Application for Employment

AMR-FRM-08-01

PHOTO

PART I. PERSONAL PARTICULARS AND INFORMATION

Position Applied: Availability: Click here to enter a date.

Name: Nationality:
Date of Birth: Click here to enter a date.
Place of Birth:
Marital Status: Choose an item.
Address 1 : Next of Kin:

Address 2 : Relationship: Choose an item.

Contact number : Contact number :

PART II. PASSPORT DETAILS

Country Place of Issue Number Date of Issue Date of Expiry

Click here to enter a date. Click here to enter a

date.
Click here to enter a date. Click here to enter a
date.

PART III. SEAMAN BOOK

Country Place of Issue Number Date of Issue Date of Expiry

Click here to enter a date. Click here to enter a

date.
Click here to enter a date. Click here to enter a
date.

PART IV. CERTIFICATE OF COMPETENCY

Issuing Authority Grade of Licence Number Date of Issue Date of Expiry

Click here to enter a date. Click here to enter a

date.
Click here to enter a date. Click here to enter a
date.

PART V. NAUTICAL, ENGINEERING OR RADIO SCHOOLS ATTENDED

Date Attended
Type of Degree or Diploma
Name of School Address
Received upon Graduation
From To
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.

Version 01. Original date: 17 October 2023. Version date: N/A. Valid version only on QMS site. 1/4
Form prepared by: Crewing Manager. Approved by: General Manager. Validated by: Quality Representative.
 Application for Employment
AMR-FRM-08-01

PART VI. CERTIFICATE OF PROFICIENCY

Issuing Authority STCW Course Certificate Number Date of Issue Date of Expiry

Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
Choose an
Choose an item. Click here to enter a date. Click here to enter a date.
item.
PART VII. SEA SERVICE
Anchor
Rig Move Total Period
Vessel Vessel Handling Operation Sign Sign
Company Flag GRT BHP Experience Rank
Name Type Experience Area On Off
Yes/ No Month Day
Yes/ No
Click Click
here here
to to
enter enter
a date. a date.
Click Click
here here
to to
enter enter
a date. a date.
Click Click
here here
to to
enter enter
a date. a date.
Click Click
here here
to to

Version 01. Original date: 17 October 2023. Version date: N/A. Valid version only on QMS site. 2/4
Form prepared by: Crewing Manager. Approved by: General Manager. Validated by: Quality Representative.
 Application for Employment
AMR-FRM-08-01

enter enter
a date. a date.
Click Click
here here
to to
enter enter
a date. a date.
Click Click
here here
to to
enter enter
a date. a date.
Click Click
here here
to to
enter enter
a date. a date.
Click Click
here here
to to
enter enter
a date. a date.
Click Click
here here
to to
enter enter
a date. a date.

PART VIII. DECLARATION

Have you been CONVICTED of, found by a COURT to have COMMITTED, or have you COMMITTED any of the following criminal offenses in your state
or similar offenses in another state or jurisdiction?

Please answer “YES” or “NO” to each listed offense.

A sex offense

A drug-related offense

A theft-related offense

A violence-related offense

Any injuries or involved in accidents or

incidents?

I hereby certify the given information above are true and correct to the best of my knowledge and belief.

Click here to enter a date.

APPLICANT’S SIGNATURE DATE

FOR OFFICE USE ONLY

Present / Last Employer :

Type Of Nationalities worked with : Burmese Filipino Indians Indonesian Malaysian Thai Africans East
European

Others : Click here to enter text.

Version 01. Original date: 17 October 2023. Version date: N/A. Valid version only on QMS site. 3/4
Form prepared by: Crewing Manager. Approved by: General Manager. Validated by: Quality Representative.
 Application for Employment
AMR-FRM-08-01

Number of years in offshore Industry :

Number of years at Current Rank :

Suitable for
Anchor Rig ISM English Employment
Static Remarks
Handling Move Knowledge Proficiency / Not
Tow
Suitable
Choose Choose
an item. an item.
Available commence date: Click here to enter a date.

Position Offered:

Last drawn Salary: USD $

Salary : USD $

Interviewed on/ By : / Click here to enter a date. Signature :

Version 01. Original date: 17 October 2023. Version date: N/A. Valid version only on QMS site. 4/4
Form prepared by: Crewing Manager. Approved by: General Manager. Validated by: Quality Representative.