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Seaman's Application Form Template

This document appears to be an application form for a seaman position. It requests personal details of the applicant such as name, date of birth, passport information, qualifications, medical information, and records of previous sea service including vessel names, flags, positions held, and dates of employment. National and international certifications are also listed to verify the applicant's qualifications for the position.

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58 views1 page

Seaman's Application Form Template

This document appears to be an application form for a seaman position. It requests personal details of the applicant such as name, date of birth, passport information, qualifications, medical information, and records of previous sea service including vessel names, flags, positions held, and dates of employment. National and international certifications are also listed to verify the applicant's qualifications for the position.

Uploaded by

57f9bmfjf2
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

SEAMAN's APPLICATION FORM

FOTO A. SEAMAN'S PERSONAL DETAILS

POSITION TO APPLY FOR CERTIFIED FOR


NAME / SURNAME
FATHER'S NAME MOTHER'S NAME
D.O.B./P.O.B. NATIONALITY UKRAINE
Height (in cm): Weight (Kg): Shoes size: Parka size:
ADDRESS
MOBILE No.: SKYPE ADDRESS:
e-mail:
PHONE No.:
MARITAL STATUS MARRIED CHILDREN HOW MANY UNDER
YES NO YES NO 18 YRS OLD
NEXT OF KIN RELATION
SEAMAN'S PASSP NO. ISS / VALID DATE
TRAVEL PASSP NO. ISS / VALID DATE
GRADUATED FROM
ENGLISH ABILITY FLUENT VERY GOOD GOOD FAIR

B. NATIONAL CERTIFICATION
CERTIFICATE NUMBER ISSUING - VALIDATION ISSUING PLACE
DATE
CERTIFICATE OF COMPETENCY
ENDORSEMENT OF CERTIFICATE
GMDSS CERTIFICATE
ENDORSEMENT OF GMDSS
SHIP SECURITY OFFICER
BASIC SAFETY
PROFICIENCY IN SURV CRAFT
MEDICAL FIRST AID
ADVANCED FIRE FIGHTING
BRIDGE/ENGINE - TEAM MNGMNT
SECURITY RELATED TRAINING
DESIGNATED SECURITY DUTIES
SAFETY FAMILIARIZATION

ECDIS
RADAR, ARPA (DECK OFF.)
DANGEROUS SUBSTANCES
LAST MEDICAL
USA VISA
VACCINATIONS YELLOW FEVER : DOI DOE
CHOLERA : DOI………………………. DOE ……………………….

C. FLAG CERTIFICATION
Based on NATIONAL
FLAG TYPE / No. RANK ISSUED VALID ENDORSEMENT
([Link]/ENDORS/STICKER) NUMBER

D. PREVIOUS SEA SERVICE


VESSEL FLAG TYPE/DWT ENG/HP RANK S/ON S/OFF OWNERS

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