Scribd
Upload
96 views3 pages

Licence (Certificate of Competency) : Ran K Last Name Nationali Ty

This document contains an application for employment that collects personal information and details past experience. It requests information such as name, contact details, nationality, licenses held, medical certifications, passport information, sea experience aboard various vessels, and any additional comments. The applicant provides details of their education and qualifications, next of kin contacts, employment history, licenses and certifications held, and a record of their sea service experience aboard different vessels, including vessel names, flags, tonnage, engine type and power.

Uploaded by

Paolo Ferjančić
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
96 views3 pages

Licence (Certificate of Competency) : Ran K Last Name Nationali Ty

This document contains an application for employment that collects personal information and details past experience. It requests information such as name, contact details, nationality, licenses held, medical certifications, passport information, sea experience aboard various vessels, and any additional comments. The applicant provides details of their education and qualifications, next of kin contacts, employment history, licenses and certifications held, and a record of their sea service experience aboard different vessels, including vessel names, flags, tonnage, engine type and power.

Uploaded by

Paolo Ferjančić
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
You are on page 1/ 3

.

01

APPLICATION FOR EMPLOYMENT


RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE

Ran First Last Nationali


k Name Name ty
Date & Place
Marital Status:
of Birth:
Present
Next of Kin:
Address:
Home phone: Name / Relationship:
cell phone:
Address:
Fax:
Email: Next of kin Cell Phone :
Fathers name Mothers name:
Nearest Km from Present
Airport: Airport: Employer:
Languages: Tel + email:
Medical Certificate Previous
Expired:
issued: Employer:
Any visa issued: Expired: Tel + email:
Weight(kg Coverall
Height(cm) Shoes Size: Hair: Eyes:
) Size:
Position Applied: Date of availability:
Education: high/secondary school (4 years) , Last wage (inclusive of leave pay):
college (2-3 years) ; university (4-5 years):

Licence (Certificate of Competency)


Licence Country Grade of Licence Number Place & Date Issued Date Expired

Passports If several passports write them all.


Number Place Issued Date Issued Date Expired

Seamans Book - If several seamans books write them all (even if expired)
Country Place Issued Date Issued Number Date Expired

DP Log Book
Country Place Issued Date Issued Number Date Expired

DP Certificates
Certificates Place Issued Date Issued Number Date Expired
DP Basic
(induction)
DP Advanced
DP Limited
DP unlimited

Application Form Page 1 of


3
.01

APPLICATION FOR EMPLOYMENT


RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE

Certificate
Expiration
Certificates STCW Date Issued Place Issued License Number
date
Yellow Fever certificate

Helicopter Underwater Escape Training

Helicopter Landing Officer


MEDICAL (First Aid) VI/4
MEDICAL (Care) VI/4
ARPA
GMDSS IV/2

Advanced Fire Fighting VI/3

PSCRB (proficiency in survival craft) VI/2


Basic Safety Training Certificate (or Items
from 1 to 4 below MANDATORY) VI/1
1 - Personal Security and Social
Responsibilities
2 - Personal Survival Technique

3 - First Aid at sea

4 - Fire fighting

BOSIET

SSO (Ship Security Officer) VI/5

Application Form Page 2 of


3
.01

APPLICATION FOR EMPLOYMENT


RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE
Previous Sea Experience
For Offshore Ships: Type of Job Performed (supply,
Eng Type & Period: Period:
Vessels Name Flag GRT Vessel Type Company Name Rank anchorhandling, towing), Water Depth, Type of Rig or
KW From To
Barge Work With, Area of Operation, Charterer-Client

ANY ADDITIONNAL INFORMATIONS OR JOB DESCRIPTIONS /EXPERIENCES YOU WANT TO DETAIL IN PARTICULAR. WRITE HERE:
Detail the work you have done onboard previous vessels and your previous experience

Application Form Page 3 of 3

You might also like