Join Our Crew Company Form SEND US EMAIL SEAFARER APPLICATION FROM 1-Personal Data: Full Name Nationality Date of Birth Place of Birth Rank applied for: Last Salary: Ready From (date): Nearest Airport: Permanent Address(full description): Address/Contact Information: City: Country: Email: Tel: Mobile: .. weight Height Sweater size Boilersuit size: Shoe Size: How did you find and knows about us? Friends Crewing agency members already in organization Internet Others LANGUAGES / COMPUTER SKILLS [ E : excellent - G : good - A : average - P : poor ] English Spoken: E G A P Written E G A P Read E G A P Computer Skills Software E G A P MS Office E G A P Maintenance E G A P Have Marlins course ? Yes No Test Result ( % ): Are you smoking / no smoking? Yes No Are you drinking alcohol / no drinking? Yes No Part 1, Notice if any? 2-Personal ID / Documents: Passport Country of Issue No. Date of Issue Issued at (Place) Valid Until Seaman’s Book Country of Issue No. Date of Issue Issued at (Place) Valid Until Medical Country of Issue No. Date of Issue Issued at (Place) Valid Until Yellow fever Country of Issue No. Date of Issue Issued at (Place) Valid Until Part 2, Notice if any? 3-Nominee / Next of Kin & Family Details Full Name of Nominee for compensation in case of fatality: Relationship Address/Contact Information: City: Country: Email: Tel: Mobile: Family Data:No of child Marital Status No of Childs Part 3, Notice if any? Social Media Data ....Write Your Email Below if Any Facebook Instagram Twitter LinkedIn 4-STCW & (amend.) Compliant Certificates / Courses and Other Qualifications: (A) Reg II / 1-5, III / 1-5 Officers Certificate of Competency & Ratings Watch-keeping Certificate (including flag state endorsements) 1 Description of Cert / Course Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority (B) GMDSS Certificates (including flag state endorsements) GMDSS (Main Issuing Authority) Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority GMDSS (Flag State) Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority Enter here actual description given in the Competency Certificate / Watchkeeping Certificate held by you (C) Basic/mandatory/recommended Certificates / Courses – (as applicable) Certificate Advanced fire fighting A-VI/3-1 Basic training A-VI/1-1 to 1-4 Designated Security Duties ( STCW 2010 ) A-VI/6-2 ECDIS ( STCW 2010 ) Fast rescue boat A-VI/2-2 Free Fall Lifeboat A-VI/2 GMDSS General Operator's Certificate - A-IV/2 GMDSS Restricted Operator's Certificate-IV/2 Medical Fitness Cert Reg I/9 Security Awareness ( STCW 2010 ) A-VI/6-1 Ship Security Officer - SSO- A-VI/5 STCW Advanced Fire Fighting - AFF - A-VI/3 STCW Elementary First Aid - EFA - A-VI/1-3 STCW Fire Prevention and Fire Fighting - FPF - A-VI/1-2 STCW Medical care on board ( Ship Captain ) A-VI/4-1 STCW Medical First Aid - MFA - A-VI/4-2 STCW Personal Safety & Social Resp.-PSSR - A-VI/1-4 STCW Personal Survival Techniques -PST - A-VI/1-1 STCW Prof in Fast Rescue Boats - FRB - A-VI/2-2 STCW Prof in Survival Craft / lifeboat - PSCRB - A-VI/2 Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority Certificate Advanced fire fighting A-VI/3-1 Basic training A-VI/1-1 to 1-4 Designated Security Duties ( STCW 2010 ) A-VI/6-2 ECDIS ( STCW 2010 ) Fast rescue boat A-VI/2-2 Free Fall Lifeboat A-VI/2 GMDSS General Operator's Certificate - A-IV/2 GMDSS Restricted Operator's Certificate-IV/2 Medical Fitness Cert Reg I/9 Security Awareness ( STCW 2010 ) A-VI/6-1 Ship Security Officer - SSO- A-VI/5 STCW Advanced Fire Fighting - AFF - A-VI/3 STCW Elementary First Aid - EFA - A-VI/1-3 STCW Fire Prevention and Fire Fighting - FPF - A-VI/1-2 STCW Medical care on board ( Ship Captain ) A-VI/4-1 STCW Medical First Aid - MFA - A-VI/4-2 STCW Personal Safety & Social Resp.-PSSR - A-VI/1-4 STCW Personal Survival Techniques -PST - A-VI/1-1 STCW Prof in Fast Rescue Boats - FRB - A-VI/2-2 STCW Prof in Survival Craft / lifeboat - PSCRB - A-VI/2 Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority Certificate Advanced fire fighting A-VI/3-1 Basic training A-VI/1-1 to 1-4 Designated Security Duties ( STCW 2010 ) A-VI/6-2 ECDIS ( STCW 2010 ) Fast rescue boat A-VI/2-2 Free Fall Lifeboat A-VI/2 GMDSS General Operator's Certificate - A-IV/2 GMDSS Restricted Operator's Certificate-IV/2 Medical Fitness Cert Reg I/9 Security Awareness ( STCW 2010 ) A-VI/6-1 Ship Security Officer - SSO- A-VI/5 STCW Advanced Fire Fighting - AFF - A-VI/3 STCW Elementary First Aid - EFA - A-VI/1-3 STCW Fire Prevention and Fire Fighting - FPF - A-VI/1-2 STCW Medical care on board ( Ship Captain ) A-VI/4-1 STCW Medical First Aid - MFA - A-VI/4-2 STCW Personal Safety & Social Resp.