Sea Service Record (Start from Your Last Ship First)

Job Application Form / Marine & Offshore Crewing Agency /
/ Pakistan, India, Bangladesh, Sri Lanka,
Philippine, Indonesia, China, Myanmar
Russia, Ukraine, Georgia
FOR OFFICIAL USE
Date / Interviewed By / Status
(Approved / Rejected)
Comments:
PERSONAL PARTICULARS
Rank Applied / Name (as in Passport)
Preferred Ship / Nationality / Paste your less than 3 months old Photo here
Wages (Last / Expected) / Date of Birth
Date of Availability / Place of Birth
Tel (Home) / Gender
Tel (Mobile) / Height / Weight
Tel (Emergency) / Blood Group
Email (Personal)
Email (Emergency)
Home Address
Nearest Airport
Remarks
DOCUMENTATION CHECKLIST
DOCUMENT NAME / Issued By / Number / Issue Date / Expiry Date / Agent Check /

Employer Check

Travel Documents
Passport
Seaman Book (CDC)
National Identity Card
Visa USA
Visa Singapore
Visa Schengen
Visa China
Visa (Any other)
FlagState
Documentation / Seaman Book / CoE for CoC / CoE for GoC / CoE for SSO / DCE (Oil) / DCE (Chm) / DCE (Gas)
Expiry Date / Expiry Date / Expiry Date / Expiry Date / Expiry Date / Expiry Date / Expiry Date
Panama
Liberia
MarshalIsland
Singapore
Hong Kong
Malaysia

Pre-Departure Documentation Checklist

DOCUMENT NAME / Issued By / Number / Issue Date / Expiry Date / Agent Check / Employer Check
Pre-Sea Training
Bachelors in Maritime Studies (Cadets)
Work Shop Training (Eng. Staff)
GPIII (Training)
Cert. of Watch-keeping (Ratings)
Navigational Watch-Keeping
Engine Room Watch-Keeping
Cert. of Competency / Class
C.o.C
CoC Limitation (1)
CoC Limitation (2)
LoA for CoC (Must)
DCE / Level (M, O, S)
Petroleum
Chemical
Gas
Radio Communication Training
GOC (GMDSS)
LoA for GoC (Must)
Basic Safety Training
Personal Survival Techniques
Personal Safety and Social Responsibilities
Fire Prevention and Fire Fighting
Elementary First Aid
Advance Safety Training
Proficiency in Survival Craft & Rescue Boat (PSCRB)
Advance Fire Fighting (AFF)
Proficiency in Ship Security Officer
LoA for PSSO (Must)
Medical Care
Ship Safety Officer
Fast Rescue Boats
Tanker Safety Training
Specialised Petroleum Tanker Safety
Specialised Chemical Tanker Safety
Specialised Gas Tanker Safety
Tanker Familiarisation
Navigation Courses
Electronic Navigation System (ENS)
Navigation Control Course (NCC)
Electronic Chart Display Information System (ECDIS)
Bridge Team Management (BTM)
Ship Handling & Manouvering
Bridge Resource Management (BRM)
Maritime Resource Management (MRM)
Engineering Course
Engine Team Management
Engine Simulator
Electrical Staff Training
Electrical Diploma
Electronic Diploma
Bachelors in Electrical / Electronics
Masters in Electrical / Electronics
Other Optional Training
Efficient Deck Hand
ISM Code Familiarisation
ISM Internal Auditor
Cargo Simulator
Risk Assessment
Pre-Vetting Inspections
OPA 90
Shipboard Training
Company Security Officer
Proficiency in English
Health Documents
Medical Test
Drug & Alcohol Test
Vaccination (Yellow Fever) Compulsory
Vaccination (Typhoid) Compulsory
Vaccination (Cholera) Optional
Chemical Retention Test
Additional Document’s required
20 Photographs (with white back ground)
National ID Card (copy)
Company Documents
Contract (signed copy)
HSE Policy (signed copy)
D&A Policy (signed copy)
Letter of Undertaking (if any)
Letter of Acceptance (if any)
Security Clearance Letter
SMS AOH Tel Nos. provided

I hereby certify that I am carrying all original documents as listed above. Rank …………………… Signature………………………..

EXPERIENCE
Experience in Rank Applied / Experience with Operator / Experience on Type of Tanker joining
GENERAL INFORMATION
Cargo Carried:
Type of cargo tanks
(stainless steel or coated)
Type of cargo pumps you are familiar
Oil Majors Vetting Inspections experience
Trading Area
Nationality of Officers & Crew sailed with:
Issue Date: 01.08.13 / Page 1 of 5 / Email:

Job Application Form / Marine & Offshore Crewing Agency /
/ Pakistan, India, Bangladesh, Sri Lanka,
Philippine, Indonesia, China, Myanmar
Russia, Ukraine, Georgia

Sea Service Record (Start from your last Ship first)

Rank

/ Ship Manager / Vessel Particulars / From / To / Reason for Leaving
Name / Flag / Type / DWT / Engine Name / Type & KW / DD.MM.YY / DD.MM.YY
SHORE BASED EXPERIENCE DETAILS (if any):
NEXT OF KIN (EMERGENCY SITUATIONS)
Name (as in Passport)
Relation
Tel (Home)
Tel (Mobile)
Email
Home Address
Nearest Airport
Remarks

BANK ACCOUNT DETAILS (required for Home Allotments)

Account Name

Account Number

Bank Name

Bank Address

Swift Code

Safety Gear and Uniform Size
Boiler Suit / Safety Shoes / Uniform Shirt / Uniform Trouser / Winter Jacket
IMMIGRATION INFORMATION
Have you ever been denied a foreign visa?
If yes, state which country and reason (if known)
Have you been the subject of a court of enquiry or involved in a maritime accident?
Reference Check 1 / Reference Check 2
Name of Company
Person
Telephone
Email
Address
Country
Declaration by the candidate:
I here by confirm that all the documents listed above are genuine and i am bringing the Originals accordingly onboard, in case I am not able to produce the Original listed documents onboard I will be liable for the expenses and consequences.
Name / Rank / Signature
FOR OFFICIAL USE (Interview by Manning Agency)
Evaluated by / Approved by
English Proficiency / ISM & ISPS Knowledge
Attitude / Vetting Inspection Knowledge
Physical Appearance / Maintenance Knowledge
Reputation in Industry / Emergency Knowledge
Dry Docking Experience / Ship Business Knowledge

The End

Issue Date: 01.08.13 / Page 1 of 5 / Email: