APPLICATION FOR THE POSITION OF:

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CURRICULUM VITAE (CV)

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# Form have to be completely filled with information and signed * Dates to be in entered in DD/MM/YY format
A. PERSONAL DATA
Name (Exactly As in Passport) Contact No. 1
Place of Birth Contact No. 2
Date of Birth* Nationality & Race
Current Salary in USD Expected Salary in USD Date of Availability*
International Passport No. Passport Expiry Date*
Seaman Book No. Seaman Book Expiry*
Working Coverall Size Working Shoe Size
Body Weight in KG Height in CM Religion
Medical Certificate Issue Date* Medical Certificate Expiry*
Email Address Skype ID Medical History (if any)
Main Airport Name Drug & Alcohol Date*
Marital Status Name of Spouse No. of Children Gender & Age
Mother's Name & Age Deceased (Yes or No) Father's Name & Age Deceased (Yes or No)
Home Address Home Telephone No.
Next of Kin Name (Emergency) Relationship
Next of Kin Address Contact No.

B. EDUCATIONAL BACKGROUND
Highest School Attended Year (e.g 1990 - 1995)
Highest Qualification Attained Major
Marlins Test Score Test Location Test Licence Code

C. CERTIFICATE OF COMPETENCY
Description of Certificate Certificate Class Certificate No. Issued Date* Expiry Date* Limitations Applying (if any) Country of Issuance
National Certificate of Competency
National Certificate of Competency End
National GMDSS / GOC
National GMDSS / GOC Endorsement
Singapore COE
Singapore GOC
Malaysia COR

D. COURSE ATTENDED &

CERTIFICATES OBTAINED
Description of Certificate Certificate No Issued Date* Expiry Date* Revalidated (Yes or No) Country of Issuance
Basic Safety Training (A-VI/1-1 to 1-4)
Personal Survival Techniques (A-VI/1-1)
Basic Firefighting (A-VI/1-2)
Elementary First Aid (A-VI/1-3)
Personal Safety & Social Responsibility (A-VI/1-4)
Survival Craft & Rescue Boat (A-VI/2 para 1-4)
Fast Rescue Craft (A-VI/2 para 5-8)
Advance Fire Fighting (A-VI/3)
Medical First Aid On Board (A-VI/4-1)
Medical Care On Board (A-VI/4-2)
Ship Security Officer (A-VI/5 & B/VI-5)
Security Training for Seafarers with Designated Security Duties (A-VI/6)
Security Awareness Training (A-VI/6-1) 27-244772 20-AUG-14 PHILIPPINES
Bridge Resource Management (A-II/2)
ECDIS (A-II/1 & A-II/2)
Radar Observer
Radar & ARPA
ISM Code
BOSIET / FOET
HUET
Helicopter Landing Officer (HLO)
H2S
Ship's Crane Operator
Any other certs (please indicate)
MARPOL ANNEX 1
MARPOL ANNEX II
MARPOL ANNEX VI

E. DP CERTIFICATION
Description of Certificate Certificate No Issued Date* Expiry Date* Date Due for Revalidation* Country of Issuance
Unlimited Full DP Certificate
Limited DP Certificate
DP Advance (Simulator)
DP Basic (Induction)
Azimuth Thruster 360 Deg.

SEA SERVICES RECORD AS IN

F. SEAMAN BOOK. INDICATE MUST BE TRUE and HONEST in SEA SERVICES and Previous RANK - SEA TIME STATED BELOW MUST BE THE SAME WITH SEAMAN BOOK & DP LOGBOOK
MAXIMUM

Engine Signed Signed Type and number of Charter & Areas Reason
No Vessel Name Company & Country Type of Vessel DP System DP1/DP2/ GRT Rank Rank in DP Flag offshore operations BHP/K-WATT
DP3 Type On* Off* carried out of Operations Leav

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

G. REFERENCES H. DECLARATION
No Name of Company Name of Contact Person Email Contact Number
1 I hereby declare that the information furnished above is true to the best of my knowledge.
2
3
4 Signature Date*
5
 EG
JP
y) in
or o
ls ot
pu t Ph
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(C ece
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Country of Issuance

Country of Issuance

PHILIPPINES

Country of Issuance

TED BELOW MUST BE THE SAME WITH SEAMAN BOOK & DP LOGBOOK

Reason For
Leaving

DECLARATION

I hereby declare that the information furnished above is true to the best of my knowledge.

