Pass Fail

Recruitment
Initials
Ops. Dept. Intro to Principal

PERSONAL DATA/APPLICATION FORM

S
BSM Crew Service Centre Philippines, Inc.
Rank/Position Applied For: ABLE SEAMAN

Last Name: First Name Middle Name

ALCAZAR RAFFY BAÑEZ
Home Address: Tel. No.

Contact Address: Cell No. Passport Photo

Email add:
alcazar061622@gmail.com
Place of Birth: Civil Status: SINGLE

Wedding Date:
Course Finished: Year Attended Name of School:
From:(dd/mm/yy) To: (dd/mm/yy)

Interests/Activities/Hobbies:

Languages Spoken (pls. check all applicable For Office Staff Use Only:
choices):  IHTS Height: _______ Cm
 English Blood Pressure:_____________ Weight: _______ Kg
 Filipino
Religion: ___________________ BMI: _______
 Others_________________________
SSS No.: TIN No.: PAG-IBIG No.: PHILHEALTH No.:

Cholera Exp.: Yellow Fever Reference No.: Year Started Seagoing Years in Present Employment:
Employment:

Next of Kin
Name: Date of Birth (dd/mm/yyyy): Relationship:

Address: Telephone No.:

Children Below 21 Years Old

Name Sex Date of Birth (dd/mm/yy)
RAZIYA S. ALCAZAR FEMALE 06/04/2016

RASHIKA S. ALCAZAR FEMALE 13/04/2017

Total No. of Children:

2
Parents Details
Mother’s Maiden Name: Father’s Name:
Date of Birth: Date of Birth:
Home Address:

BSM/Ser 11/Effective 19.06.18/PDAF

BSM/Ser 11/Effective 19.06.18/PDAF