EMPLOYMENT APPLICATION

Personal data
Full Name: Rank:
Address:
Home Phone No.
Mobile Phone No
E mail:
Skype:
Place of Birth:
Date of Birth:
Citizenship: picture
Marital Status:
Spoken Languages:
Height/Weight Passport
Country
Education: Number Place Issued Date Issued Expiry Date

Visa
Country Number Place Issued Date Issued Expiry Date

Certificate of Competency
Grade of License Country Number Place Issued Date Issued Expiry Date

Seaman′s Book
Country Number Place Issued Date Issued Expiry Date

Medical
Medical Country Place Issued Date Issued Expiry Date

Drug & Alcohol

Place Issued Date Issued Expiry Date

Yellow Fever
Place Issued Date Issued Expiry Date

Certification & Training

Certificate Country Number Place Issued Date Issued Expiry Date
VI/1 - BASIC TRAINING
VI/3 - ADVANCED FIRE
FIGHTING
VI/4-1 - MEDICAL FIRST AID
VI/4-2 - ADVANCED MEDICAL
CARE
VI/5 - SSO
VI/6-1 - SECURITY AWARENESS
VI/6-2 - SEAFARER WITH
DESIGNATED SECURITY
DUTIES
B-V/B,V/C - DANGEROUS AND
HAZARDOUS SUBSTANCES
IV/2 - GMDSS
VI/2-1 PROF. IN SURV. CRAFT
AND RESCUE BOAT
ECDIS
ECDIS SPECIFIC

Reference:

Company
Name
e-mail

Company
Name
e-mail
Previous Sea Experience

Vessel Name Vsl Type Eng Type* DWT kW* Company Rank Joined Leave

*for engineers only

Remarks:
 CONSENT

I give my Consent as stated below

By submitting this application form I confirm I have read and understood Damaco Company Privacy Policy posted at www.damaco.com.hr and agree that Damaco d.o.o.
save, use and share my personal data which I have provided in this application form, and in accordance with General data protection policy in EU Reg. (EU) 2016/679

I hereby also confirm that all the information provided by me in this application is true and correct to the best of my knowledge and belief; further, that no Certificate or License
issued to me has ever been revoked or suspended. I also certify that my medical history mentioned previously is true and any false statement or undisclosed material
information about past illness or injury will disqualify me from any employment benefits and claims.