Manning Office: Applicant Surname:

ZODIAC MARITIME AGENCIES Ltd.
13th Floor, Sea Containers House
20 Upper Ground
London SE1 9PD
UK / Form: / OF939
Issue: / 002
Date: / 27/06/08
Approved by: / JT

EMPLOYMENT APPLICATION FOR SHIP PERSONNEL

Computer No. (Assigned by Zodiac London):
Application for Rank:
Preferred ship type:
Date Available for Joining:
US Visa: YES / NO - US Visa Expiry Date:
P
ER
S
ONAL
P
ART
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C
ULAR
S
F A M I L Y / Surname : / First Name :
NOTE: Name must appear as it does on your passport! Dates must be in DAY/MONTH/YEAR format!
Middle Name: / Nationality:
Date of Birth: / Place of Birth:
Marital Status: / Name of Spouse:
Permanent Address:

Telephone No.:

/

Height: cm

/ Weight: kg

Mobile No.:

/ Nearest International Airport:
Email Address:
Passport No.: / Place of Issue:
Date of Issue: / Date of Expiry:
Seaman’s Book No.: / Place of Issue:
Date of Issue: / Date of Expiry:
NOTE: Give particulars of your immediate family members and indicate your relationship with them.
Name
/ Relationship / Occupation

NEXT OF KIN

NOTE: Next of kin is the person who will be notified in case of an accident and will receive insurance benefits in case of death – therefore carefully consider who is entered here.

Name of Next of Kin: / Address:
Relationship:
Telephone No.: / Mobile No.:
For Office Use:
L
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C
E
N
S
E
C
O
U
R
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Q UAL
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F
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CAT
I
ON
S /

LICENCE PARTICULARS

Country / Grade / Cert. No. / Date/Place of Issue / Date of expiry

National Licence

United Kingdom

Liberian

Bermuda
Cayman Islands
Other

S. T. C. W. COURSES

Basic safety
training
evidence /

Course Name

/ Yes/No? /

Date/Place of Issue

Personal survival techniques

Fire fighting

Elementary first aid
Personal safety and social responsibility
Personnel assigned with other safety functions / Proficiency in surv craft and rescue boat

Advanced fire fighting

Medical first aid
Medical care
Safety Officer (2/O ONLY)
Ship Security Officer (Captains ONLY)

GMDSS navigation

/ GMDSS only GOC (see note)

ECDIS

Bridge team management
Personnel on tankers /

Tanker familiarisation

Oil specialised

Chemical specialised

Liquefied gas specialised
Ship handling course (Captains ONLY)
NOTE: We only employ candidates holding GOC and NOT ROC

Academic Qualifications and Professional Qualifications

Name of
College/Institute/Academy etc. / Name of Degree/Diploma/Qualification / Date Completed

Zodiac Application Form 0F939 (Page 1/9)

Manning Office: Applicant Surname:

DETAILS OF PREVIOUS SEA SERVICE (Please give Maximum details.)

Name of Vessel / Type of vessel / DWT / Rank
(see note 2) / Period of service / Name of vessel manager or operator
Flag / Year / Type of Engine
(see note 1) / TEU and Engine Power
(see note 3) / Sign On / Sign Off / Contact No. of company & person in charge
1
2
3
4
5
6
If you have more than 6 vessels, please continue on page 9.
NOTE 1: Please give full details of engine / make / model. e.g.: MAN B&W 6S70 MC
NOTE 2: For Engineer ranks please use our company format i.e.: C/E, 1A/E, 2A/E, 3A/E
NOTE 3: Please only show kW engine sizes. Please convert if necessary, (1Kw= 1.3HP). And also state max TEU intake if ship is a container.

Zodiac Application Form 0F939 (Page 1/9)

Manning Office: Applicant Surname:

SUMMARY OF OFFICER EXPERIENCE (In months)

EXPERIENCE AS / BULK
CARRIER / CONTAINER
CARRIER / CHEMICAL TANKER / LPG TANKER / OIL
TANKER / PURE CAR CARRIER / GENERAL CARGO / OTHER /
TOTAL
CPT / C/E
C/O / 1/E
2/O / 2/E
3/O / 3/E
CDT
E/E
TOTAL

FOR ENGINEER APPLICANTS ONLY

/

FOR ALL APPLICANTS

TYPE OF ENGINE / DURATION (Months) / Please specify all nationalities you worked with!
MAN / NATIONALITY /

DURATION

(Months)
B & W
SULZER
S.E.M.T PIELSTICK
STEAM TURBINE
U.M.S.
DECK CARGO CRANE EXPERIENCE
(SPECIFY TYPE/MAKE)
Reason For Leaving Last Company:
Whether Agreeable To Join Vessel Trading In War Zone : Yes / No

Zodiac Application Form 0F939 (Page 1/9)