Eurocrew Ltd

Position applied for

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Personal Details

Surname / First name(s) / Portrait Photo of Applicant
Date of Birth / Place of Birth
Nationality / Marital Status
Sex / Children
Shoe Size / Weight
Height / Overall size
Address
City / Country / Phone
Nearest Airport / Mobile phone
Next of kin / Relationship
Address/Contact

National Documents

Name of Maritime Training Institute
No. / Date / Place of issue / Expiry Date
Passport
Seaman’s Book
US Visa
CoC:
GOC (GMDSS) (IV/2)
Basic Safety Training (VI/1)
Survival Craft (VI/2)
Advanced Fire Fighting (VI/3)
Medical Care (VI/4)
Tanker Familiarization (V/1)
Advanced Oil (V/1)
Advanced Chemical (V/1)
Advanced Gas (V/1)
Ship Security Officer
Inert Gas System Operations
Crude Oil Washing
Bridge Team Management
Safety Management System
Operation of Electrical and Electronic Control Equipment
Carrying Dangerous and Hazardous Cargoes
Radar & ARPA
Yellow Fever Vaccination

Personal Skills

/ Excellent / Very Good. / Good / Poor / Fair / Remarks
Command of English language
Computer literacy
Other
Super-statutory training
Flag State Documents / Endorsements

Enter No. and Exp. Date

/ Liberia / Cayman Island / Marshal Island / Germany
Seaman’s Book
CoC:
Basic Safety Training (VI/1)
Survival Craft (VI/2)
Advanced Fire Fighting (VI/3)
Medical Care (VI/4)
GOC (GMDSS) (IV/2)
Tanker Familiarization (V/1)
Advanced Oil (V/1)
Advanced Chemical (V/1)
Advanced Gas (V/1)

Sea Service (from latest to previous)

Name of Vessel / Position / Vessel Type / DWT / Eng. Type / BHP / Year Built / Flag / Manager / Crew Agent / from / to
References (state previous ship manager(s) including address, phone and person in charge):
Above information is to the best of my knowledge correct. (to be signed by the person, who completed the form)

Date

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Name in Print

/ Signature

Please send this application form as attached document immediately to Eurocrew. You can also use the Fax-Number: +38 048 7215377.