117438
Tel: +65 6337 2133 Fax: +65 6337 1623 www.bwshipping.com, www.bwgroup.net 3/7
(IBO Form # 07-5/1 Rev 1)
 Select :
DWT / GRT /
Cu Metres

SEAGOING EXPERIENCE (If space not sufficient below, please use separate sheet)

DWT / Period of Service

M/E Type BHP (for (dd-mm-yy)
Rank Name of Vessel Your Employer Vessel Type* GRT / Days
(for Engr)* Engrs)
Cu Mtrs From To
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
* Please complete the 'vessel type' or 'engine type' categories as per nomenclature below, in case application form is being completed by hand

CONSOLIDATED SEAGOING EXPERIENCE

Deck Officer Rank Served Years Months Engineer Officer Rank Served Years Months
Product Carrier B&W
Crude Carrier SULZER
VLCC / ULCC MAN
Chemical Carrier PIELSTICK
Bulk Carrier Gas Turbine
OBO Steam Turbine
General Cargo / Cont. UMS
LPG / LNG
Others

REFERENCES (Must mention details of person to contact from applicant's last employers. Reference check shall not be taken without the consent of applicant)

Name Company Contact details

Have you been involved in either or both of the following, during service with any of your previous employers?
(a) a maritime accident involving loss of life and/or a considerable loss of property
(b) an incident involving oil pollution damage to environment

If the answer to above is YES, please give details and attach a separate page if necessary

I certify that the above information is true and correct. I fully understand and agree that any false declaration herein above shall result in instant dismissal
without any responsibility or liability whatsoever on the part of the company.

Date : Applicant

BW Maritime Pte. Ltd., 10, Pasir Panjang Rd, #18-01 Mapletree Business City, Singapore 117438
Tel: +65 6337 2133 Fax: +65 6337 1623 www.bwshipping.com, www.bwgroup.net 4/7
(IBO Form # 07-5/1 Rev 1)
ADDITIONAL PROFESSIONAL COURSES (Date in dd/mm/yy)

Type Certificate Number Date Issued Institute / Remarks

SEAGOING EXPERIENCE (If space not sufficient below, please use separate sheet)

Period of Service
M/E Type BHP (for (dd-mm-yy)
Rank Name of Vessel Your Employer Vessel Type* DWT Days
(for Engr)* Engrs)
From To
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
* Please complete the 'vessel type' or 'engine type' categories as per nomenclature below, in case application form is being completed by hand

CONSOLIDATED SEAGOING EXPERIENCE

Deck Officer Rank Served Years Months Engineer Officer Rank Served Years Months
Product Carrier B&W
Crude Carrier SULZER
VLCC / ULCC MAN
Chemical Carrier PIELSTICK
Bulk Carrier Gas Turbine
OBO Steam Turbine
General Cargo / Cont. UMS
LPG / LNG
Others

REFERENCES (Must mention details of person to contact from applicant's last employers. Reference check shall not be taken without the consent of applicant)

Name Company Contact details

I certify that the above information is true and correct. I fully understand and agree that any false declaration herein above shall result in instant dismissal
without any responsibility or liability whatsoever on the part of the company.
Date : Applicant