-PSSR - A-VI/1-4 STCW Personal Survival Techniques -PST - A-VI/1-1 STCW Prof in Fast Rescue Boats - FRB - A-VI/2-2 STCW Prof in Survival Craft / lifeboat - PSCRB - A-VI/2 Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority Certificate Advanced fire fighting A-VI/3-1 Basic training A-VI/1-1 to 1-4 Designated Security Duties ( STCW 2010 ) A-VI/6-2 ECDIS ( STCW 2010 ) Fast rescue boat A-VI/2-2 Free Fall Lifeboat A-VI/2 GMDSS General Operator's Certificate - A-IV/2 GMDSS Restricted Operator's Certificate-IV/2 Medical Fitness Cert Reg I/9 Security Awareness ( STCW 2010 ) A-VI/6-1 Ship Security Officer - SSO- A-VI/5 STCW Advanced Fire Fighting - AFF - A-VI/3 STCW Elementary First Aid - EFA - A-VI/1-3 STCW Fire Prevention and Fire Fighting - FPF - A-VI/1-2 STCW Medical care on board ( Ship Captain ) A-VI/4-1 STCW Medical First Aid - MFA - A-VI/4-2 STCW Personal Safety & Social Resp.-PSSR - A-VI/1-4 STCW Personal Survival Techniques -PST - A-VI/1-1 STCW Prof in Fast Rescue Boats - FRB - A-VI/2-2 STCW Prof in Survival Craft / lifeboat - PSCRB - A-VI/2 Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority Certificate Advanced fire fighting A-VI/3-1 Basic training A-VI/1-1 to 1-4 Designated Security Duties ( STCW 2010 ) A-VI/6-2 ECDIS ( STCW 2010 ) Fast rescue boat A-VI/2-2 Free Fall Lifeboat A-VI/2 GMDSS General Operator's Certificate - A-IV/2 GMDSS Restricted Operator's Certificate-IV/2 Medical Fitness Cert Reg I/9 Security Awareness ( STCW 2010 ) A-VI/6-1 Ship Security Officer - SSO- A-VI/5 STCW Advanced Fire Fighting - AFF - A-VI/3 STCW Elementary First Aid - EFA - A-VI/1-3 STCW Fire Prevention and Fire Fighting - FPF - A-VI/1-2 STCW Medical care on board ( Ship Captain ) A-VI/4-1 STCW Medical First Aid - MFA - A-VI/4-2 STCW Personal Safety & Social Resp.-PSSR - A-VI/1-4 STCW Personal Survival Techniques -PST - A-VI/1-1 STCW Prof in Fast Rescue Boats - FRB - A-VI/2-2 STCW Prof in Survival Craft / lifeboat - PSCRB - A-VI/2 Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority Certificate Advanced fire fighting A-VI/3-1 Basic training A-VI/1-1 to 1-4 Designated Security Duties ( STCW 2010 ) A-VI/6-2 ECDIS ( STCW 2010 ) Fast rescue boat A-VI/2-2 Free Fall Lifeboat A-VI/2 GMDSS General Operator's Certificate - A-IV/2 GMDSS Restricted Operator's Certificate-IV/2 Medical Fitness Cert Reg I/9 Security Awareness ( STCW 2010 ) A-VI/6-1 Ship Security Officer - SSO- A-VI/5 STCW Advanced Fire Fighting - AFF - A-VI/3 STCW Elementary First Aid - EFA - A-VI/1-3 STCW Fire Prevention and Fire Fighting - FPF - A-VI/1-2 STCW Medical care on board ( Ship Captain ) A-VI/4-1 STCW Medical First Aid - MFA - A-VI/4-2 STCW Personal Safety & Social Resp.-PSSR - A-VI/1-4 STCW Personal Survival Techniques -PST - A-VI/1-1 STCW Prof in Fast Rescue Boats - FRB - A-VI/2-2 STCW Prof in Survival Craft / lifeboat - PSCRB - A-VI/2 Country of Issue Number Date of Issue Date of Expiry Place of Issue Issuing Authority Other Courses specified below if any: Courses only for rank Cook's Training Certificate ( MLC, 2006): Part 4, Notice if any? 5. Sea Experience : (Start the listing below with the most 3 recent experience) Company 1 Flag & Vessel Name Type GRT DWT Main Engine BHP Rank Date From Date To . Company 2 Flag & Vessel Name Type GRT DWT Main Engine BHP Rank Date From Date To . Company 3 Flag & Vessel Name Type GRT DWT Main Engine BHP Rank Date From Date To type: Use only the abbreviations for vsl types as folllowing: general cargo (G.C)….. etc Main Engine: Engineers to give make/model of engines, e.g. “MAN 14V52/55A” or “SULZER 5RTA58” Part 5, Notice if any? 6-General (A) Have you been the subject of a court of enquiry or involved in a maritime accident? Yes No (B) Give details below of two recent employers who we may contact for references: Name of Company Reference 1 Reference 2 Name of person to contact Reference 1 Reference 2 Address Reference 1 Reference 2 Country Reference 1 Reference 2 Reference 1 Reference 2 Part 6, Notice if any? Upload Resume Submit SEND US EMAIL Company Details Company Type* crewing Company Shipowner Other Company Name* Country* Town* Office Phone Code* Office Phone* Company Email* Company Website* Message* Submit
