Application form

Personal Info

Position 1:

Position 2:

Readiness:

Last salary:

Your photo:

Personal Info:

First Name:

Last Name:

Father's Name:

Date Of Birth(mm/dd/yy):

Seaman's Book №:

Passport(Traveling) №:

Place of birth:

Citizenship:

City:

Main addres:

Date of issue:

Date of issue:

Phone:

Phone 2:

Skype:

Email:

Valid until:
Valid until:
Next of Kin info:

Next of Kin Name:

Relationship:

Phone:

Main addres:

Height:

Weight:

Marital status:

Overalls:

Shoes:

Eyes:

Hair:

USA Visa Info:

Number:

Date of issue:

Valid until:

Schengen Visa Info:

Number:

Date of issue:

Valid until:

Sea Expirience
Record 1:

Company:

Vessel:

Type:

DWT:

Engine:

Rank:

From:

To:

Record 2:

Company:

Vessel:

Type:

DWT:

Engine:

Rank:

From:

To:

Record 3:

Company:

Vessel:

Type:

DWT:

Engine:

Rank:

From:

To:

Record 4:

Company:

Vessel:

Type:

DWT:

Engine:

Rank:

From:

To:

Record 5:

Company:

Vessel:

Type:

DWT:

Engine:

Rank:

From:

To:

Record 6:

Company:

Vessel:

Type:

DWT:

Engine:

Rank:

From:

To:

Record 7:

Company:

Vessel:

Type:

DWT:

Engine:

Rank:

From:

To:

Record 8:

Company:

Vessel:

Type:

DWT:

Engine:

Rank:

From:

To:

Certificates
National Certificate of Competency:

Number:

Date issued:

Valid until:

National Endorsement:

Number:

Date issued:

Valid until:

National Certificate of Competency 2:

Number:

Date issued:

Valid until:

National Endorsement 2:

Number:

Date issued:

Valid until:

GMDSS GENERAL IV/2:

Number:

Date issued:

Valid until:

GMDSS RESTRICTED:

Number:

Date issued:

Valid until:

GMDSS ENDORSEMENT:

Number:

Date issued:

Valid until:

National Oil Tanker V/1:

Number:

Date issued:

Valid until:

National Liquefied Gas Tanker V/1:

Number:

Date issued:

Valid until:

National Liquid Chemical Tanker V/1:

Number:

Date issued:

Valid until:

Crude Oil Washing:

Number:

Date issued:

Valid until:

Inert Gas Systems:

Number:

Date issued:

Valid until:

Danger/Hazard Cargo B-V/4;5:

Number:

Date issued:

Valid until:

Tanker familiarization V/1:

Number:

Date issued:

Valid until:

Tanker Basic (Oil/Chemical):

Number:

Date issued:

Valid until:

Tanker Basic Gas V/1-2:

Number:

Date issued:

Valid until:

Tanker Basic Special (Oil) V/1-2:

Number:

Date issued:

Valid until:

Tanker Basic Special (Chem.) V/1-2:

Number:

Date issued:

Valid until:

Tanker Basic Special (L Gas) V/1-2:

Number:

Date issued:

Valid until:

Ro-Ro Passenger V/2-3:

Number:

Date issued:

Valid until:

Passenger other then Ro-Ro:

Number:

Date issued:

Valid until:

Basic safety training and instruction VI/I:

Number:

Date issued:

Valid until:

Proficiency in Survival Craft VI/2:

Number:

Date issued:

Valid until:

Proficiency in fast rescue boats:

Number:

Date issued:

Valid until:

Fire Fighting advanced VI/3:

Number:

Date issued:

Valid until:

Medical first aid VI/4-1:

Number:

Date issued:

Valid until:

Medical care VI/4-2:

Number:

Date issued:

Valid until:

Radar Observer Radar Simulator:

Number:

Date issued:

Valid until:

Radar Navigation - Mng.Level:

Number:

Date issued:

Valid until:

ARPA:

Number:

Date issued:

Valid until:

Restricted R.T Comm.Course:

Number:

Date issued:

Valid until:

Bridge Team mgmt:

Number:

Date issued:

Valid until:

Ship's Handling Certificate:

Number:

Date issued:

Valid until:

ECDIS VI/4-1:

Number:

Date issued:

Valid until:

Engine Room Management:

Number:

Date issued:

Valid until:

Electrical&Electronic equipment:

Number:

Date issued:

Valid until:

Ship security officer (ISPS code):

Number:

Date issued:

Valid until:

Ship safety officer IMOA741(18):

Number:

Date issued:

Valid until:

ISM code:

Number:

Date issued:

Valid until:

Breathing Apparatus:

Number:

Date issued:

Valid until:

Security Awareness:

Number:

Date issued:

Valid until:

Risk Assessment:

Number:

Date issued:

Valid until:

Designated security duties:

Number:

Date issued:

Valid until:

Incedent and Accident Investigation:

Number:

Date issued:

Valid until:

Ship Security:

Number:

Date issued:

Valid until:

Yellow Fever Vaccination Certificate:

Number:

Date issued:

Valid until: