WORKBOAT INTERNATIONAL DMCCO

Attachment 2.0 APPLICATIONS FOR EMPLOYMENT PHOTO

POST APPLIED FOR:__________________________________

1. PERSONAL DATA
Name in Full
Permanent Address:

Mobile/Home NO:
Date of Birth DD: MM: YY: Place of
Birth
Nationality Race Religion
EPF NO. SOCSO INCOME TAX NO

Bank A/C No.

Height Weight
PPE Size Size of Safety
Coverall Shoes

DOCUMENT COUNTRY NUMBER ISSUED DATE VALIDITY

Travelling Passport
Discharge Book
Seaman Card
Name of Next-of-Kin Relationship
Address:

Mobile/Home No.:

MARITAL STATUS Married / Single * * delete where applicable

RELATIONSHIP NAME AGE

FATHER
MOTHER
WIFE
CHILD Male/Female
CHILD M/F
CHILD M/F
CHILD M/F
CHILD M/F

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 WORKBOAT INTERNATIONAL DMCCO
2. CERTIFICATES / COURSES
A. HIGHEST COMPETENCY CERTIFICATE HELD:
Issuing Authority Date Issued Place STCW
Country Grade Certificate Number Issued Validity

B. Other Certificates held and Courses attended

COURSES/CERTIFICATE Number Date Issued Place Issued Validity
Basic Safety Training:-
i-Personal Survival
ii-Basic Fire Fighting
iii-Basic First Aid
iv-Personal Safety & Social Resp.
Proficiency in Survival Craft & Rescue
Boat
Medicare/Medical First Aid
Advanced Fire Fighting
Radar Observer
Radar Simulator
Electronic Navigation Aid Course
General Operator Certificate
Shipboard Management Course
ISM course
S.S.O course
Bosiet
Ringing and Slinging

C. Watch Keeping Certificate (For Ratings only)

Certificate Number
Certificate to work as: (e.g. AB / Oiler) Date Issued Place Issued Validity

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3. SEA EXPERIENCE: (Last 5 years) [Most recent experience on top line]

 WORKBOAT INTERNATIONAL DMCCO
Company Vessel Type GRT Main Engine* BHP RANK SIGN-ON SIGN-OFF

* Engineers to include make/model of engines.

4. MEDICAL HISTORY: It is of utmost importance that all illness other than minor afflictions should be stated. The Company is
entitled to refuse any claim for treatment, cost or any other insured benefits if a complete statement of all previous illness has not been
given.
(A) Have you ever signed off a ship due to medical reasons? Yes / No*
(If yes, please provide following details:)
Name of Vessel Date of Occurrence Place of Occurrence
Brief Description of illness / injury / accident:

(B) Have you undergone any medical operation in the past? Yes / No*
Details of Operation Date Period of Disability Present Condition

(C) For what illness or accidents have you consulted a doctor during the last 12 months?
Details of illness Date Therapy / Treatment

(D) Please give details of any health or disability problem.

Details of illness Date of occurrence

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5. GENERAL
(A) Have you ever been denied a foreign visa? If yes, please state country and reason Yes No*
(if known):
 WORKBOAT INTERNATIONAL DMCCO
(B) Willing to accept lower rank? Yes No*
(C) Ability writing in English ? Yes No*
(D) Ability speaking and understanding in English? Yes No*
(E) Have you been the subject of a court enquiry or involved in a maritime accident? If Yes No*
yes, please attach details.
(F) Have you ever work for Company or Vessel which are having ISM / ISO Yes No*
Certifications? If yes, please indicate details below.
COMPANY VESSEL POSITION Date Sign-On Date Sign-Off

REFERENCES: Please give referees from 2 recent employers who we may contact for reference.
Name of Company
Name of Person to Contact
Address

Country
Telephone

I hereby declare that the above is true.

Date :________________________ Signature :________________

6. FOR OFFICE USE ONLY (Interviewer to check requirement against Company guidelines) Refer interview form.
Interviewer Comment: Approved By:

Name :
Postions
Assessment: Suitable / Unsuitable / Pending Date:
Deploy to Rank
Effective Date Salary
REMARKS

(*Strike out whichever is not applicable.)

Revision No: 00
Form : Application for Employment Retention Period - As long as under employment Custodian : MM
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