Quality Assurance into the

21st Century and beyond

Personnel Form
TSM Form
No. 070

Date of Application:
☐ Application
☐ Nomination Position Applied:
Picture
☐ Promotion
Readiness to Join:
☐ Amendments

A. Personal

Family Name Given Name Middle Name Gender

☐ M ☐F
Birth Date Place of Social Security / Tax
Nationality National Reg. No.
(DDMMYY) Birth Ref Number

NA NA

Address Contact Email

Home:

Cell:

Passport No. Place of Issue Issued Date Expiry Date Civil Status

NA

US Visa No. Place of Issue Issued Date Expiry Date Religion

NA

Schengen Visa No. Place of Issue Issued Date Expiry Date Nearest Int’l Airport

B. Next of Kin

Family Name Given Name Middle Name Relationship

Address Contact Details

Home:
Cell:

CONTROLLED Revision: 15 Mar 2019

Approved by DPA/DMR
Page 1 of 11
 TSM Form No. 070
Personnel Form

C. National Certification

Graduated From Highest Qualification Year of Graduation

Discharge Book No. Issued Date Expiry Date

National Certificate No. Issued Date Expiry Date Issuing Country

D. Bio Data

Height (cm) Weight (kg) Color of Eyes Color of Hair

NA NA

Boiler Suit Size Safety Shoe Size

E. Certificates and Qualificat ions

Flag Issued Expiry

Documents Held STCW’95 Number
State (DDMMYY) (DDMMYY)

Foreign Certificate of STCW II –

Competency (s) Deck

STCW III -
Engine

STCW IV –
Radio

Ratings Watch keeping Cert - STCW A-II/4

Deck

Ratings Watch keeping Cert - STCW A-II/4

Engine

CONTROLLED Revision: 15 Mar 2019

Approved by DPA/DMR
Page 2 of 11
 TSM Form No. 070
Personnel Form

Basic Safety Training STCW A-VI /

1
1. Personal Survival
Technique
2. Fire Prevention and
Fire Fighting
3. Elementary First Aid
4. Personal Safety and
Social Responsibility

Proficiency in Survival Craft STCW A-VI /

and Rescue Boats 2

Proficiency in Fast Rescue STCW A-VI /

Boats 2-2

Ship Handling & Manoeuvring STCW A-II /

2

Bridge Team Management or STCW A-II /

Bridge Resource Management 1 (IMO
Model 1.22)

Generic ECDIS STCW A-II /

1 (IMO
Model 1.27)

Engine Room Simulator or STCW A-III /

Engine Room Resource 1&2 (IMO
Model 2.07)

STSDSD or SSO STCW A-VI /

6 or 5

Tanker Specific Requirements

Basic Tanker Training STCW A-V/1-

(Oil/Chem/Gas) 1.1 & 2.1

Advanced Tanker Training (Oil) STCW A-V/1-

1.2

Advanced Tanker Training STCW A-V/1-

(Chem) 1.2

Advanced Tanker Training STCW A-V/1-

(Gas) 2.2

CONTROLLED Revision: 15 Mar 2019

Approved by DPA/DMR
Page 3 of 11
FRAMO experience Yes ☐ No ☐ Centrifugal Pumps Yes ☐ No ☐
with Pump Room

Wartsila-Sulzer RT-flex Yes ☐ No ☐ Man B&W ME-B/C Yes ☐ No ☐

experience experience
(electronic)

F. Other Qualificat ions / STCW’95 Courses

Certificate Name Certificate No. Date of Issue Date of Expiry

G. Sea Service Record (Note: Sea service should be listed in chronological order with
most recent assignment first and should include details for the past 5 years as a
minimum)
Engine Period
Type / KW (DD/MM/YY)
DWT (indicate Length Ship
Vessel
Rank Vessel Name / full engine of Owner /
Type
TEU make/type Manager
From To
for Time
engineers) Onboard
For Offshore applicants only:

Anchor Handling operations during contract? ☐ Yes (If yes, how many hours / days ) ☐ No

What depth? Anchor type? Location & name of rig?

Towing during contract? ☐ Yes ☐ No. If yes, name of barge towed

From where to where? Tow Length? Charterer?

Boat handling experience? _

H. Reference(s) from Previous Employ me nt

No. Company Name of Contact Person Contact Details

I. Cargo Experience Information Sheet

 For Tanker Vessels – refer to Annex 1

 For Dry Bulk Vessels – refer to Annex 2

I would like to apply for a position on below ship types based on my personal preference and
relevant experience (tick as applicable):
TANKERS

Ship
Ship size Tick if Tick if
Ship type Ship type size
(DWT) Applicable Applicable
(DWT)
Very Large Crude Asphalt & Bitumen
160K+ ☐ ALL ☐
Carrier Carrier

AFRAMAX / SUEZMAX 80-160K ☐ Very Large Gas Carrier ALL ☐

Chemical Tanker
ALL ☐ LPG ALL ☐
(Hard Core Chemicals)
Chemical Tanker
ALL ☐ LNG ALL ☐
(Soft / Easy Chemicals)
Product Tanker ALL ☐ Ethylene Carrier ALL ☐

DRY BULK

Ship
Ship size Tick if Tick if
Ship type Ship type size
(DWT) Applicable Applicable
(DWT)
Very Large Ore Carrier >210 K ☐ Handysize + Handymax 40-50K ☐

