CREW APPLICATION FORM

DIANA SHIPPING SERVICES S.A. Date :

RANK:

SURNAME : PERMANENT ADDRESS:

FIRST NAME :
MIDDLE NAME : TEL: MOBIL:
FATHER’S NAME : NATIONALITY:
MOTHER’S NAME:
WIFE’S NAME : NAME & ADDRESS OF NEXT OF KIN:
CHILDREN :
BIRTH DATE : BIRTH PLACE : C/STATUS :
HEIGHT : CM WEIGHT: KG ANY DISTINGUISHING MARKS :
SCHOOL :
DOCUMENTS
DOCUMENT NUMBER DATE ISSUED VALID UNTIL PLACE ISSUED / AUTHORITY
SEAMAN’S BOOK
PASSPORT
IDENTIFICATION CARD
USA VISA
AUSTRALIAN VISA
CHINESE VISA
LICENSES
LICENSES NUMBER DATE ISSUED VALID UNTIL PLACE ISSUED / AUTHORITY

CERTIFICATES
CERTIFICATES NUMBER DATE ISSUED VALID UNTIL PLACE ISSUED / AUTHORITY
LIFE SAVING, FIGHTING,
RESCUE BOATS
G.M.D.S.S. (G.O.)
MEDICAL CARE
SSO - CSO
B.R.M. - B.M.S. - B.T.M.
ECDIS
TANKERS SAFETY
HAZMAT (Hazardous materials)
HEALTH C/F

REMARKS: ____________________________________________________________
 PREVIOUS SEA SERVICE

SIGNED SIGNED CAUSE OF MAIN VSL’S

RANK MONTHS VESSEL’S NAME NAT/TY DWT ENGINE TYPE
COMPANY
ON OFF DISCHARGE