KT Ship LLC

Appendix 1 of SOP No. 4 Crew Manning – Application Form

F–4

APPLICANT’S PERSONAL DATA

POSITION APPLIED FOR:
DATE OF AVAILABILITY:
REQUESTED SALARY:

SURNAME / NAME: NEXT OF KIN:

DOB / POB: RELATION:
CITIZENSHIP: ADDRESS:
ADDRESS: MARITAL STATUS:
TOWN / COUNTRY: NR. OF CHILDREN:
PHONE: E – MAIL:

MARINE EDUCATION
TYPE OF DEGREE
NAME OF SCHOOL FROM TILL
RECEIVED

TRAVEL DOCUMENTS
DOCUMENT TYPE COUNTRY NUMBER ISSUED VALID
TRAVEL PASSPORT
SEAMAN’S BOOK

VISAS
COUNTRY OF VISA VISA NO ISSUED VALID
USA
NETHERLANDS

CERTIFICATES
CERTIFICATE GRADE NUMBER ISSUED VALID
CERTIFICATE OF COMPETENCY
C. O. C. ENDORSEMENT
GMDSS
GMDSS ENDORSEMENT
TANKER ENDORSEMENT

ADVANCED FIRE FIGHTING

BASIC SAFETY TRAINING / SOLAS
MEDICAL FIRST AID / CARE
PROFICIENCY IN SURVIVAL
CRAFT

RADAR/ ARPA
SHIP SECURITY OFFICER
BRIDGE TEAM MANAGEMENT
BRIDGE RESOURCE
MANAGEMENT
ENGINE RESOURCE
MANAGEMENT
HAZARDOUS MATERIALS
SHIP SAFETY OFFICER
ECDIS
SECURITY AWARENESS
DESIGNATED SECURITY DUTIES
HIGH VOLTAGE TRAINING

REV. 2 – 26.01.2018
72 A - 217, KADAKA STREET, TALLINN 12618, ESTONIA
TEL: +372 6718642 / 6718640; FAX +372 6718644
 KT Ship LLC
Appendix 1 of SOP No. 4 Crew Manning – Application Form
F–4

FLAG STATE DOCUMENTS

TYPE OF
GRADE COUNTRY NUMBER ISSUED VALID
DOCUMENT
ENDORSEMENT
SEAMAN’S BOOK

TANKER DOCUMENTS
NAME OF DOCUMENT NUMBER ISSUED VALID
TANKER FAMILIARIZATION
CHEMICAL TANKER FAMILIARIZATION
LPG TANKER FAMILIARIZATION
OIL TANKER FAMILIARIZATION
SPECIALIZED CHEMICAL TRAINING
SPECIALIZED OIL TRAINING
SPECIALIZED LPG TRAINING
CRUDE OIL WASHING
INERT GAS SYSTEM

MEDICAL CERTIFICATES
TYPE OF DOCUMENT NUMBER COUNTRY ISSUED VALID
MEDICAL CERTIFICATE
YELLOW FEVER VACCINATION
DRUG & ALCOHOL TEST
DENTAL CERTIFICATE

SIZES
CLOTHES: SHOES: HEIGHT: WEIGHT:
HAIR COLOR: EYES COLOR:

ENGLISH LANGUAGE
POOR SATISFACTORY GOOD

In accordance GDPR (Regulation (EU) 2016/679) herewith I confirm my compliance with the automatic processing of my
personal data given in this application form, including transfer of my personal data and documents to the third parties and storage
of this data and documents for employment purposes. I confirm that my personal data and documents inserted into this application
are considered to be public information.

В соответсвии с регулирующим актом Евросоюза «Общие положения о защите данных» (General Data Protection
Regulation, GDPR), я подтверждаю, что согласен с автоматической обработкой моих персональных данных, указанных в
данной анкете, включая передачу этих данных и копий моих документов третьим лицам, и их хранением в целях
трудоустройства. Подтверждаю, что мои персональные данные и документы, указанные в анкете, являются
общедоступными.

REV. 2 – 26.01.2018
72 A - 217, KADAKA STREET, TALLINN 12618, ESTONIA
TEL: +372 6718642 / 6718640; FAX +372 6718644
 KT Ship LLC
Appendix 1 of SOP No. 4 Crew Manning – Application Form
F–4

SEA SERVICE – LAST 10 YEARS

EMPLOYMENT
ENGINE TYPE
VESSEL’S NAME COMPANY FLAG TYPE DWT GRT TEU KWT CRANES RANK PRIOD
ENGINE MARK
D/M/Y D/M/Y

In accordance GDPR (Regulation (EU) 2016/679) herewith I confirm my compliance with the automatic processing of my personal data given in this application form, including
transfer of my personal data and documents to the third parties and storage of this data and documents for employment purposes. I confirm that my personal data and documents inserted
into this application are considered to be public information.

В соответсвии с регулирующим актом Евросоюза «Общие положения о защите данных» (General Data Protection Regulation, GDPR), я подтверждаю, что согласен с
автоматической обработкой моих персональных данных, указанных в данной анкете, включая передачу этих данных и копий моих документов третьим лицам, и их хранением в
целях трудоустройства. Подтверждаю, что мои персональные данные и документы, указанные в анкете, являются общедоступными.

REV. 2 – 26.01.2018
72 A - 217, KADAKA STREET, TALLINN 12618, ESTONIA
TEL: +372 6718642 / 6718640; FAX +372 6718644