MARITIME RISK SOLUTIONS

APPLICANT INFORMATION
Last Name Street Address City Phone Date Available Position Applied for Are you a citizen of South Africa? Have you ever worked for this company? Have you ever been convicted of a felony? YES YES YES NO NO NO Do you have a Passport Passport Number Nationality YES NO ID No. State E-mail Address Nationality First M.I. Date

Apartment/Unit # ZIP

REQUIREMENTS*
Do you have a Psira Certificate? What grade Company Do you have a Weapons Competency Certificate? Hand weapon Weapons Competency Certificate Number Do you have a level 1 Anti Terrorist Awareness Training( US DOD) Do you have a Seamans Book? Company Seaman Book Number Phone ( ) Rifle Certificate number Phone ( )

MILITARY/POLICE SERVICE
Branch Rank at Discharge If other than honorable, explain From Type of Discharge To

DISCLAIMER AND SIGNATURE

Postnet suite #44, Private Bag x31, Knysna. 6570 Tel: 072 793 0845 Fax: 0866722900 www.maritimerisksolutions.com

MARITIME RISK SOLUTIONS

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signature Date

Postnet suite #44, Private Bag x31, Knysna. 6570 Tel: 072 793 0845 Fax: 0866722900 www.maritimerisksolutions.com