APPLICATION FORM

DECK CREW

Personal Details
Rank: Nationality:
First Name: Surname:
Father’s Name: Mother’s name
Date of birth: Place of birth:
Telephone: Requested Salary:
Mobile Phone: Nearest Airport:
E-mail: Shoes size:
Skype Address: Overall size:
Home Address:

Next of Kin
Surname: Name:
Relationship: Telephone:
Home Address:

Travel Documents Number Place of Issue Issued on Expires on

National Passport:
Seaman’s Book:
US Visa:
Schengen Visa:

License(s) Held Limitation(s) on GRT (if any) Grade/Class of license

STCW Certificates Number Place of Issue Issued on Expires on

Certificate of competency
Endorsement STCW
Basic Safety Training
GMDSS Gen. Operator Certificate
GMDSS Gen. Operator Endorsement
Radar Observation and Plotting
Automatic Radar Plotting Aids (ARPA)
Prof. in Survival Craft& Rescue Boats
Prof. in Fast Rescue Boats
Advanced Fire Fighting
Medical First Aid
Medical Care
Ship Security Officer SSO
Security awareness training
Security awareness – Designated duties
Ship Safety Officer
HAZMAT
BRM / BTM
ECDIS

Tanker Certificates Number Place of Issue Issued on Expires on

Oil Tanker familiarization
Oils Tanker advanced
 APPLICATION FORM
DECK CREW

Chemical Tanker familiarization

Chemical Tanker advanced
LPG familiarization
LPG advanced
Crude oil washing
Inert gas system

Special Training Certificates Number Place of Issue Issued on Expires on

DP Induction/Basic course
DP Advanced/Simulator course
DPO Unlimited
DPO Limited
BOSIET
HUET
Helicopter Landing Officer (HLO)

Medical Certificates Number Place of Issue Issued on Expires on

Physical Examination
Yellow Fever Vaccination
Cholera Vaccination

Previous Sea Service (Please Start With Last Contracts)

# From To Vessel Flag GRT Type Position Company
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