SEAFARER's APPLICATION FORM - Page 1 of 3 - PERSONAL DATA

www.seatrans.no

(Passport Photo) Norway: [email protected] Poland: [email protected] Croatia: [email protected] Romania: [email protected]

SEAFARER'S APPLICATION FORM - Page 1 of 3 - PERSONAL DATA PERSONAL INFORMATION Family Name First Name (s) Birth Date Birth Place Nationality Religion Marital Status No. of Children Height (cm) Weight (kg) Nearest Airport ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any) Street & Nr. Email Address Location Mobile Phone City Residence Phone State, Country Fax Postal (ZIP) Code P.O. Box (if any) NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary) Family Name First Name(s) Nationality Relationship Street & Nr. Email Address Location Mobile Phone City Residence Phone State, Country Fax Postal (ZIP) Code P.O. Box (if any) REMARKS Requested Rank Availability Date Prefer. Vessel Type Minimum Salary SUMMARY OF QALIFICATION AND EXPERIENCE Years with operator Years in rank Years on chemical-/oil tankers Years on LPG tankers Years on tankers (all types) English Language Skills Spoken: fluent / good / average / poor - Written: fluent / good / average / poor Other Foreign Languages Professional School / Academy - Name & Period (From - To) Foreign Crew Experience (specify nationalities) Other Skills

Further Remarks

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge. Date: Signature: Attn.: Seatrans Crewing A/S - Crew Dept. -

SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF DOCUMENTS

Please note that due to legal requirements boarding is only possible once we are in possession of photo copies of all listed documents and certificates - in urgent cases you may therefore have to send them by courier, fax or email (.jpg format, scans max. 600 pixel wide or 900 pixel high). Passport photos may arrive later (by mail).

Family First Rank Name Name(s) A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES Document Name (Desciption) Document Number Country Issue Place Issue Date Exp. Date Passport Seaman's Book (national) Seaman's Book (flag state) Seaman's Book (flag state) Visa - United States (type C1/D) Visa - Others (Work/Resid. Permits) Medical Examination Report Drug & Alcohol Test Vaccination against Yellow Fever Vaccination against Cholera Passport Photos B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES - deck & engine certificates & endor- - radio certificates & endorsements - nav., deck, technical & management sements (officers / ratings) - safety training (surv., fire, medical) courses (radar/ARPA, ISM, Marpol, - electrical & reefer certificates - tanker courses (oil, chem., gas) simulators, computer, welding etc.) - cook & steward certificates - passenger vsl, roro, hazmat courses - any flag state certificates Document Name (Desciption) Document Number Country Issue Place Issue Date Exp. Date

Date: Signature: Attn.: Seatrans Crewing A/S - Crew Dept. SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)

Please indicate your sea service in the last 10 years as exact as possible - required are the actual sign-on and sign-off dates according to the service certificates resp. seaman's book entries. To speed up processing kindly indicate phone and/or fax numbers of your previous employers. Ship sizes are to be indicated in gross tons, total engine output in kilo Watt (1 kW = 1.34 bhp) to go along with STCW limitations. Please be prepared to provide evidence for sea service that cannot be confirmed by reference check. The information provided may be passed on to our clients and to flag state administrations to allow for verification of rank experience. Please use the European date format (DD.MM.YY).

Family Name: First Name(s): Date of Birth: Vessel's Name Flag GT kW Ship Type Eng.Make Rank S/On Date S/Off Date Employer (company to contact for reference)

Date: Signature:

How did you find info about Seatrans? ; from newspaper from internet from colleagues from advertisement from other place, ………………….. www.seatrans.no

ENGINE OFFICERS

RELEVANT EXPERIENCE / SKILLS & FAMILIARITY WITH

A) HOW MANY MONTHS IN RANK?(SEASERVICE / TOTAL) B) HOW MANY MONTHS ON CHEMICAL TANKERS (DOING WHAT?) C) HOW MANY MONTHS ON OIL TANKERS (DOING WHAT? D) HOW MANY MONTHS ON LNG/ LPG TANKERS (DOING WHAT?) E) M / E & REMOTE CONTROL (TYPE/ MAKER/ TWO – FOUR STROKES) F) MANUAL/ UMS OPERATIONS EXPERIENCE G) DIESEL GENERATORS (TYPE & MAKER) H) BOILERS (TYPES: STEAM/ THERMAL OIL AND MAKER: AALBORG, ETC) I) CARGO PUMPS/ OVERHAULING EXPERIENCE/ ANY COURSES DONNE? (TYPE: HYDRAULIC/ ELECTRICAL AND MAKER: MARFLEX/ FRAMO/ SWANHOY) J) HYDRAULICS & PNEUMATICS AUTOMATION (TYPE/ MAKER) K) ENGINE MANEUVERING/CONTROL SYSTEMS (TYPE/ MAKER) L) INSTRUMENTATION & CONTROL/ ELECTRICAL SKILLS (HAVE YOU WORKED W/OUT ELECTRICIANS?) M) WORK SHOP EXPERIENCE (SHORE BASED) (WHERE/DOING WHAT?) N) WELDING SKILLS (TIG / GAS / ARC / CI) O) COMPUTER SOFTWARE PROFICIENCY (LOADING/ PLANNED MAINTENANCE AND COMMUNICATION SOFTWARE SUCH AS: LOTUS NOTES, AMOS, RAST, STAR IPS, MICROSOFT, OTHERS) P) COMPUTER HARDWARE PROFICIENCY Q) EXPERIENCE ON MULTINATIONAL CREWS (WHICH NATIONS / FLAG?) R) ANY EXPERIENCE/ INVOLVEMENT IN BUDGETS AND ADMINISTRATION S) SHIPYARD EXPERIENCE (IN WHICH RANK? / DOING WHAT?) T) INVOLVED IN ANY ACCIDENTS? (FIRE, NAVIGATIONAL ERRORS, CARGOCONT., OTHERS) U) AREAS/ REGION TRADED V) OTHER RELEVANT TRAINING/ COURSES (IF ANY) X) MINIMUM SALARY ACCEPTED

OTHER RELEVANT SUBJECTS:

ANY RATING EXPERIENCE (ON WHICH RANK AND TYPE OF VESSELS/ ENGINES)?

ANY EXPERIENCE ON SMALLER SHIPS/ AGREE TO JOIN?

HOW DO YOU SEE YOURSELF IN THE FUTURE?

ANY SEASICKNESS EXPERIENCE?