Please fill in the application form and attach your CV. All Fields marked with (*) are compulsory.


PERSONAL DETAILS
  Job Category *
  Rank Applied *   Date Applied *
  Name * SURNAME
 FIRST NAME
MIDDLE NAME
  Permanent Address *   Present Address *
  City & Pin code *   City & Pin code *
  Contact Tel *   Contact Tel *
  Email 1 *   Email 2     
  Date of Birth(dd/mm/yyyy) *
  Place of Birth *
  Nationality *
        
  Next of Kin (Name)
  Relationship
  Address of next of kin:
       
  Height *   Marital Status *
  Weight*   Blood Group *
  Cover All   Shoe *
  Name of Spouse   Number of Children
TRAVEL DOCUMENT DETAILS
  PASSPORT *
Number
 Place of Issue
 Date of Issue
Date of Expiry
  SEAMAN BOOK *
Number
 Place of Issue
 Date of Issue
Date of Expiry
ACADEMIC QUALIFICATIONS
  School / College *
Name
 Grade / Degree
From (Year)
To (Year)
  Pre-sea Training Institute *
Name
 Grade / Degree
From (Year)
To (Year)
LICENCE / CERTIFICATE OF COMPETENCY
Issuing Authority Capacity Any Limitations Number Date of Issue Date of Expiry Date Revalidation









STCW AND OTHER CERTIFICATES
STCW COURSES Certificate No Date of Issue Date of Expiry Place of Issue Issuing Authority /INSTITUTE
PSSR

EFA / FAS / MFA / MEDICARE (First Aid)

SAS / PST(C) / PSCRB (Survival)

FP & FF / BFF / AFF (Fire Fighting)

GMDSS / GOC

ARPA

REFRESHER & UPDATING

W/K CERT. FOR RATINGS

SIMULATOR TRAINING
RANSCO / RSC

SMS / NAV CONTROL

ENGINE SIMULATOR

BTM / ETM

OTHER COURSES
FRC

HUET

SSO

CRANE OPERATOR

RIGGER / SLINGER

DP CERTIFICATES
INDUCTION

SIMULATOR

DP OPERATOR’S LICENCE

DP LOG BOOK DETAILS Total DP Hrs in Present Position Total DP hrs as Junior Position
MEDICAL HISTORY
Have you ever signed off a ship due medical reason?
Have you undergone any medical operations in past
Have you consulted a doctor during the past 12 months for an illness/Accident?
Do you have any health or disability problem now?
If answer to any of above is YES then give further details
NOTE: All our clients have STRICT Alcohol and Drug Policy, which means ZERO TOLERANCE for alcohol and drugs
GENERAL
Have you ever been the subject of a court of enquiry or involved in a maritime accident?
Have you ever had a professional license suspended or revoked?
If answer to any of above is YES then give further details
REFERENCES (LAST EMPLOYER)
  Company Name *   Person to be contacted *
  Address *   Tel No *
  Email: *   Contract Period *
  Last salary drawn   Reason for leaving
SEA EXPERIENCE: (Most recent first)
COMPANY / AGENTSVESSEL PERIODMAIN ENGINE REASON FOR SIGN-OFF
NAME TYPE GRT DP System DP hrs RANK
FROM TO M / D
MAKE MODEL BHP
  Attach CV *