SEAFARER APPLICATION

DÖHLE MARINE SERVICES EUROPE LTD Passport

Batorego str.28-32, PO Box 379, 81-366 Gdynia 1, photo
Tel: +48 58 660 6099 , +48 58 660 8066 ,Fax: +48 58 660 5770 ,
E-mail: office@doehle-mse.com ,www.doehle-mse.com

Rank Surname 1st Name(s)

Date of Birth Place of Birth Nationality
Marital Status No. of Children Phone
Mobile Phone
Full Address
E-Mail Address
Nearest Airport Availability Date
Next of kin Relationship Phone
Address
Education Year completed
Identity / Travel Documents Nationality Type Number Place of Issue Issued Expiry
Passport
US-Visa
Other Visa
National Seaman Book
Other Seaman Book
Medical Certificates Nationality Type Number Place of Issue Issued Expiry
Certificate of Medical Fitness
Yellow Fever Vaccination
Certificates - Courses Nationality Position Number Place of Issue Issued Expiry
Certificate of Competence
Flag Certificate of Competence
Certificate of SSO
General Operator Cert. (GMDSS)
Basic Safety Training
Proficiency Survival Craft
Proficiency Fast Rescue Boats
Advanced Fire Fighting
Medical First Aid
Medical Care
HAZMAT (US-CFR 49)
ARPA
ECDIS Generic
ECDIS ship specific

Experience-Knowledge Subject or Hard- / Software Self-Evaluation (please tick)

Language Knowledge English Good Satisfactory Nil / Poor
Language Knowledge Good Satisfactory Nil / Poor
ECDIS (primary navigation) Good Satisfactory Nil / Poor
Computer Experience Microsoft Office (Word, Excel) Good Satisfactory Nil / Poor
Marine Software’s Good Satisfactory Nil / Poor
Stability / Cargo Planning System Belco/Macs3 Good Satisfactory Nil / Poor
Other Stability / Cargo System Good Satisfactory Nil / Poor
Planned Maintenance System CODie ISMAN Good Satisfactory Nil / Poor
Other Planned Maintenance Syst. Good Satisfactory Nil / Poor
Working Experience Monitor / Maintain Reefer Containers Good Satisfactory Nil / Poor
Working Experience Operate / Maintain Ship's Cranes Good Satisfactory Nil / Poor
Working Experience Automation Systems / ER Monitoring System Good Satisfactory Nil / Poor
Working Experience Common Rail M.E. Good Satisfactory Nil / Poor
Working Experience ISM ,PSC, Audits Good Satisfactory Nil / Poor
Nationalities of Seafarers you sailed with:
Senior Officers
Junior Officers
Ratings

Sea-Service (Last 5 years)

Rank Vessel Type IMO GRT TEU
No
 Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank Vessel IMO
Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe
r Chartere Trading
r Area

Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
From T Main Pow Vessel's
o Engine er Flag
Make -
kW
Type
 Employe Chartere Trading
r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area
Rank IMO
Vessel Type GRT TEU
No
Main Pow
T Engine er Vessel's
From
o Make - Flag
Type kW

Employe Chartere Trading

r r Area

By sending this application I am accepting below terms and condition:

1) I hereby affirm that all the information provided by me is true and correct to the best of my knowledge and belief. I further affirm that no certificate of Competency or License issued to me has ever been
revoked or suspended. I understand that previous employers may be asked for information concerning my employment record with them and I hereby release from liability or damage those individuals or
companies who provide such information.
2) I hereby agree to the use of my personal data included in my job application as acquired by the recruiting process (according to the Polish law of August 29, 1997 in respect of a protection of personal data
Dz. Ust. Nr 133 poz.833).