Nearest Airport

RANK ID number: photo Nearest Airport Date available:

1. SEAMAN’S PERSONAL INFORMATION 1.1 Surname 1.2 First name 1.3 Nationality 1.4 Date of Birth (dd /mm / yyyy) 1.5 Place of Birth (City & Country) 1.6 Full style home address (Permanent) 1.7 Home / Mobile phone numbers 1.8 E-Mail / SKYPE 2. SEAMAN’S TRAVEL DOCUMENTS Description Number Issue Date Expire Date Place of Issue 2.1 Passport No 2.2 Seaman Book No 2.3 Seaman ID 3. SEAMAN’S LICENCIES / ENDORSEMENTS Description Grade Number Issue Date Expire Date Place of Issue 3.1 Certificate of Competency 3.2 Endorsement of Certificate 3.3 Flag Endorsement 4. USA visa 4. Schengen visa 4. Other (………………….) Issue date Expire date Issue date Expire date Issue date Expire date 4.1 4. 4.3 2 5. SEAMAN’S (STCW) CERTIFICATES Description Number Issue Date Expire Date Place of Issue 5.1 Basic Safety Training (VI/1,1) 5.2 Proficiency in Survival Crafts (VI/2,1) 5.3 Advanced Fire Fighting (VI/3) 5.4 Medical Care (A-VI/4-2) 5.5 Medical First Aid (A-VI/4-1) 5.6 GMDSS (A-IV/2) 5.7 GMDSS Endorsement (A-IV/2) 5.8 ECDIS (A-II/1; A-II/2) 5.9 Bridge resource management (A-II/1); (A-II/2) 5.10 Ship Security Officer (A-VI/5) 5.11 Designed Security Training (A-VI/6-1) (A-VI/6-2) 5.12 Carriage of Packaged Dangerous Hazardous cargoes (B-V/c) 5.13 Other: 5.14 Medical Examination Report (National) 5.15 Vaccination (Yellow Fever) 6, ADDITIONAL INFORMATION 6.1 Reason for leaving previous employer: 6.2 Reefer container experience 6.3 Cargoes carried 6.4 Experience with other multinational ties 6.5 Yard deliveries taken

6.6 United States Coast Guard inspection attended:

7. Contact of last three employers

Company / management name 1 2 3 Telephone numbers Contact person name

SEA SERVICE: FOUR TOP OFFICERS LAST 10 YEARS (MASTER, CHIEF OFFICER, CHIEF ENGINEER, SECOND ENGINEER) DECK / ENGINEE OFFICERS LAST 5 YEARS PERIOD OF SERVICE TYPE OF NAME OF GRT ENG.TYPE / MARK KW FLAG NAME OF COMPANY / MANAGEMENT RANK FROM TO VESSELS VESSELS D M Y D M Y

EDUCATION ENGLISH LEVEL NEXT OF KIN ADDITIONAL INFORMATION NAME / YEAR OF COMPLETION MARLIN TEST % NAME CLOTHES SIZE WEIGHT CES 5.1 TEST % RELATIONSHIP SHOES HAIR COLOUR MOB./HOME TELEPHONES HEIGHT EYEES COLOUR PERMANENT ADDRESS