Application for Employment

Marine Personnel
Position: Completed? Please send form to: crew.management@hlag.com

Personal Details
General
Surname:
First Name: Middle Name:
Picture
Nationality: Sex:
Birthday: Birthplace:
Civil Status: No.of Children / Dependent:

Address
Street: Tel.: + /
City/ZIP Code: Mobile: + /
Country: Fax: + /
Airport: or: Email:

Next of Kin
Name: Tel.: + /
Relation: Mobile: + /
Street: Fax: + /
City/Country: Email:

Travel Documents
Passport No: Issued: Expired: Place:
Seamansbook No: Issued: Expired: Place:
German SB.No: Issued: Expired: Place:
U.S.VISA No: Issued: Expired: Place:
Other Visa No: Issued: Expired: Place:
Other Visa No: Issued: Expired: Place:

Languages
Mother Language:
Level of English (written): Level of English (spoken):
Other Language:
Other Language:

Medical Fitness
National (Place): Issued: Expired:
German (Place): Issued: Expired:

Vaccination
Cholera: Issued: Expired:
Yellow Fever: Issued: Expired:
Other: Issued: Expired:
Other: Issued: Expired:
Application for Employment
Marine Personnel
Position: Completed? Please send form to: crew.management@hlag.com

Qualification
1. Certificate of Competency (Nautical or Technical)
1.1. National
Competence: Cert.No: Issued: Expired:
1.2. German
Competence: Cert.No: Issued: Expired:
1.3. Watchkeeping (Deck/Engine)
Cert.No: Issued:

2. GOC (General Operator's Certificate )

2.1. National
Cert.No: Issued: Expired: Place:
2.2. German
Cert.No: Issued: Expired: Place:

3. BASIC SAFETY TRAINING STCW

3.1. Basic Safety Bundle
Cert.No: Issued: Expired: Place:
3.2. Certificate of Proficiency in Survival Craft
Cert.No: Issued: Place:
3.3. Certificate of Proficiency in Fast Rescue Boat
Cert.No: Issued: Place:
3.4. Medical Care
Cert.No: Issued: Expired: Place:
3.5. Medical First Aid
Cert.No: Issued: Place:
3.6. Advanced Fire Fighting
Cert.No: Issued: Place:
3.7. ISPS Ships Security Officer
Cert.No: Issued: Place:
3.8. Dangerous, hazardous & harmful cargoes (HAZMAT)
Cert.No: Issued: Expired: Place:

4. Other Certificates/ Courses

4.1. High Voltage
Cert.No: Issued:
4.2. Automatic Radar Plotting (ARPA)
Cert.No: Issued:
4.3. ME Electronic Engine
Cert.No: Issued:
4.4. LNG Fuel Basic (IGF I) LNG Fuel Advanced (II)
Cert.No: Issued: Expired: Place:

Cert.No: Issued: Expired: Place:

5. Any Other Additional Qualification

Application for Employment
Marine Personnel
Position: Completed? Please send form to: crew.management@hlag.com

Experience
1. Training Courses
Training Course / Seminar Location Duration Date

2. Graduated From:

3. Form of Education:

4. Sea Service (For last five years or last 10 ships served)

Type Engine from
Name of vessel Rank
Gross tonnage kW Company to

5. Availability for Serivce:

Date: Remarks:

6. Notes and Remarks: