Application for Employment
Personal Data
1.
First Name
Middle Name (s)
Nationality (or current
Citizenship )
Country of Origin
Last Name / Surname
Date of Birth:
PASSPORT SIZE
PHOTOGRAPH
HERE
Place / City of Birth
(DD / MM / YY)
Marital Status:
Gender :
Male
Female
Rank applied for:
Willing to accept lower rank?
Primary / Permanent Address:
Yes
No
Available From (date):
(DD / MM / YY)
Alternative / Temporary Address:
City:
Post Code:
City:
Post Code:
Country:
Nearest Airport :
Country:
Nearest Airport:
Mobile Ph:
Home Ph.:
Phone:
Mobile Ph:
Fax.:
Email:
Height :
Weight:
Hair Colour :
Eyes Colour :
Boilersuit Size :
Sweater Size :
Shirt Size :
Trousers Size :
Shoes Size :
2. Next of Kin & Family Details
Full Name of Nominee for compensation in case of fatality:
Relationship:
Gender : Male
Female
Nationality :
Address:
City:
Post Code:
Country:
Tel:
Mobile
3. Personal ID / Documents / Visa
Document
National passport
Seam.passport or
Seam.book
Medical Examination
Drug and Alcohol test
OGUK / UK Medical
Examination
Valid visas
TOSE
(Marlins Test of
Spoken English)
ISF Marlins Test
(online test)
Country of
Issue
Number
Date of Issue
(DD / MM / YY)
Valid Until
(DD / MM / YY)
Issued at (Place)
4. Maritime Educational Institution ( MEI )
Diploma
Number
Name of MEI
Grade
Year of Graduation
5. STCW-1978 ( amended 1995) Compliant Certificates / Courses and Other Qualifications:
Certificates of Competency:
Country of
Issue
Number
Date of Issue
(DD-MM-YY)
Date of Expiry
(DD-MM-YY)
Place of
Issue
Issuing Authority
/ Body
Other mandatory/recommended Certificates / Courses
Description of Cert / Course
ARPA & Radar (Reg II/1 +
Solas)
ARPA & Radar II/2
BTW and SAR
Personal Survival Techniques
Proficiency in Survival Craft & Rescue
Boat
Proficiency in Fast Rescue Boats
Advanced Fire Fighting
Medical First Aid
Medical Care
GMDSS -(GOC)
ECDIS
ECDIS-Furuno spec.
Ship Security Officer
Shipboard Safety Officer
Bridge Team & Resource
Management
HUET+EBS Opito Approved
BOSIET+EBS Opito Approved
BOSIET+EBS Nogepa 0.5A
BOSIET+OLF Supplement
DP-Induction
DP-Advance
Country of
Issue
Number
Date of
Issue
(DD-MMYY)
Date of
Expiry
(DD-MMYY)
Place of
Issue
Issuing Authority /
Body
6. Sea Experience :
Company
Ship’s Name
Flag
Type
DWT
HP
ME type
Rank
7. Two recent employers who we may contact for references:
Reference 1
Reference 2
Name of Company
Name of person to contact
Country
Telephone
Mail
Place:
Notes:
Date:
Signature:
Date From
dd/mm/yy
Date To
dd/mm/yy