Marine Officer CV Form (Rev 4.

1 - June 2011)
11/22/2012

CV No Processed Date

Remarks

Original copies of relevant certificates/records must be made available for verification and candidate briefed by contractor (with
evidence) prior assessment otherwise candidate will be rejected.
Appointment for:
SMR Assessment Re-briefing

*Acceptance criteria for candidates with <2 years service in rank or promotion:
Shipboard/In-service competence assessment & recommendation by Master/ Chief Engineer, supported by DPA

Practical mooring/vessel handling assessment by SMR/2x (for Workboat Master)

Proof of at least 5 rig/barge moves done last 3 years (for AHTS/AHT Master)

For contractor's input

Contractor Contract Holder

Vessel Name Gross Tonnage

Vessel Type Propulsion (KW)

Candidate Name New In BSP

Birth Date Age < 2 Years In Rank*

Nationality Promotion*

Position
Date Format: MM/DD/YY
Certificate Of Competency Regulation

Limitation Expiry Date

Passport Number Expiry Date

Seaman Book Expiry Date

GMDSS Operator Certificate Expiry Date

DP Operator Certificate Issue Date

Training Certification (STCW'95) * validity 5 years unless stated

Personal Survival Techniques* Issue Date

Fire Prevention and Fire Fighting* Issue Date

Elementary First Aid* Issue Date

Personal Safety and Social Responsibilities* Issue Date

Proficiency In Survival Craft and Rescue Boats* Issue Date

Proficiency In Fast Rescue Boat* Issue Date

Advanced Fire Fighting* Issue Date

Medical First Aid and Medical Care Issue Date

Radar Navigation & Automatic Radar Plotting Aids* Issue Date

Shipboard Management* Issue Date

Sea Service Records (Most recent first backdating to last 4 years) Date Format: MM/DD/YYYY

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration 0 3 22
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration
Year Month Day

Accumulative Duration in Rank Proposed

0 3 22
Year Month Day
Sea Service Records (Most recent first backdating to last 4 years)-Continued Date Format: MM/DD/YYYY

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration 0 0 0
Year Month Day

Vessel Rank Master

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration 0 0 0
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration 0 0 0
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration 0 0 0
Year Month Day

Vessel Rank

Vessel Type GT KW

Period (MM/DD/YYYY) From To

Duration 0 0 0
Year Month Day

Total Accumulative Duration in Rank Proposed

0 0 0 0 0 0
Year Month Day

Mandatory scanned copies (legible/readable) of following certificates/records to be attached with this form:
1) Certificate of Competency
2) CoC Endorsement
3) Seaman Discharge Book (pages showing personal particulars & last 4 year sea service)
4) International Passport (personal particulars page showing expiry date)
5) GMDSS Operator Certificate (if applicable)
6) DP Operator Certificate & Training Logbook (if applicable)