SEAFARER’S APPLICATION FORM

船员申请表

This application form serves to provide with all information of the Applicant and will be treated as personal record should the Applicant be
employed. 此表用于填写申请人的个人信息，所填写的内容作为个人纪录登记入库。
Applicant is required to complete all parts in BLOCK CAPITALS. Copies of all certificates, Seaman's book, passport and appraisal from the
previous companies (if any) are to be attached.申请人需要用大写字母填写此表并且提供所有证书扫描件和由上任公司签发的在船评估表。
Applicant must be at least 18 years of age for any position applied. 所有申请人的年龄必须大于（包括）18 岁。

POSITION APPLIED FOR： Date:

申请职务: 日期：

PERSONAL DETAILS 个人信息

Surname 姓 Middle Name Last Name 名 Nationality 国籍

Date of Birth 出生日期 Place of Birth 出生地 Religion 宗教 Age 年龄

Height/Weight Safety Shoe Size Overall Size Marital Status Affix

身高/体重 安全鞋尺码 工作服尺码 婚姻状况 Recent
Colour
Photo
Passport Number Issuing Authority Date of Issue Date of Expiry 粘贴近期照片
护照号 签发机关 签发日期 过期日期

Seaman’s Book Number Issuing Authority Date of Issue Date of Expiry COC Grade
海员证号码 签发机关 签发日期 过期日期 适任证书级别

Mobile Phone Number House Telephone Number Email Address & Skype ID (if Hometown Airport
手机号码 家庭电话 available) 邮箱地址 / 网络电话(SKYPE) 临近机场

Last Salary 上次任职薪水 Readiness 准备就绪日期

Permanent Address 永久地址

HIGHEST ACADEMIC QUALIFICATION 教育信息

Name of University/College Qualifications School period Education Qualification
毕业院校名称 就读专业 (MM/YY-MM/YY) 就读时间 学历

NEXT-OF-KIN 第一联系人
Name 姓名 Relationship 关系 Contact Number 联系方式

Address (if different from the above) 地址（如与上述不同）

Officer Certification (STCW) Certificate Number Issuing Authority Date of Issue Date of Expiry

Form SMS 01 Rev 03/ 15 August 2014 Page 1

 高级船员证书 证书号码 签发机关 签发日期 过期日期

Rating Certification (STCW) Certificate Number Issuing Authority Date of Issue Date of Expiry
普通船员证书 证书号码 签发机关 签发日期 过期日期

Training Certification (STCW) Certificate Number Issuing Authority Date of Issue Date of Expiry
培训合格证 证书号码 签发机关 签发日期 过期日期
Basic Training (VI/1)
基本安全
Proficiency in Survival Craft and
rescue boat(VI/2)
精通救生艇筏
Advanced Fire Fighting(VI/3)
高级消防
Medical First Aid (VI/4-1)
精通急救
Medical Care (VI/4-2)
船上医护
Ship’s Security Officer (VI/5)
船舶保安员
Security Awareness Training
(VI/6) 保安意识培训
Security Designated Duties (VI/6)
负有指定保安职责船员培训
Basic Oil/Chemical Tanker (V/1-1)
油船和化学品货物操作基本培训
Advanced Oil Tanker Cargo
Operations (V/1-2)
油船货物操作高级培训
Advanced Chemical Tanker Cargo
Operations (V/1-2)
化学品船货物操作高级培训
Basic LPG Tanker (V/1-1)
液化气船货物操作基本培训
Advanced LPG Tanker Cargo
Operations (V/1-2)
液化气船货物操作高级培训
Bridge Resource Management
驾驶台资源管理
Ship handling Course
船舶操纵培训
ECDIS
电子海图
Bridge/Engine Team Management
驾驶台/机舱团队管理
MEDICAL AND VACCINATION Certificate Number Issuing Authority Date of Issue Date of Expiry
体检和疫苗 证书号码 签发机关 签发日期 过期日期
Medical Certificate(ILO/MLC)
体检证书
Yellow Fever
黄热
Cholera Vaccination
霍乱

Form SMS 01 Rev 03/ 15 August 2014 Page 2

 SEA SERVICE 海上资历
Type/
Model
Cargo
Name of KW Trading Month
Company Type GT Rank From To
Vessel 主机品 Area s
公司 货物类 总吨 职务 从 至
船名 牌/型 航区 月数
型
号 &马
力

To list Sea Service Period from Junior Officer (for Officer) and lowest Rank (for Rating) onward.
对高级船员的资历，请从三副三管轮开始的所有海上服务资历列起；对普通船员的资历，从最低职位海上资历列起。

Date: Signature:
日期： 签名：

Form SMS 01 Rev 03/ 15 August 2014 Page 3