MSC CREWING SERVICES PRIVATE LIMITED

APPLICATION FORM
1 Position ID/PD No. (For Office Use Only)
_______________________
Position applied for: TRAINEE OS
Are you willing to accept any other positions? If YES, which positions would you consider? YES/NO N

Are you responding to a media advertisement? If YES, please state which publication
PHO YES/NO N
O
O

From what date will you be available?

TO O
1ST Nov 2022

2 Personal details

Name: (Surname) SINGH

(First Names) AMAN
(Middle Name)
Date/Place of Birth: 13-03-2002 / KOLKATA Nationality: INDIAN
Permanent address: 1,DEB NARAYAN BANERJEE ROAD, KALIGHAT, KOLKATA
Pin Code: 700026
E-Mail: amansingx3@gmail.com Tel No. Mobile 7044114706
Local address: 1, DEB NARAYAN BANERJEE ROAD, KALIGHAT, KOLKATA
Pin Code: 700026
E-Mail: amansingx3@gmail.com Tel No. Mobile 7044114706

3a Educational Background
Qualification School / College From To Percentage/ Grade
10th ANDHRA ASSOCIATION HIGH SCHOOL 2019 2020 48%
12th ANDHRA ASSOCIATION HIGH SCHOOL 2020 2021 52%

3b Technical Background
Degree/ Diploma Institute/ College From To Percentage / Grade
GP RATING TRIDENT COLLEGE OF MARINE TECHNOLOGY 01/01/2022 30/06/2022 PASS

4 Identity documents

DOCUMENT COUNTRY NUMBER DATE OF PLACE OF ISSUE DATE OF EXPIRY

Passport: INDIAN V0965631 ISSUE
15/03/2021 KOLKATA 14/03/2031
Seaman Book: National KOL 18/11/2021 KOLKATA 17/11/2031
Panamanian 127310
Liberian
Others
Do you hold a US Visa ‘C1/D’? YES/NO NO Issue Date: Expiry Date:
Do you hold a US Visa ‘B1/B2’? YES/NO NO Issue Date: Expiry Date:
Have you been rejected for any visa applied for? YES/NO NO
If YES, please state the country and reasons
INDOS No: (only for Indians) 21ZN1756 YELLOW FEWER V/T YES
MUI NO : V/T

5 Family Details: (If Unmarried kindly give details of Father / Mother)

NAME PASSPORT PLACE OF DATE OF DATE OF
Relation DOB POB EC
NO. ISSUE ISSUE EXPIRY
AJAY KUMAR SINGH FATHER 18-04-1977 BIHAR
SUSHMA SINGH MOTHER 01-03-1984 BIHAR

MSCCS-MANN-8.5-01-01 1ST MAY 2017 REV - 0 PAGE 1 OF 4

6 Certificates (Highest certificate of competency held)
Grade/Class Date of Certificate
Issuing Country Date Issued Place Issued Valid Until
Of COC Passing No.
Country Exam

7 Certificates Of Competency issued by other countries (Issued by countries other than in Section 6)

Issuing Country Certificate No. Date Place Valid Until

Panama Issued Issued
Others
8 Details of Courses
Courses Certificate No. Issued By Date Date Of Expiry
30300861012102312 TCMT Issued
21/06/2022 20/06/2027
FPFF / AFF
EFA / MFA / MEDICARE 30300861012102312 TCMT 21/062022 20/06/2027
PSCRB
PST 30300861012102312 TCMT 21/06/2022 20/06/2027
PSSR – Personal Safety & Social Responsibilities 30300861012102312 TCMT 21/06/2022 20/06/2027
SSO – Ship Security Officers Course
ISPS Course
ROSC – Radar OBS Simulator
ARPA – Automatic Radar Plotting Aid
RANSCO – Radar, Arpa & Navigation Simulator
BTM
SMS / SHS / ERS
ECDIS
Bridge / Engine Resources Management (BRM / ERM)
Ship Master Command and Control Course
GMDSS + endorsement
RUTC – Refresher & Up gradation Course
Container Operations Familiarization
Electrical Familiarization for Marine Engineers
Electronics for Marine Engineers
Instrumentation & Shipboard Control Systems
Automation and Controls
Container Refrigeration
Hydraulics for Engineers (Basic / Advance)
Hazmat (In compliance with STCW-95 Section-B -V/b & V/c & CFR – 49)
CFR-49 and Pneumatics Workshop
Hydraulics
Watch Keeping Certificate Ratings (Deck/Engine)
Applied Electronics (AELC)
Practical Marine Electrical Workshop
Engine Equipment Maintenance Workshop
Basic Electrical and Fluid Technology
Reefer Container and Maintenance Course
MEPC
Operational competence enhancement course for deck
officers
Safety, Environment Compliance & Pollution Prevention
Training for Crew
Vessel Resource Management (VRM)
Electro Technical Officer/ Rating Certificate
Security Training For Seafarers With Designated Security 3030086621210376 HMT 21/09/2021 NA
Duties (STSDSD)

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 9 Record of previous service
9 (Please give a full record starting with the last vessel on which you served)

VESSEL D.W.T/ CONTS VSL TYPE OF ENGINES SIGN ON SIGN OFF DURATION REASONS FOR
COMPANY VESSEL NAME B.H.P RANK
TYPE GRT TEU’S AGE (Please give full dtls) dd/mm/yy dd/mm/yy yy/mm/dd S/OFF

MSCCS-MANN-8.5-01-01 1ST MAY 2017 REV - 0 PAGE 3 OF 4

10 For Engineers (Please provide details)

Generators

Purifiers and Boilers

Type of Cranes / No of
Reefer Containers

11 Sailing Experience: (Please advise PRESENT RANK EXPERIENCE on each type of vessel)

Container PCC Reefer Multi Purpose Others

LAST SALARY DRAWN (PLEASE MENTION CURRENCY)

12 Medical history
Have you ever signed off a ship due to medical reasons? YES/NO NO
Have you undergone any operation in the past? YES/NO NO
Have you consulted a doctor during the last 12 months for an illness/accident? YES/NO NO
Do you have any health or disability problems now? YES/NO NO

(If the answer is YES to any of the above, please give full details and attach a separate page if necessary)

13 General

Have you ever been the subject of a court of enquiry or involved in a maritime accident? YES/NO NO
Have you ever had a professional license suspended or revoked? YES/NO NO

(If YES, please give full details and attach a separate page if necessary)

14 References (Please give the name and address of your current or immediate past employer)

Name of company 1. MEDITERRANEAN SHIPPING COPMANY 2.

Name of person to contact Capt. SANJAY KUMAR
Address 1/1B BENINANDAN STREET,2ND FLOOR
KOLKATA-700025.
 No. +91-8981591979

15 Review

If immediate employment is not available do you wish to be considered for future vacancies? YES/ NO YES
If YES, please give any alternative contact details not shown in Section 2 +91-983520731

16 Declaration

I hereby declare that the above particulars are true and authorise you to contact the referees listed above.

Date: 13-10-2022

Signature
17 BOILER SUIT SIZE: SAFETY SHOE SIZE:

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