Date*
 APPLICATION FOR THE POSITION OF:

EG
JP
y) i n
CURRICULUM VITAE (CV)

or o
ls ot
pu t Ph
om n
(C ece
R
# Form have to be completely filled with information and signed * Dates to be in entered in DD/MM/YY format
A. PERSONAL DATA
Name (Exactly As in Passport) Contact No. 1
Place of Birth Contact No. 2
Date of Birth* Nationality & Race
Current Salary in USD Expected Salary in USD Date of Availability*
International Passport No. Passport Expiry Date*
Seaman Book No. Seaman Book Expiry*
Working Coverall Size Working Shoe Size
Body Weight in KG Height in CM Religion
Medical Certificate Issue Date* Medical Certificate Expiry*
Email Address Skype ID Medical History (if any)
Main Airport Name Drug & Alcohol Date*
Marital Status Name of Spouse No. of Children Gender & Age
Mother's Name & Age Deceased (Yes or No) Father's Name & Age Deceased (Yes or No)
Home Address Home Telephone No.
Next of Kin Name (Emergency) Relationship
Next of Kin Address Contact No.

B. EDUCATIONAL BACKGROUND
Highest School Attended Year (e.g 1990 - 1995)
Highest Qualification Attained Major
Marlins Test Score Test Location Test Licence Code

C. CERTIFICATE OF COMPETENCY
Description of Certificate Certificate Class Certificate No. Issued Date* Expiry Date* Limitations Applying (if any) Country of Issuance
National Certificate of Competency
National Certificate of Competency End
National GMDSS / GOC
National GMDSS / GOC Endorsement
Singapore COE
Singapore GOC
Malaysia COR

D. COURSE ATTENDED &

CERTIFICATES OBTAINED
Description of Certificate Certificate No Issued Date* Expiry Date* Revalidated (Yes or No) Country of Issuance
Basic Safety Training (A-VI/1-1 to 1-4)
Personal Survival Techniques (A-VI/1-1)
Basic Firefighting (A-VI/1-2)
Elementary First Aid (A-VI/1-3)
Personal Safety & Social Responsibility (A-VI/1-4)
Survival Craft & Rescue Boat (A-VI/2 para 1-4)
Fast Rescue Craft (A-VI/2 para 5-8)
Advance Fire Fighting (A-VI/3)
Medical First Aid On Board (A-VI/4-1)
Medical Care On Board (A-VI/4-2)
Ship Security Officer (A-VI/5 & B/VI-5)
Security Training for Seafarers with Designated Security Duties (A-VI/6)
Security Awareness Training (A-VI/6-1)
Engine Room Resource Management
Maintenance of Electrical & Electronics
High Voltage Certificate
BOSIET / FOET
HUET
H2S
Any other certs (please indicate)

E. DP CERTIFICATION
Description of Certificate Certificate No Issued Date* Expiry Date* Date Due for Revalidation* Country of Issuance
DP System Maintenance
Azimuth Thruster 360 Deg.
SEA SERVICES RECORD AS IN
F. SEAMAN BOOK. INDICATE MUST BE TRUE and HONEST in SEA SERVICES and Previous RANK - SEA TIME STATED BELOW MUST BE THE SAME WITH SEAMAN BOOK & DP LOGBOOK
MAXIMUM

Engine Signed Signed Type and number of Charter & Areas Reason For
No Vessel Name Company & Country Type of Vessel DP System DP1/DP2/ GRT Rank Flag offshore operations BHP/K-WATT
DP3 Type On* Off* carried out of Operations Leaving

