APPLICANT
Application Source
*
SELECT
Applied Rank/
*
SELECT
Availability Date/
*
PERSONAL INFORMATION
Name
*
Surname
*
Date Of Birth
*
Place Of Birth
Nationality
*
SELECT
Military
*
Marital Status
*
SELECT
Married
Engaged
Divorced
Single
No of Children
Height
Weight
Rank
*
SELECT
Optional Rank
SELECT
Competence
SELECT
Gender
SELECT
Male
Female
Desired Vessel Type
(Up to three Vessels)
CONTACT DETAILS
Address
SELECT
Country
*
City
*
SELECT
Zip Code
Home Number
Mobile
*
Email Address
*
CitizenID
*
Second E-mail(if any)
Categories
SELECT
CLOTHING
Shoes & Cloth Sizes
BOILER SUIT SIZE
EDUCATION HISTORY
Institution
Department
End Date
End Date
Qualification
Add
Name
Department
Begin Date
End Date
Qualification
English Language Skills
Speaking
Writing
Other Foreign Languages
WORK RELATED EDUCATIONAL EXPERIENCES (COURSES,SEMINARS ETC.) OF THE APPLICANT WITH DATES
Name 1
Name 2
Name 3
Name 4
Name 5
Name 6
Name 7
NEXT OF KIN (PERSON TO CONTEACT IN CASE EMERGENCY
Name & Surname of your father
Name & Surname of your mother
Name of your wife
Name / Age / Education of your children
Name & Contact details of your next of kin to be contacted in case of emergency
HEALTH
Are you a Smoker?
Yes
Do you have a private health insurance for your familiy?
Do you have a surgical background? If yes, please specify
Are you currently under any medical treatment?
Are you under regular medication?
Do you have any oral or dental problem?
Do you have any idiopathic or allergic diseases?
REFERENCES
1st reference
2nd reference
3rd reference
4th reference
5th reference
CERTIFICATES OF COMPETENCY & ENDORSEMENTS
Level of competency
Seamean book no
Certificate no
Port of registry
Date of issue
Date of issue
Valid Until
Valid Until
Endorsements,if any
Other certificates, if any
MEDICAL CERTIFICATES & TRAVEL DOCUMENTS
Passport type and no
Date of issue
Issue by
Valid Until
Do you hold valid visas in your passport? If yes,what is the expiry date?
MEDICAL CERTIFICATE OF FITNESS
Valid Until?
VACCINATION CARD
Issue Until?
DOCUMENT OF COMPLIANCE FOR SHIPS COOKS
Issue Until?
IS THERE ANY CREMINAL CASE? IF YES PLEASE EXPLAIN
PREVIOUS SEA SERVICE
Vessel
Type
SELECT
Rank
SELECT
DWT:
Flag
M/E Maker:
M/E Power:
Sign On
Sign On
Company Name
Add
Vessel
Type
Sign On
Katılış Tarihi
Sign Off
Ayrılış Tarihi
Company Name
Firma Adı
OTHER
Home Airport
Color of Hair/Eye:
Last Salary
English Proficiency:
English Knowledge and Marlins Test Result
CES TEST
TRAVEL DOCUMENTS AND CERTIFICATES
#
Certificate Name
Document No
Place Of Issue
Date Of Issue
Date Of Expiry
ADDITIONAL INFORMATION
Cargo Carried
Trading Areas
Nationalities Sailed With
Cargo gears/Loading Systems/Cranes
Reason for Leaving Last Employer
Contact details of last three Companies
Personal Comments