ANGLO EASTERN GROUP FROM

Fax to +91-22-61124650 or e-mail to manning.bom@angloeasterngroup.com DATE

REF.
NOMINATION FOR M. V.

APPLICATION FOR EMPLOYMENT

Position applied for: Nationality:

Surname: Marital status: Married/Single/divorced*

Forenames: Photo

Date & Place of Birth: Address :

Last Salary: Local Tel No . Mobile :

Availability Date: Perm. Tel No . E-mail :

Last Employer: Name , PIC & contact no. :

Academic qualifications: Last School / College :

Pre Sea Training : Apprenticeship :

Documents Number Date & Place Issued Expiry Date

Passport

CDC (National )

U.S. Visa C1/D

National Lic. Class 1 / Class 2 / OOW *

Equivalent License :  Panama  Liberan  Singapore  Malaysia  Bahama  Bermuda
Oil Major Vetting attended :  Shell  BP  Exxon INDOS Number :

PREVIOUS SEA EXPERIENCE : Please attach extra sheets if the space provided does not suffice.
Vessel's Name For Deck - Trade & DWT Type of Vessel Company's Name Rank Period Dates Months / Days
For Eng - Type & BHP From - To Reason for s/off

CERTIFICATION/ENDORSEMENTS IN ADDITION TO MANDATORY STCW CERTIFICATES / EXPERIENCE:

DCE Oil TSC/OTFC BRM Yard Delivery Gantry ECDIS
DCE Chem CSC/CTFC BTM Major Conversion Self Unloader SFTY OFF
DCE Gas GSC/ GTFC Framo Pump Dry Dock Crane / Grab Secu Off

NOTE: DETAILED BIO-DATA FORM TO BE SUBMITTED UPON CONFIRMATION OF EMPLOYMENT

We do not charge any placement fees. If you have any grievances in this regard please write to: welfare.bom@angloeasterngroup.com
Form : AEI-FPD 01 Revision : 4 Page 1 of 1 Issue date : 13 Jul 10