Quality Assurance into the 21st

Century and beyond

Personnel Form
TSM Form
No. 070

☐ Application Date of Application: ________________________

☐ Nomination
Position Applied: __________________________ Picture
☐ Promotion
☐ Amendments Readiness to Join: _________________________

A. Personal

Family Name Given Name Middle Name Gender

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

Address Contact Email

Home:

Cell:

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

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

Schengen Visa Place of

Issued Date Expiry Date Nearest Int’l Airport
No. Issue

B. Next of Kin

Family Name Given Name Middle Name Relationship

Address Contact Details

Home:

Cell:

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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

Boiler Suit Size Safety Shoe Size

E. Certificates and Qualifications

Flag Issued Expiry

Documents Held STCW’95 Number
State (DDMMY (DDMMY
Foreign Certificate of Competency STCW II – Deck
Y) Y)
(s)
STCW III -
Engine
STCW IV – Radio
Ratings Watch keeping Cert - Deck STCW A-II/4
Ratings Watch keeping Cert - STCW A-II/4
Engine
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 and STCW A-VI / 2

Rescue Boats
Ship Handling & Manoeuvring STCW A-II / 2
Bridge Team Management or STCW A-II / 1
Bridge Resource Management (IMO Model 1.22)
Generic ECDIS STCW A-II / 1
(IMO Model 1.27)
Engine Room Simulator or Engine STCW A-III / 1&2

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Room Resource (IMO Model 2.07)

STSDSD or SSO STCW A-VI / 6 or
5

Tanker Specific Requirements

Basic Tanker Training STCW A-V/1-1.1
(Oil/Chem/Gas) & 2.1
Advanced Tanker Training (Oil) STCW A-V/1-1.2
Advanced Tanker Training (Chem) STCW A-V/1-1.2
Advanced Tanker Training (Gas) STCW A-V/1-2.2

FRAMO experience Yes ☐ No ☐ Centrifugal Pumps with Yes ☐ No ☐

Pump Room
Wartsila-Sulzer RT-flex experience Yes ☐ No ☐ Man B&W ME experience Yes ☐ No ☐

F. Other Qualifications / 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)
Period Length of Ship
Vessel DWT / Engine (DD/MM/YY)
Rank Vessel Name Time Owner /
Type TEU Type / KW
From To Onboard Manager

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H. Reference(s) from Previous Employment

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

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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 + Supramax 50-80K ☐ Container Vessels ALL ☐

J. Declaration and Signature

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.
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.

Signature of Applicant: Date:

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Annex 1:
CARGO EXPERIENCE INFORMATION SHEET – TANKERS
Instruction to Applicant: Please tick appropriate box for cargoes that you have been carried before.

OIL / DPP YES

(Note: Experience with any 1 of the listed cargoes is required NO
for oil tanker assignment) As Rating As Jr Officer As Sr Officer
CRUDE OIL
FUEL OIL
CARBON BLACK

ASPHALT YES
(Note: Experience with any 1 of the listed cargoes is required NO
for asphalt tanker assignment) As Rating As Jr Officer As Sr Officer
ASPHALT
BITUMEN
COAL TAR
RESIDUAL OIL

CLEAN PETROLEUM PRODUCTS (CPP) YES

(Note: Experience with any 2 of the listed cargoes is required NO
for product (CPP) tanker assignment) As Rating As Jr Officer As Sr Officer
KEROSENE GTL
CONDENSATES
GASOLINE
GASOIL
JET A-1
AVGAS
DIESEL OIL
LUB OIL
AVIATION ALKYLATES
DISTILLATES

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SOFT CHEMICALS YES

(Note: Experience with any 2 of the listed cargoes is required NO
for soft chem tanker assignment) As Rating As Jr Officer As Sr Officer
VEGETABLE OIL
SOYA BEAN OIL
FAME
TALLOW
ETHYLENE DICHLORIDE (EDC)
STYRENE MONOMER
BENZENE
XYLENE
TOLUENE
ACIDS
SODIUM HYDROXIDE SOLUTION
UREA AMMONIUM NITRATE (UAN)

HARD CHEMICALS YES

(Note: Experience with any 1 of the listed cargoes is required NO
for hard chem tanker assignment) As Rating As Jr Officer As Sr 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 NO YES

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(Note: Experience with any 2 of the listed cargoes is required
for gas tanker assignment)
As Rating As Jr Officer As Sr Officer
AMMONIA, ANHYDROUS
BUTADIENE
BUTANE
BUTANE-PROPANE MIXTURES
BUTYLENES
ETHANE
ETHYLENE
MIXED C4
PENTANES
PENTENE
PROPANE
PROPYLENE
PROPYLENE OXIDE
VINYL CHLORIDE
OTHER INFORMATION /
NO YES COMMENTS
AREAS OF KNOWLEDGE
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:

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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 Rating As Jr Officer As Sr 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 /
NO YES COMMENTS
AREAS OF KNOWLEDGE
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:

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