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Seaman Employment Application Form

This document is a Seaman's Employment Application Form that collects personal details, employment history, and qualifications of the applicant. It includes sections for personal particulars, documents and certificates, sea service, and special remarks. The form requires the applicant's signature and date for submission.

Uploaded by

Carina Chyrill A. Moribus
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© All Rights Reserved
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36 views1 page

Seaman Employment Application Form

This document is a Seaman's Employment Application Form that collects personal details, employment history, and qualifications of the applicant. It includes sections for personal particulars, documents and certificates, sea service, and special remarks. The form requires the applicant's signature and date for submission.

Uploaded by

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

SEAMAN’S EMPLOYMENT APPLICATION FORM

Foto
Position applied for: Second choice (if any): Available from:
Family name: First name:
Personal particulars
Date of birth: Place of birth: Nationality:
Marital status: Color of hair: Color of eyes:
Height (cm): Weight (kg): Size: Shoes:
Name of father:_____________ Name of mother:_____________ Name of spouse:_______
Children under 18 (name/date of birth):______________________________________________________________________
Home address:
Telephones:
Next of Kin: Surname________Name_____________ Relationship__________
Address/Telephones
The same
E-mail:

Documents and certificates


Documents No Place of issue Date of issue Valid until
Seaman’s passport
Civil travel passport
Civil passport ID №

Certificates of Grade No Place of issue Date of issue Endorsement


Competency valid until
National
Malta
Liberia
Name of Marine School (Academy):_____________________________________________________ Graduated on _______

STCW Certificates No Date of issue Valid until


Basic safety/survival at sea
GMDSS
ROPS, ARPA
Advanced fire-fighting
Proficiency in survival craft
Medical care / First aid
Dangerous cargo (Hazmat)
Security officer
Safety officer
Yellow fever
US VISA
Sea Service during last five years (count backwards)
Rank Vessel’s Main engine Ship-owner/Manager From To
Name Flag Type DWT Type HP ([Link]) ([Link])

Наличие справок о плавании и отзывов о работе приветствуется


Notes:

Special Remarks (to be filled by office only)


English: ______ PS Test: _____ Other: -
___________________________________________________________________

Signature _____________________________ Date __________________

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