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Application Form: "Crnogorska Plovidba" A.D.Kotor

This document is an application form for employment with "CRNOGORSKA PLOVIDBA" A.D.KOTOR, a maritime shipping company based in Kotor, Montenegro. The multi-page form requests information about the applicant's personal details, passport and certifications, medical history, sea service record, and references. It includes 10 sections to collect details on the applicant's position applied for, personal information, licenses and certificates held, courses completed, medical information, vessel experience, and references.

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Slobodan Vukasinovic
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253 views5 pages

Application Form: "Crnogorska Plovidba" A.D.Kotor

This document is an application form for employment with "CRNOGORSKA PLOVIDBA" A.D.KOTOR, a maritime shipping company based in Kotor, Montenegro. The multi-page form requests information about the applicant's personal details, passport and certifications, medical history, sea service record, and references. It includes 10 sections to collect details on the applicant's position applied for, personal information, licenses and certificates held, courses completed, medical information, vessel experience, and references.

Uploaded by

Slobodan Vukasinovic
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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"CRNOGORSKA PLOVIDBA" A.D.

KOTOR
POMORSKO BRODARSKO DRUŠTVO (MARITIME SHIPPING COMPANY)
85330 KOTOR, SKALJARI B.B., (P. O. BOX 90), MONTENEGRO
Ph.:/Fax: + 382 32 304 164/5, E-mail: info@crnogorskaplovidba.com

Application Form

PHOTO

Section 1 Position
Position Applied for
Lowest Position Acceptable
Date of Availability
Section 2 Personal Details
Family name / Surname
First Name / Given Name
Date & Place of Birth
Nationality
Present Address

Present Contact Number


Phone Fix
Mobile Number
Email Address
Nearest Airport
Section 3 Passport, Seaman’s book) and USA Visa
Passport Seaman’s book USA Visa
Number
Issued place
Date issued
Date of expiry
Section 4 Next of Kin
Full Name / Relationship
Address
Contact Numbers
"CRNOGORSKA PLOVIDBA" A.D.KOTOR
POMORSKO BRODARSKO DRUŠTVO (MARITIME SHIPPING COMPANY)
85330 KOTOR, SKALJARI B.B., (P. O. BOX 90), MONTENEGRO
Ph.:/Fax: + 382 32 304 164/5, E-mail: info@crnogorskaplovidba.com

Section 5 Highest Certificate of Competency / Licence Held

Capacity Issuing Certificate Date issued Date of expiry Limitations


country No. applying ( If any)

Section 6 Courses Attended and Certificates Obtained

Name of Course / Certificate Certificate No. Issued place Issued date Date of expiry

Personal survival techniques


Fire prevention and Fire fighting
Elementary first aid
Personal safety and social
responsibility
Proficiency in survival craft &
rescue boats
Advance fire fighting
Proficiency in medical first aid
Medical care
Bridge team management
Security awareness
Security training for seafarers
with designated security duties
(SDSD)
Ship Security Officer (SSO)
Dangerous Cargo Handling
Medical Fitness Certificate
"CRNOGORSKA PLOVIDBA" A.D.KOTOR
POMORSKO BRODARSKO DRUŠTVO (MARITIME SHIPPING COMPANY)
85330 KOTOR, SKALJARI B.B., (P. O. BOX 90), MONTENEGRO
Ph.:/Fax: + 382 32 304 164/5, E-mail: info@crnogorskaplovidba.com

Section 7 Medical History

Have you ever signed off a ship due medical reason?


Have you undergone any medical operations in past?
Do you have any health or dimity problem now?

If answer to any of above is YES then give further details below or on a separate sheet

Section 8 General

Have you ever been the subject of a court of enquiry or involved in a maritime accident
Have you ever had a professional licence suspended or revoked

If yes to any of above then please on separate sheet of paper

Section 9 References ( Last 3 Recent Employers)

Name of company
Person in charge/ position
Tel No
Email

Name of company
Person in charge/ position
Tel No
Email

Name of company
Person in charge/ position
Tel No
Email
"CRNOGORSKA PLOVIDBA" A.D.KOTOR
POMORSKO BRODARSKO DRUŠTVO (MARITIME SHIPPING COMPANY)
85330 KOTOR, SKALJARI B.B., (P. O. BOX 90), MONTENEGRO
Ph.:/Fax: + 382 32 304 164/5, E-mail: info@crnogorskaplovidba.com

I hereby declare that the above particulars are true and I authorize you to contact the referees listed
above

Signed: Date:
"CRNOGORSKA PLOVIDBA" A.D.KOTOR
POMORSKO BRODARSKO DRUŠTVO (MARITIME SHIPPING COMPANY)
85330 KOTOR, SKALJARI B.B., (P. O. BOX 90), MONTENEGRO
Ph.:/Fax: + 382 32 304 164/5, E-mail: info@crnogorskaplovidba.com

Section 10 Record of Sea Service (All Dates to be entered as dd/mm/yy)


STARTING FROM LAST VESSEL FIRST
Vessel name DWT
Type of Sign off
or Main engine type KW Rank Sign on date
Vessel date
Company name GT

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