Cape Size 130-200K ☐ Log Carrier ALL ☐

Panamax 80-130K ☐ Ice Class ALL ☐

Kamsamax +
50-80K ☐ Container Vessels ALL ☐
Supramax

OFFSHORE

Propulsion Type Any Other Tick if

Ship type DP Class
(CPP / Azimuths) Limiting Factors Applicable
Anchor Handling Tug Supply ☐

☐
Platform Supply Vessel

Offshore Construction Vessel ☐

Seismic (Mother Vessel) ☐

Seismic (Chaser Vessel) ☐

Offshore Support Vessel ☐

Accommodation Vessel ☐

Dive Support Vessel ☐

Other (Specify): ☐

J. Declaration and Signature

1. I hereby certify that the information given above are true and correct to the best of my
knowledge and belief and that I have not withheld any information that would affect my
application unfavourably.
2. Any false declaration I supplied herein may constitute ground for disqualification and non-
acceptance to the company and can be further subjected to applicable penalties in accordance
to existing laws governing the recruitment and employment of overseas seafarers.
3. I give consent to the Company for holding and processing all my personal data as disclosed in
this Form for the purposes of (i) To keep me informed about any upcoming vacancy (Note: you
can unsubscribe from any time), (ii) To process my application, (iii) To use my data for
processing my Payment, as applicable, and (iv)To share my data with such third party who act
for and on behalf of the Company or in connection with the business of the Company for further
processing in accordance with the purposes for which the data was originally collected.
[IMPORTANT NOTE: Please do note that you have the right to withhold your consent. You can
find out more about how we use your data from our “Public Privacy Policy” which is available
from our website at <https://www.thome.com.sg/wp-content/uploads/2018/11/Thome-Group-
Public-Privacy-Policy.pdf> or from the Company representative. You can also withdraw or
change your consent at any time by contacting the local manning office / agent or Company
representative.]
Please note that all processing of your personal data will cease once you have withdrawn
consent, other than where this is required by law, but this will not affect any personal data that
has already been processed prior to this point.]

Signature of Applicant: Date:

Annex 1:
Cargo experience information sheet – Tankers
Instruction to applicant: Please tick appropriate box for cargoes that you have been carried before.

Yes
Oil / DPP
As
(Note: experience with any 1 of the listed cargoes is No As As Senior
Junior
required for oil tanker assignment) rating Officer
Officer
Crude oil
Fuel oil
Carbon black

Yes
Asphalt
(Note: experience with any 1 of the listed cargoes is No As
As As Senior
required for asphalt tanker assignment) Junior
rating Officer
Officer
Asphalt
Bitumen
Coal tar
Residual oil

Yes
Clean Petroleum Products (CPP)
As
(Note: experience with any 2 of the listed cargoes is No As As Senior
Junior
required for product (CPP) tanker assignment) rating Officer
Officer
Kerosene GML
Condensates
Gasoline
Gasoil
Jet a-1
Avgas
Diesel oil
Lub oil
Aviation Alkylates
Distillates

Yes
Soft chemicals
(Note: experience with any 2 of the listed cargoes is No As
As As Senior
required for soft chemical tanker assignment) Junior
Rating Officer
Officer
Vegetable oil
Soya bean oil
Fame
Tallow
Ethylene Dichloride (EDC)
Styrene Monomer
Benzene
Xylene
Toluene
Acids
Sodium hydroxide solution
Urea Ammonium Nitrate (UAN)

Yes
Hard chemicals
As
(Note: experience with any 1 of the listed cargoes is No As As Senior
Junior
required for hard chem tanker assignment) Rating Officer
Officer
MDI
TDI
Phenol
Propylene oxide / isoprene
Acrylates
Hexamethylene diamine (HMD)
Cumene
Latex
Acrylonitrile (ACN)
Methyl ethylene glycol (MEG) fibre grade (0.5 ppm
chlorides)

Gas Yes
(Note: experience with any 2 of the listed
No As Junior
cargoes is required for gas tanker As Rating As Senior Officer
assignment) Officer

Ammonia, Anhydrous
Butadiene
Butane
Butane - propane mixtures
Butylenes
Ethane
Ethylene
Mixed c4
Pentanes
Pentene
Propane
Propylene
Propylene Oxide
Vinyl Chloride

Other information / Areas of knowledge No Yes Comments

Crude oil washing

Deep well pump experience
Specialised framo course
Tank coating – phenolic epoxy
Tank coating – epoxy
Tank coating – zinc paint
Tank coating – stainless steel
Tank coating – marineline
Any other relevant information that you would like to inform us about:

Annex 2:
Cargo experience information sheet – Dry bulk
Instruction to applicant: Please tick appropriate box for cargoes that you have been carried before.

Yes
Dry bulk No As Junior
As rating As Senior Officer
Officer
Grain & agricultural products
Coal
Ore
Steel & steel products
Timber
Logs
Reefers (container vessels only)
IMDG (container vessels only)
Others (please specify below):

Other information / Areas of knowledge No Yes Comments

Geared vessel experience

(if yes, please specify what kind of cranes)
Types of hatch covers (please specify)

Any other relevant information that you would like to inform us about: