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Application form

APPLICATION FOR SEA STAFF EMPLOYMENT
Applying for:
Position applied for:
Date available:
Nationality:
Date applying:
 
GENERAL INFORMATION
Surname*:
Name*:
Date of birth*: Country*:
Place of birth*:
Passport No:   
Issue Date: Expiry Date:
Place of Issue:
Permanent Address.
Country*:
Phone*:
City*:mob.Phone:
Street, house*:Fax:   
  E-mail:  
Present Address:     
Nearest Aiport/Station:
Marital Status*: No. of Children:
Next of kin*:
Address of next of kin*:
Height (cm) *: Weight (kg) *:Color of Hair*: Color of Eyes*: 
Boiler Suit size*: Shoes size*: 
 
CERTIFICATES
GRADE
NUMBER
PLACE OF ISSUE
ISSUED
EXPIRY
Certificate of competency
Endorsement / watchkeeping
Gmdss
Endorsement
      
Survival craft & rescue boat
Advanced fire fighting
Medical first aids / medical care
Radar
Arpa
Sso
Stcw / solos
Other courses
      
Medical fithess certificate
Yellow fever
National passport
Seaman's book
Other seaman's book
 
CERTIFICATE AUTHENTICITY VERIFIED?       YesNo
 
PREVIOUS SEA SERVICE
VESSELS NAME / COMPANY
TYPE
FLAG
GRT
KW
RANK
EMPLOYMENT PERIOD
REASON FOR LEAVING A VSL OTHER THAN COMPLETION OF CONTRACT:
 
LANGUAGES
EnglishGoodSatisfactoryPoor
GoodSatisfactoryPoor
GoodSatisfactoryPoor
 
OFFICE REMARKS