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Applied for Rank :
For International Crew
Tel :
E mail
Mobile:
Passport
Seaman's Book
US VISA-C1/D
Family Details :
Name D.O.B. P.O.B. Passport No. Date of Issue Place Expiry Nationality
Wife
Children :
Certificate of Competency
Date of Issuing
Grade Number Expiry Remarks Ok/Others
Issue Country
National C.O.C.
GMDSS
DCE - PET.
DCE- CHEM.
DCE- LPG
Cyprus
Marshall Is.
Liberia
Panama
Singapore
Others
Personal Survival
Tech.
PSC & RB
PSSR
Ship Captain's
Medicare
Medical First Aid
ARPA
Radar Simulator
RANSCO
Sp.Tanker safety
Pet.
Sp.Tanker Safety
Chem.
Sp.Tanker Safety
-LPG
OTFC
CTFC
GTFC
Other courses
Ship Manov.&
Simulator
Simulator-Engine
Room
LCHS
HAZMAT
BTM
BRM
FRAMO
TKR VETTING
INSPECTION
BULK CARRIER
SAFETY
V.R.M.
Practical Experience : Have you experience of the following (Please signify thus 'X')
New Building [ ] Planned Maintenance System [ ]
Steam Turbines Cargo Pumps [ ] (a) Computerised (Specify) [ ]
Engine Driven Cargo pumps [ ] Planned Maintenance System
Cargo Pump type (a) Computerised (Specify) [ ]
a) Centrifugal pumps [ ] (b) Others [ ]
b) Screw pumps [ ] Container (specify TEU) [ ]
c) FRAMO Pump [ ] Reefer container [ ]
Cargo Reefer plant [ ] Reefer Cargo [ ]
Deck crane type Dry dock [ ]
a) Thyrister control [ ] Major repairs [ ]
b) Electrical [ ] Major Fire [ ]
c) Electro hydraulic [ ] Collision [ ]
d) Gantry [ ] Pollution Incident [ ]
Knowledge of ships electrical and
[ ] [ ]
Crude Oil Wash operations electronic system
Knowledge of vessels automation and
[ ] [ ]
Inert Gas System computerized system
Officers :
Ratings :
Reason for application : State why you wish to leave your present employment:-
May we approach your PRESENT employer for Reference ? Tel no.____________ Name :
May we approach your PAST employer for Reference ? Tel no.________________ Name :
I hereby affirm that all the information provided by me in this application is true and correcct to the best of
my knowledge and belief; further, that 'no Certificate Of Competency or Licence issued tome has ever been
revoked or suspended.