CREW15

Application for Employment

Personal Information
Position Desired: CH.ENG. Date Available: 05/08/2023
(photo)
Name: ABDELMAWGOUD SAMY Age:
(Family Name) (First Name)

Address: 18 STR.ELTERSANA ELGOMROK Area: ALEX. Post Code:

Tel: Mobile: 201005890947 Email: samy1975.se@gmail.com

Sex: ### Male Female Marital Status: Married ### Single Spouse: SHERIHAN MOURSY

Children: 2 yousef & joudy

(Number) (Names)
Place of Birth: ALEX. Date: 27/08/1975 Father: ELSAYED Mother: RAQIA

In case of emergency notify: ELSAYED MOHAMED Tel: 1207435410

(Give name of closest relative)

Nationality: EGYPTION Passport No.: A22378031 Valid until: 25/04/2025

Seaman's Book: S00032833 Rank: CH.ENG. Voyages: Months:

Greek License No & Grade: Other Licenses:

(Translate in English) (Country, number and Grade)
STCW Certificates: 3507 18/07/2023 13/06/2028
(Copies should be attached) (Serial Number) (issued at) (Expiry Date)

(Serial Number) (issued at) (Expiry Date)

Other Certificates:
(Copies should be attached) (Title) (Serial Number) (issued at) (Expiry Date)

Knowledge of English: Speak: ### Excel Good Fair Read & Write: Excel Good ### Fair
Additional Languages Spoken:

Additional Info: Height / Weight: 170/65 Overall size: M Boots size: 41 Collar:

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 Employment History (last five years)
Dates Vessel Type/ DWT Engine Reason of
Vessel Name Company/ Phone Rank
Mo./ Year ∂ ● Discharge
From: 12/21
To: 05/23 ELREEDY STAR 20572525151 CONTINER MITSUBISHI CH.ENG
From: 04/21
To: 10/21 SCII 20572525151 CEMENT DEUTEZ350 CH.ENG
From: 09/20
To: 02/21 ELREEDY STAR 20572525151 CONTINER MITSUBISHI CH.ENG
From:###
### 6
To: ### 20 NAMMA 2025202272 RORO/PASSENGER WERKSPOR CH.ENG
From:###
### 5
To: ###
09/ 5 SINAA PASSENGER WARTSILA 2ND.ENG
From:
To:
From:
To:
From:
To:
From:
To:
∂ Bulker/ General/ Container/ Logger/ Freighter/ Reefer/ Tanker ● DOXFORD/ GOTAWERKEN/MAN-B&W/SULZER/MITSUBISHI/PIELSTICK/STORK

To be filled out by Crewing Manager

References:
Comments:
Planned for M/V:
Agreed Salary:
(Please continue on the reverse side.)

Medical History
(for statistical purposes, not affecting employment)
Prescription by Practitioner
Medication Reason imperative for drug related
medication
1.
2.

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4.
5.
6.

I hereby confirm that all the information provided by me above is true and correct to the best of my knowledge.
I hereby give my consent that any records stated herein are made accessible to any third-parties.

Date: 05/08/2023 Applicant's name & signature: SAMY ELSAYED MOHAMED

(To be filled out by Crewing Manager)

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 Application Date:
(dd/mm/yyyy) 05/08/2023

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