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

G. INDICATE
NUMBER.
SOME ENGINE MODEL
EXAMPLE OF ENGINE MODEL AS BELOW
1 2 3 4 5 Remarks
6 7 8 9 10

H. REFERENCES I. DECLARATION
No Name of Company Name of Contact Person Email Contact Number
1 I hereby declare that the information furnished above is true to the best of my knowledge.
2
3
4 Signature Date*
5
 APPLICATION FOR THE POSITION OF:

in
to
CURRICULUM VITAE (CV)

ho
om G t P

y)
or
(C PE en

ls
J ec

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R
# Form have to be completely filled with information and signed * Dates to be in entered in DD/MM/YY format
A. PERSONAL DATA
Name (Exactly As in Passport) Contact No. 1
Place of Birth Contact No. 2
Date of Birth* Nationality & Race
Current Salary in USD Expected Salary in USD Date of Availability*
International Passport No. Passport Expiry Date*
Seaman Book No. Seaman Book Expiry*
Working Coverall Size Working Shoe Size
Body Weight in KG Height in CM Religion
Medical Certificate Issue Date* Medical Certificate Expiry*
Email Address Skype ID Medical History (if any)
Main Airport Name Drug & Alcohol Date*
Marital Status Name of Spouse No. of Children Gender & Age
Mother's Name & Age Deceased (Yes or No) Father's Name & Age Deceased (Yes or No)
Home Address Home Telephone No.
Next of Kin Name (Emergency) Relationship
Next of Kin Address Contact No.

B. EDUCATIONAL BACKGROUND
Highest School Attended Year (e.g 1990 - 1995)
Highest Qualification Attained Major
Marlins Test Score Test Location Test Licence Code

C. CERTIFICATE OF COMPETENCY
Description of Certificate Certificate Class Certificate No. Issued Date* Expiry Date* Limitations Applying (if any) Country of Issuance
National Certificate of Competency
National Certificate of Competency End
National GMDSS / GOC
National GMDSS / GOC Endorsement
Singapore COE
Singapore GOC
Malaysia COR

D. COURSE ATTENDED &

CERTIFICATES OBTAINED
Description of Certificate Certificate No Issued Date* Expiry Date* Revalidated (Yes or No) Country of Issuance
Basic Safety Training (A-VI/1-1 to 1-4)
Personal Survival Techniques (A-VI/1-1)
Basic Firefighting (A-VI/1-2)
Elementary First Aid (A-VI/1-3)
Personal Safety & Social Responsibility (A-VI/1-4)
Survival Craft & Rescue Boat (A-VI/2 para 1-4)
Fast Rescue Craft (A-VI/2 para 5-8)
Advance Fire Fighting (A-VI/3)
Medical First Aid On Board (A-VI/4-1)
Medical Care On Board (A-VI/4-2)
Ship Security Officer (A-VI/5 & B/VI-5)
Security Training for Seafarers with Designated Security Duties (A-VI/6)
Security Awareness Training (A-VI/6-1)
Bridge Resource Management (A-II/2)
ECDIS (A-II/1 & A-II/2)
Radar Observer
Radar & ARPA
ISM Code
BOSIET / FOET
HUET
Helicopter Landing Officer (HLO)
H2S
Ship's Crane Operator
HDA Initial training (OPITO)
MARPOL ANNEX 1
MARPOL ANNEX II
MARPOL ANNEX VI

E. DP CERTIFICATION
Description of Certificate Certificate No Issued Date* Expiry Date* Date Due for Revalidation* Country of Issuance
Unlimited Full DP Certificate
Limited DP Certificate
DP Advance (Simulator)
DP Basic (Induction)
Azimuth Thruster 360 Deg.

SEA SERVICES RECORD AS IN

F. SEAMAN BOOK. INDICATE MUST BE TRUE and HONEST in SEA SERVICES and Previous RANK - SEA TIME STATED BELOW MUST BE THE SAME WITH SEAMAN BOOK & DP LOGBOOK
MAXIMUM Type and number of
No Vessel Name Company & Country Type of Vessel DP System DP1/DP2/ GRT Engine Rank Rank in DP Signed Signed Flag offshore operations Charter & Areas BHP/K-WATT
Reason
DP3 Type On* Off* carried out of Operations Leav
1 FC
1 For Board
1
2
3
4
5
6
7
8
9
10
11
12
13
13
14
15
16
17
 18
19
20

G. REFERENCES H. DECLARATION
No Name of Company Name of Contact Person Email Contact Number
1 I hereby declare that the information furnished above is true to the best of my knowledge.
2
3
4 Signature Date*
5

