APPLICATION FORM

Rank according STCW:
Position for applying*		Add photo*
Second choise (if any):
Last salary (USD):

Personal information:

Surname*:			Name*:
Date of birth*			Father's name*			Place of birth*
Marital status*			Number of children			Number of children before 18
Nationality*			Religion			Blood group
Next of Kin			PPE Size
Physical parameters Height: Weight: Eyes: Hair: Overalls: Shoes:
Present address
Country*:			City*:
Street*:			Building#*:		Apt#:
Phone 1*:			Phone 2:
E-mail*:			Skype:

Background education
Name*:
Date:			Qualification:
English			Marlins (%):			CES (%):

Documents

Passport	Number	Place of issue	Date of issue	Date of expiry	Add Files
Seaman's book*
Travel (OVIR) passport
Civil passport*
Foreign seaman's passport

Certificate of competency

Name of certificate	Number	Place of issue	Date of issue	Date of expiry	Add Files
Certificate of competency
Endorsement to Certificate of competency
GMDSS Certificate of competency
GMDSS Endorsement
Other Endorsement (both sides)

STCW certificates

Name of certificate	Number	Place of issue	Date of issue	Date of expiry	Add files
Basic training (A-VI/1)
Medical Care
Dangerous cargoes
Proficiency in survival craft
Fast rescue boats
Ship Handling Arrangement
Ship's Security Officer
Security Awareness Certificate
Bridge / Engine team Management
Radar and Electronic Engineering
Tanker safety course
Oil tanker specialized training
Chemical tankers specialized
Liquid Gas tankers specialized
High Voltage
Ro-Ro Passenger ships
Passenger Ships other then Ro-Ro
H2S Awareness
BOSIET (Basic Offshore Safety Inductions & Emergency Training)
HUET (Helicopter Underwater Escape Training)
FOET (Further Offshore Emergency Training)

DP certificates

Name of certificate	Number	Place of issue	Date of issue	Files
DP Basic (Induction) Course
DP Advanced (Simulation) Course
DP Limited
Full DP Certificate
DP Maintenance

Previous sea service (last 7 years)

Rank	Vessel's name	Type of vessel	DWT	Type and power of engine	Company	From	To

Offshore experience:

Oil region:

Duration (yy/mm)