Application Form
Date of application: Click here to enter a date.
Name of manning agent:
General:
Last name:
Date of birth:
Address:
Country:
Telephone:
E-mail:
Position applying for:
Available from:
Sea history:
Vessel name
Vessel
type
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OFC-007 (08-15)
Please upload picture here
First name:
Place of birth:
City:
Nationality:
Mobile:
Skype ID:
Click here to enter a date.
Flag
Rank
DWT
Maker,
model,
BHP/KW
From
(dd/mm/yyyy)
Until
(dd/mm/yyyy)
Y/M/D
Company
Application Form
Documents:
Document name:
Passport:
Seamans book:
Others:
Country:
Number:
National license / endorsement:
Country:
Number:
Highest rank on endorsement:
Valid for chemical tankers:
Valid for oil tankers:
Place of issue:
Place of issue:
Place of issue:
Medical examination:
Country:
Date of issue:
Vaccination Yellow Fever:
Date of issue:
Expiry date:
Others:
Weight:
Height:
Marital Status:
Religion:
Nearest international airport
Nearest domestic airport
Date of issue:
Expiry date:
Date of issue:
Expiry date:
Date of issue:
Expiry date:
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Choose an item.
Other Flag State licenses:
Country:
Number:
Maritime education:
Grade:
OFC-007 (08-15)
School:
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Expiry date:
Country:
Date (from – to):
Application Form
OFC-007 (08-15)
Certifcates:
Date of issue:
Expiry date:
Date of issue:
Expiry date:
Basic safety training, or:
Personal survival techniques
Fire prevention and fire fighting
Elementry First Aid
Personal Safety / Social Responsibility
Proficiency in survival craft / PSCRB
Advanced fire fighting
GMDSS
Medical care on board
Medical First aid
Radar navigator
Shiphandling (IMO model course 1.22)
Bridge team and resource management
Engine room resource management
Ship Security Officer
Designated Security Duties
ECDIS (generic – IMO model course 1.27, 40 hrs.)
ECDIS JRC type specific training
ECDIS FURUNO type specific training
ECDIS TOTEM type specific training
Tanker familiarization
Advanced chemical training
Advanced oil training
Ship Safety Officer
Ships Cook training certificate
Steward/Messman certificate
Visa:
US Visa (C1/D)
Schengen visa
Next of kin:
Telephone:
Address:
No. of dependents
Relationship:
Relationship:
Relationship:
Relationship:
Relationship:
Date of birth:
Name:
Name:
Name:
Name:
Date of birth:
Date of birth:
Date of birth:
Date of birth:
Application Form
OFC-007 (08-15)
Tanker Information Sheet - (For applications of Deck Officers, Bosun and Pumpman)
YES/NO
Year*
Rank**
Chemical Products
Aromatics:
Styrene
-
Toluene
-
Benzene
-
Xylene
-
Alcohols & Glykols
-
Methanol
-
Ethanol
-
Iso-propyl Alcohol (IPA)
-
Butyl /Isobutyl Alcohol
-
2-Ethylhexanol (Octanol)
-
Mono Ethylene Glycol (MEG)
-
Molasses
-
-
Acids:
Phosphoric
-
Sulphiric
-
Acrylic
-
Acetic
-
-
Paraffins:
Slack Wax
-
Hexane
-
Cyclohexane
-
-
Vegoils:
Such as Crude Palm Oil,
Rapeseed Oil, Soyabean Oil,
Sunflower Oil, etc.
*Year: enter year of latest experience
Yes/No
Year*
Rank**
Chemical Products
-
-
Perchlorethylene
-
Trichlorethylene
-
MDI/TDI
-
Ethylene/Methylene Dichloride
-
Styrene Monomer
-
MethylTert-Butyl Ether (MTBE)
-
Butyl Acetate
-
Acetone
-
Acrylonitrile
-
Caustic Soda
-
Chloroform
-
Phenols
-
Propylene Oxide
-
Vinyl Acetate Monomer (VAM)
-
Urea Ammonia Nitrate
-
Dowanol
-
-
-
Clean Petroleum Products (CPP):
Gasoil /Diesel Oil
-
ULSD
-
Gasoline
-
Naphta
-
Fuel Oil
-
Luboils
-
-
**Rank: enter highest rank of experience
Parcel Trade Exp. (max. no during single voyage):
Cargo Pumps Experience
Deepwell:
Framo
Marflex (electrical driven)
Centrifugal
Screw
Steam Turbine
Vetting Inspections (indicate which)
CDI Inspection (indicate date of last inspection)
OCIMF Inspection (indicate date of last
inspection)
USCG Inspection (indicate date of last inspection)
Dry Dock Experience (indicate shipyard)
Experience in Delivery of New Buildings
Trading Area (indicate areas)
Ice Navigation Experience (indicate areas)
Ship-to-Ship Experience (indicate areas)
Tank’s Coating Type Experience
Expoxy
Zinc Silicate
Marineline
Stainless Steel
Tank’s Passivation Experience
Wall Wash Experience
-