Nearest Airport

photo

RANK

/ ID number:

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 / 4.2 / 4.3

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:

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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

TYPE OF
VESSELS / NAME OF
VESSELS / GRT / ENG.TYPE / MARK / KW / FLAG /

NAME OF COMPANY / MANAGEMENT

/ RANK / PERIOD OF SERVICE
FROM / TO
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

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