You are on page 1of 3

COMPANY WORK FORM Form No. F6.2.

APPLICATION FORM MANNING Issue B 01/05/01


OFFICE Date MD
Authorised
By

DATE AVAILABLE:
POSITION APPLIED FOR:
FULL NAME: ATTACH
SURNAME: PHOTO
FIRST NAME: HERE
MIDDLE NAME(S)
PERSONAL DETAILS
DATE OF BIRTH PLACE OF BIRTH NATIONALITY HEIGHT

WEIGHT HAIR COLOUR EYE


COLOUR
MARITAL STATUS SPOUSES NAME No. of
Children
FATHERS NAME MOTHERS NAME NEXT OF
KIN
HOME ADDRESS TEL. No.
(PERMANENT)
OTHER ADDRESS TEL. No.

E-MAIL: Skype: Homeport: Mob No.

LICENCES / DOCUMENTS HELD


ITEM No. I S S U E D EXPIRING GRADE
DATE PLACE BY DATE
NATIONAL LICENCE
STCW ENDORSEMENT
LIBERIAN ENDORSEMENT
MARSHALLS ISL ENDORSEMENT
MALTESE ENDORSEMENT
OTHER LICENCE
PASSPORT
NATIONAL SEAMANS BOOK/CDC
OTHER SEAMANS BOOK / CDC
U.S.VISA
YELLOW FEVER VACCINATION
P.R.C. No. (Filipino Crew only)
National data base of seafarers INDOS
Certificate No. (Indian personnel only)
CERTIFICATES HELD
ITEM No. ISSUED EXPIRING ISSUED BY
BASIC SAFETY TRAINING (*IF ONE CERTIFICATE)
PERSONAL SAFETY & SOCIAL RESPONSIBILITIES*
PERSONAL SURVIVAL*
SURVIVAL CRAFT HANDLING*
FIRST AID AT SEA (ELEMENTARY LEVEL)*
PROFICIENCY IN SURV.CRAFT/ RESCUE BOAT (PSCRB)
ADVANCED / SHORE-BASED FIREFIGHTING
PETROLEUM TKR SAFETY BASIC/ GEN OIL TKR FAM.
PETROLEUM TKR SAFETY ADVANCED/SPECIALISED
COW / IGS
DANGEROUS CARGO ENDORSEMENT - OIL
CHEMICAL TANKER SAFETY
LNG/LPG TANKER SAFETY
LICOS (Liquid Cargo Handling Simulator)
MEDICAL CARE
SHIP MASTERS MEDICARE/ADVANCED MEFA
STCW ENDORSEMENT
ARPA
R.O.C. / RANSCO / RADAR SIMULATOR
SATCOM

\\\

Rev.5 dated 30/09/15


1 of 3
COMPANY WORK FORM Form No. F6.2.
APPLICATION FORM MANNING Issue B 01/05/01
OFFICE Date MD
Authorised
By
APPLICANTS NAME: _________________________________________________________

CERTIFICATES HELD (CONTINUED)


ITEM No. ISSUED EXPIRING ISSUED BY
GOC / GMDSS
ECDIS
SHIP MANOEUVERING/SHIP HANDLING SIMULATOR
SHIP SECURITY OFFICER
ISPS FAMILIARISATION
SHIPBOARD SAFETY OFFICER
ENGINE ROOM SIMULATOR
ENGINE ROOM RESOURCES MANAGEMENT
HUMAN RELATIONS
QUALITY AND SAFETY MANAGEMENT
RISK ASSESSMENT / RISK MANAGEMENT
MARINE ACCIDENT/INCIDENT INVESTIGATION
MANAGEMENT OF CHANGE
ENVIRONMENTAL COURSE / ISO 14001
MLC/LSC MARITIME LEADERSHIP COURSE
MARPOL I
MARPOL II
MARPOL VI
MARITIME ENGLISH
MLC 2006
BRIDGE TEAM MANAGEMENT
BRIDGE RESOURCES MANAGEMENT

RECORD OF PREVIOUS SERVICE (VERIFIED AGAINST SEAMANS BOOK ENTRIES)


COMPANY VESSELS TYPE/ DWT M/ENGS BHP/ UMS RANK FROM TO MONTHS
NAME BUILT TYPE ( Y-N)

Rev.5 dated 30/09/15


2 of 3
COMPANY WORK FORM Form No. F6.2.
APPLICATION FORM MANNING Issue B 01/05/01
OFFICE Date MD
Authorised
By
APPLICANTS NAME: ____________________________
ACTUAL TIME SERVED IN MONTHS
RANK CRUDE CARRIER OBO PRODUCT RO-RO/ BULK
TANKER CONTAINER CARRIER
MASTER OR CH. ENG.
C/OFF OR 1A/E
2/OFF OR 2A/E
3/OFF OR 3A/E
CADET/JR.ENG
ELEC OFF
PMN / FITTER
OTHER RANK

ALLOTMENT DETAILS
SURNAME
NAME
MIDDLE NAME
DATE OF BIRTH
RELATIONSHIP
ADDRESS
NAME OF BANK
ACCOUNT No.
SSS No. (Filipino crew only)
TIN No. (Filipino crew only)
WIFE & CHILD/RENs DOB POB PASSPORT NO DATE OF Issued at
NAME(s) ISSUE
EXPIRY CLRNS

How long did you stay at your previous company?


Wages on last vessel?
Trade route of vessels?
Who referred you to the company?
Any relatives with the company?
If yes, who?
ANY OTHER INFORMATION ABOUT YOURSELF:

UNION MEMBERSHIP NO.: DATE :

DOE:
ALL APPLICANTS
DATE APPLICATION FILLED OUT

SIGNATURE OF APPLICANT

FULL NAME IN BLOCK CAPITALS

Rev.5 dated 30/09/15


3 of 3