7. Sailing Experience by Rank - Please Complete in Full for All Ranks, As Applicable

7. Sailing Experience by Rank - Please Complete in Full for All Ranks, As Applicable

ATLAS INEXCO

  1. Personal Particulars
Positionappliedfor
Family name
Given name(s)
Nationality
Date of birth
Place of birth
Nearest Airport
Gender
Marital status
No of dependents
  1. Contact details

Home phone
Cellphone
E-mail
Skype
Physicaladdress
  1. Travel Documents

Type / Country of Issue / Number / Date of Issue / Expiry Date
Passport
National SRB
FlagSeamansBook
Police Clearance
Visa
  1. Medical background

Type / Country of Issue / Date of Issue / Expiry Date / Remarks / Notes
SAMSAMedicalCert.
OtherMedicalCert.
FlagstateMedical
Drugs & Alcohol
Yellow Fever Vac.
Typhoid Vac.
Cholera Vac.
Hep A Vac.
OtherVaccinations
  1. Certificate of Competency / Proficiency / Qualification

Type / Country of Issue / Number / Date of Issue / Expiry Date
National COC / Endorsement
National GMDSS
Flag state COC / Endorsement
Flag state GMDSS
Flag state COC / Endorsement
Flag state GMDSS

6. ValidCourses

STCW Course / STCW Code / Country / CertificateNumber / Date of Issue / Expiry Date
PSSR
PST
MFA
FiFi
DSD
CISC
CAFF
Medical Care
GMDSS
ECDISgeneratic
ECDIS type specific
ENS
SSO (ISPS)
BRM
ERM
AbleSeafarer
High voltage
Other:
Specialised / Code / Country / CertificateNumber / Date of Issue / Expiry Date
DP Basic Induction
DP Advanced Simulation
DP Operator Certificate
DP Maintenance Cert.
DP - Other
HUET
BOSIET
Ship Safety Off.
Other:

7. Sailing Experience by Rank - Please complete in full for all ranks, as applicable

Master / Ch. Eng. / CO / 2E / 2O / 3E / 3O / 4E / Ratings
(yy/mm): / (yy/mm): / (yy/mm): / (yy/mm): / (yy/mm):

8. Sea Service Record (Latest records on top; add rows as may be required)

Vessel Name / Vessel Type/ DP Class / Vessel GRT/
DWT / Engine (Type/BHP) / Rank / Date on / Date off / Project
Name/
Client / Description of Operation & Country/Area of Operation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Please Note the Nautical Institute’s requirements:

  1. With effect from January 2015, all parts of the DPO Training Scheme are only valid for 4 years (including DP Seatime and Training Courses). The 4 year period is based on 48 Months (eg if you attended the DPO Basic Course on 15 Jan 2015, the NI must receive your completed DPO application by 15 Jan 2019)
  2. From 1 January 2015, all DP certificates issued by The Nautical Institute will have to be revalidated every five years.

List DP System experience (Add rows as may be required)

System Details / Approx. Hours as DPO / Approx. Hours as SDPO

List DP Operations and approximate number of hours on each

Operation / Hours / Operation / Hours
SAT Diving / Flexilay
AIR Diving / Survey
ROV / Pipe Laying
Well Stimulation/ Intervention/Activation/ Extended Well tests (EWT) / DrillShip / Semi Submersible
AHTS / PSV
FMEA / Shuttle Tanker
Construction / Rock Dumping
Coring / Trenching
Heavy Lift / Accommodation / Gangway

10. Details of Relevant Past Experience

11. References

Name / Company / Position/
Designation / Contact Number / Email
1
2
3
Atlas Inexco / | Address: Perzikweg 13a, 2321 DG Leiden, Netherland / |
Phone: 0031 71 5600 565 / | Mail: / | Site:
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