Rank DP Rank in DP
Master 1 TDPO
Additional Master 2 JDPO
Chief Officer 3 DPO
Additional Chief Officer SDPO
2nd Officer
3rd Officer
Deck Cadet
Chief Engineer
2nd Engineer
3rd Engineer
4th Engineer
Engine Cadet
ETO
Electrical Engineer
Electrician
Safety Officer
Bosun
Deck Foreman
Able-Bodied
Ordinary Seaman
Oiler
Wiper
Chief Cook
Cook
Steward
 in
to
ho
om G t P

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or
(C PE en

ls
J ec

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R
Country of Issuance

Country of Issuance

Country of Issuance

TED BELOW MUST BE THE SAME WITH SEAMAN BOOK & DP LOGBOOK
Reason For
Leaving
FC

For Board Exam

DECLARATION

I hereby declare that the information furnished above is true to the best of my knowledge.

Date*
 APPLICATION FOR THE POSITION OF:

G
PEJ
y) in
CURRICULUM VITAE (CV)

or o
ls ot
pu t Ph
om n
(C ece
R
# Form have to be completely filled with information and signed * Dates to be in entered in DD/MM/YY format
A. PERSONAL DATA
Name (Exactly As in Passport) Contact No. 1
Place of Birth Contact No. 2
Date of Birth* Nationality & Race
Current Salary in USD Expected Salary in USD Date of Availability*
International Passport No. Passport Expiry Date*
Seaman Book No. Seaman Book Expiry*
Working Coverall Size Working Shoe Size
Body Weight in KG Height in CM Religion
Medical Certificate Issue Date* Medical Certificate Expiry*
Email Address Skype ID Medical History (if any)
Main Airport Name Drug & Alcohol Date*
Marital Status Name of Spouse No. of Children Gender & Age
Mother's Name & Age Deceased (Yes or No) Father's Name & Age Deceased (Yes or No)
Home Address Home Telephone No.
Next of Kin Name (Emergency) Relationship
Next of Kin Address Contact No.

B. EDUCATIONAL BACKGROUND
Highest School Attended Year (e.g 1990 - 1995)
Highest Qualification Attained Major
Marlins Test Score Test Location Test Licence Code

C. CERTIFICATE OF COMPETENCY
Description of Certificate Certificate Class Certificate No. Issued Date* Expiry Date* Limitations Applying (if any) Country of Issuance
Certificate of Competency for Cook
Training Couse for Ship's Cook
Food Handling & Hygiene
Maritime Catering
Any other certificates (please indicate)

D. COURSE ATTENDED &

CERTIFICATES OBTAINED
Description of Certificate Certificate No Issued Date* Expiry Date* Revalidated (Yes or No) Country of Issuance
Basic Safety Training (A-VI/1-1 to 1-4)
Personal Survival Techniques (A-VI/1-1)
Basic Firefighting (A-VI/1-2)
Elementary First Aid (A-VI/1-3)
Personal Safety & Social Responsibility (A-VI/1-4)
Survival Craft & Rescue Boat (A-VI/2 para 1-4)
Fast Rescue Craft (A-VI/2 para 5-8)
Medical First Aid On Board (A-VI/4-1)
Security Training for Seafarers with Designated Security Duties (A-VI/6)
Security Awareness Training (A-VI/6-1)
BOSIET / FOET
HUET
H2S
Any other certs (please indicate)

SEA SERVICES RECORD AS IN

E. SEAMAN BOOK. INDICATE MUST BE TRUE and HONEST in SEA SERVICES and Previous RANK - SEA TIME STATED BELOW MUST BE THE SAME WITH SEAMAN BOOK & DP LOGBOOK
MAXIMUM

Type and number of

No Vessel Name Company & Country Type of Vessel DP1/DP2/
GRT Engine Rank Signed Signed Flag offshore operations Charter & Areas BHP/K-WATT
Reason For
DP3 Type On* Off* carried out of Operations Leaving

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

F. REFERENCES G. DECLARATION
No Name of Company Name of Contact Person Email Contact Number
1 I hereby declare that the information furnished above is true to the best of my knowledge.
2
3
4 Signature Date*
5