APPLICATION FOR SEA STAFF EMPLOYMENT

EURONURK DATE APPLIED:
PASSPORT PHOTO
POSITION APPLIED FOR:
DATE AVAILABLE:
NATIONALITY:

GENERAL INFORMATION:

SURNAME: FIRST NAME:
DATE OF BIRTH: AGE: PLACE:
HOME ADDRESS:
HOME TELEPHONE: MOB. TELEPHONE:
MARITAL STATUS: EMAIL:
NEXT OF KIN/RELATIONSHIP/ADDRESS:
MARINE EDUCATION
HEIGHT WEIGHT CHILDREN UNDER 18:
EYES COLOR HAIR COLOR
OVERALL SIZE SAFETY SHOES SIZE

CERTIFICATES:

DESCRIPTION: GRADE NUMBER PLACE OF ISSUE ISSUED EXPIRY
CERTIFICATE OF COMPETENCY
ENDORSEMENT/WATCHKEEPING
PASSPORT
US VISA
SEAMANS BOOK
BASIC SAFETY TRAINING EVIDENCE
ADVANCED FIRE FIGHTING
SURVIVAL CRAFT | RESCUE BOAT
MEDICAL FIRST AID
RADAR , ARPA
GMDSS
ENDORSEMENT OF GMDSS
HAZMAT
SHIP SECURITY OFFICER (SSO)
MEDICAL FITNESS CERTIFICATE
YELLOW FEVER
ENDORSEMENT
SEAMEN`S BOOK
ENDORSEMENT
SEAMEN`S BOOK

PREVIOUS SEA SERVICE:

SHIPS & COMPANYS NAME YEAR BUILT FLAG RANK DD.MM.YY DD.MM.YY VSL TYPE ME TYPE DWT / BHP
REASON FOR LEAVING A VSL OTHER THAN COMPLETI ON OF CONTRACT:
NATIONALITY OF LEADING STAFF SAILED WITH:

CERTIFICATE AUTHENTICITY VERIFIED:

LANGUAGES:

ENGLISH

REMARKS:

DEPARTURE AIRPORT