SCANMAR MARITIME SERVICES, INC.

SKANFIL MARITIME SERVICES, INC.

2227 G/F Royal Enterprise Building, Chino Roces Avenue, Makati City 1231 PHOTO
Tel Nos. 8121319-22 / 8191013-17 Fax No. 8167494 E-mail: info@scanmar.com.ph (1x1)
DATE: ENGINE APPLICATION FORM
(Please write clearly with BLACK ball pen. Items with ** are OPTIONAL.)
PERSONAL DATA: AVAILABILITY: ___________________
Name: Position Applied
Last First Middle
Present Address Tel. No. Cell No.
Contact Address Tel. No. Cell No.
Weight (kg) Height (cm) Nationality Email
**Date of Birth Place of Birth Gender Civil Status Religion
SSS No. TIN No. PAG-IBIG No. Philhealth
Person to be notified in case of emergency Relationship
Address Tel. No. Cell No.
Mother’s Name: **Date of Birth: Tel. No.
Father’s Name: **Date of Birth: Tel No.
NEXT OF KIN:
DEPENDENTS RELATIONSHIP DATE OF BIRTH CONTACT NO.

EDUCATIONAL BACKGROUND: NAME OF SCHOOL/UNIVERSITY YEAR GRADUATED COURSE ATTAINED

Trade School/Vocational Course
College/University

SHIPBOARD EMPLOYMENT DOCUMENT / LICENSES: (attach photocopies of documents)

CERTIFICATE ISSUE EXPIRY ISSUE EXPIRY DATE
Flag License NUMBER
No. DATE DATE DATE
Seaman’s Book SBK_________
POEA eREG _____________
Philippine Passport SQC_________
R C1/D US Visa _____________
B1-OCS US Visa PRC LIC________
Schengen Visa ETO___________
National License ETR__________
National Endorsement _____________
National C.O.C _____________
III/5 COP-AB-ENGINE COVID 19 VACC_ NUMBER DATE BRAND
III/4 COP-EW 1st Dose_______
Yellow Fever Vaccine 2nd Dose______
SID Booster_______
STCW 2010 QUALIFICATION REQUIREMENTS:
ISSUE TRAINING ISSUE TRAINING
TRAINING CERTIFICATE NUMBER
DATE CENTER
TRAINING CERTIFICATE NUMBER
DATE CENTER
BT Maritime Law for Ship’s Officers
PSCRB Engine Watchkeeping
PFRB ADD’L FOR TANKER:
AFF BTOTC
MEFA BTLGT
STSDSD ATOT
ERS / ERRM ATCT
Consolidated MARPOL I-VI ATLGT
Auxiliary Machinery System ADD’L FOR PASSENGER:
Control Engineering Passenger Ship Crowd Management
Safety Training for Personnel Providing
High Voltage Direct Services to Passenger Spaces
HAZMAT Proficiency in Crisis Management
Human Behavior Training including
Passenger Safety, Cargo Safety & Hull
Integrity Training
ADD’L FOR OFFSHORE:
BOSIET / FOET
DP MAINTENANCE CERT
AMOS COURSE
OTHERS:

CERTIFICATE OF CERTIFICATE
SERIAL NUMBER ISSUE DATE EXPIRY DATE
PROFICIENCY (COP) NUMBER
BT-COP
PSCRB-COP
PFRB-COP
AFF-COP
MEFA-COP
STSDSD-COP
BTOTC-COP
BTLGT-COP
ATOT-COP
ATCT-COP
ATLG-COP

SHIPBOARD EXPERIENCE AT THE BACK

 DO NOT FILL BEYOND THIS LANE, FOR SCANMAR PERSONNEL USE ONLY
MEDICAL BACKGROUND YES NO IF YES, BRIEFLY DESCRIBE VERIFICATION OF LICENSES: EVALUATION OF NEW APPLICANT:
DATE REMARKS ASSESSMENT RESULTS: VERY GOOD GOOD FAIR REMARKS
ANY MAINTENANCE MEDICINE? NATIONAL COC
ANY PREVIOUS SURGERY /
ILLNESS? NATIONAL ENDR
SEA EXPERIENCE
ANY MEDICAL REPATRIATION?
Note: Submit previous or latest medical certificate from other company for verification COMPUTER BASED TEST
DO YOU HAVE ANY LEGAL CASES? YES / NO - If yes, please specify TRAINING COURSES COMPLETED
COMMUNICATION SKILLS
BACKGROUND/VERIFIED VIA: PHONE OR FAX
For Passenger Applicant:: Do you have visible tattoo? YES / NO ATTRIBUTES (Cleanliness,
If yes, please indicate the exact location ____________________________ Appearance, Overall impression)
OVERALL ASSESSMENT
I HEREBY CERTIFY that the foregoing statements are true and correct to the best of my knowledge and belief. Any false declaration I Please use another sheet for other observation
supplied herein, may constitute ground for disqualification or non-acceptance.

I hereby agree and give my consent to Scanmar/Skanfil, that it may collect, use, disclose and process my personal information set out in
______________________________ ________________________
this form and/or as otherwise provided by myself or possessed by the company for the Purposes stated in its Data Privacy Policy,
Recommended by Relationship to Applicant
including but not limited to (a) processing of this application; (b) selection process only; (c) if approved, the processing and administration
of my employment contract; and (4) compliance with the requirements of Philippine government authorities or foreign flag states / host
____________________________________________________
countries in connection with my engagement.
Signature over Printed Name of Interviewing Officer
_______________________________________________
Applicant’s Signature over Printed Name

NAME / SIGNATURE OF APPLICANT: ___________________________________________