Application Form

Position suggested

1. Personal Data Recent foto

Family Name
First Name/Middle In.
Date of Birth
Nationality
Sex
Phone
Email Adress

2. Highest Educational Degree with Diploma

Institute/School
Degree/Level
Period

3. Professional Experience
(start with latest assignment)

Rank on board Period on Vessel Type Year GT kW Manuf. Trading Reason employer
board name of of of main Area for
(from/to) vessel built engine leaving

4. Competencies, Certificates & Documents

4.1 IMO /COC License

Name of Certificate STCW Ref. (II/1, Date Place of Comments

II/2, II/4, II/5, issued issuance (if necessary)
III/1, III/2, III/4,
III/5, III/6 or III/7)
National Certificate
of Competency /
Proficiency
Please attach scans of all documents mentioned above
 Application Form

4.2 Travel Documents

Document type Obtained Y/N Expiry date

Travel Passport
Seaman’s Book
indicate Flag
USA C1/D visa

4.3. Language/ Technical Test Result to be attached

Please attach Seagull and/or Marlins Test

4.4. Question to the candidate:

a) What do you understand when talking about Ethics?

b) Have you ever had any Compliance Training before?

If yes where and what

5. Motivation of candidate / Personal evaluation, comments and remarks

(personal impression, special qualification, motivation of candidate)