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Date Filed Oct.11,2017 Position Applied For 1. Assistant Electrician 2
Date Filed Oct.11,2017 Position Applied For 1. Assistant Electrician 2
PERSONAL DATA
Last Name First Name Middle Name Maiden Name
PAREDES LINTON BALLESTA (for female Married applicants)
FAMILY DETAILS
Name Sex Date of Birth Place of Birth
Father RENA B. PAREDES MALE JAN.25,1954 BAROTAC VEIJO,ILOILO
(Please indicate Middle Name)
Mother ERLINDA B. PAREDES FEMALE NOV.11,1954 MONTAY
(Please indicate Maiden Name) MIDSAYAP,COTABATO
Spouse
(Please indicate Maiden Name)
Child/Children
EDUCATION BACKGROUND
Highest Degree Date
Level School Place
Earned From To
Collegiate/Vocational
Secondary BANISILAN 2007 APRIL BANISILAN NORT
NATIONAL HIGH 8,2011 COTABATO
SCHOOL
QSF 98/2010/Rev. 04
APPLICATION FORM
RECORD BOOKS
Date
Document No. Issuing Authority
Issued Expiry
Passport (PH) P1744438A JAN.25,2017 JAN.24,2022 DFA-DAVAO
Seaman’s Book (PH) C1037828 MAY 3,2017 MAY 1,2027 MARINA
SRC (PH)
US Visa
A. Have you ever been denied of any visa? No
If yes, please provide the following details:
Country Date of Refusal Reason for refusal
TRAINING COURSES
Issued Date
Training Name Document No. Issued Date Training Center With COP?
of COP
Basic Training APRIL
BT-17B51-17 GLOBE MARITIME
25,2017
Basic Safety Course
Refresher for BT
Updating for BT
Proficiency in
Survival Craft and
Rescue Boat
Advanced
Firefighting
Crowd
Management
Crisis Management
Watchkeeping
STSDSD
LICENSE / ENDORSEMENT
Date
Doc. No. Issuing Authority
Issued Expiry
NC I
National Certificate.
Rating in Watchkeeping
Able Seafarer Deck/Engine
Electro-Technical
PH License
Flag State License
GOC (PH)
GOC (Flag State)
*Flag State 1. Bahamas 2. Panama 3. Singapore, Others
QSF 98/2010/Rev. 04
APPLICATION FORM
QSF 98/2010/Rev. 04
APPLICATION FORM
MEDICAL HISTORY
It is important that all illness other than minor afflictions should be stated. The Company is entitled to refuse any claim
treatment, cost or any other benefits if a complete statement of all previous illness has not been given.
A. Have you ever singed of a ship due to medical reason? No
If yes, please provide following details:
Name of vessel: Date of occurrence: Place of occurrence:
Brief description of illness / injury / accident
C. What illness or accident have you consulted a doctor during the last 12 months?
Details of illness/accident Date Therapy / Treatment
LINTON B. PAREDES
Signature over Printed Name
QSF 98/2010/Rev. 04
APPLICATION FORM
PREVIOUS EMPLOYMENT
Please complete below with details of your previous employment for the past ten (10) years and provide a brief description of your specific duties and
responsibilities.
LAND / SEA EXPERIENCE (most recent first)
Address and Contact Date
Rank/ Manning Employer/ Vessel’s Vessel
No. of Manning GRT Duties and Responsibilities
Position Agency Principal Name Type* From To
Agency
*Legend:
GCD – General Cargo B/C – Bulk Carrier CON – Cellular Container MLP – Multipurpose O/O – Ore / Oil Carrier
OBO – Ore/Bulk/Oil Carriers TNC – Tanker (Crude) TNP – Tanker (Product) TNV – VLCC/ULCC TNS – Tanker (Storage)
GAS – LPG/LNG Gas Carriers CHM – Chemical Carriers PAS – Passenger Ship R/O – Ro/Ro Carriers C/S - Car Ship
OSV – Off Shore Supply Vessel DRG – Dredgers SRV – Survey Vessel LOG – Log / Timber RFR - Reefer
QSF 98/2010/Rev. 04