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EMPLOYMENT APPLICATION

Personal data

Full Name:
Address:
Home Phone No.
Mobile Phone No.
E mail:
Place of Birth:
Date of Birth:
Citizenship:
Marital Status:
No of children supported:
Spoken Languages:
Height/Weight
Education:

Rank: Chief Engineer

Next of Kin

Full Name: / Relationship:
Address: / Phone No:

Passport

Country / Number / Place Issued / Date Issued / Expiry Date

Visa

Country / Number / Place Issued / Date Issued / Expiry Date

Certificate of Competency

Grade of License / Country / Number / Place Issued / Date Issued / Expiry Date

Seaman′s Book

Country / Number / Place Issued / Date Issued / Expiry Date

Medical

Medical Country / Place Issued / Date Issued / Expiry Date

Drug & Alcohol

Place Issued / Date Issued / Expiry Date

Yellow Fever

Place Issued / Date Issued / Expiry Date

Certification & Training

Certificate / Country / Number / Place Issued / Date Issued / Expiry Date
BASIC TRAINING
ADVANCED FIRE FIGHTING
MEDICAL FIRST AID
ADVANCED MEDICAL CARE
SSO
SECURITY AWARENESS
SEAFARER WITH DESIGNATED SECURITY DUTIES
DANGEROUS AND HAZARDOUS SUBSTANCES
GMDSS
PROF. IN SURV. CRAFT AND RESCUE BOAT
ECDIS
ECDIS SPECIFIC

Reference

Company
Name
e-mail
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Previous Sea Experience

Vessel Name Vsl Type Eng Type* DWT HP* Company Rank Joined Leave

*for engineers only

Remarks: