(Passport Photo)

Marlow Navigation Co. Ltd.

Marlow Building, 13 Alexandrias Street
P.O. Box 54!!, C"#3!$ Li%assol, C&'rus
(el) *35!#$5++$5++ ,swit-./oard0
1ax) 35!#$5++$522 ,dir.0
3e/) .tt')44www.%arlow.-o%.-&4
Crew 5e'art%ent # Ad%inistration 6rou'
(el) *35!#$5++$$3 # 7%ail) re-ruit%ent8%arlow.-o%.-&
SEAFARER'S APPLICATION FORM - Page 1 of 3 - PERSONAL DATA
PERSONAL INFORMATION
Family Name First Name s!
"irt# Date "irt# Pla$e
Natio%ality Religio%
Marital Stat&s No' of C#il(re%
)eig#t $m! *eig#t +g!
Nearest Air,ort Alter%ati-e Air,ort
ADDRESS i%$l&(e tele,#o%e $o&%try . area $o(es/ a(-ise also se$o%(ary or $o%ta$t a((resses if a%y!
Street . Nr' Email A((ress
Lo$atio% Mo0ile P#o%e
City Resi(e%$e P#o%e
State/ Co&%try Fa1
Postal 2IP! Co(e P'O' "o1 if a%y!
NE3T OF 4IN INFORMATION ,erso% to $o%ta$t i% $ase of emerge%$y . i%s&ra%$e 0e%efi$iary!
Family Name First Names!
Natio%ality Relatio%s#i,
Street . Nr' Email A((ress
Lo$atio% Mo0ile P#o%e
City Resi(e%$e P#o%e
State/ Co&%try Fa1
Postal 2IP! Co(e P'O' "o1 if a%y!
REMAR4S
Re5&este( Ra%+ A-aila0ility Date
Prefer' 6essel Ty,e Mi%im&m Salary
E%glis# La%g&age S+ills S,o+e%7 fluent / good / average / poor - *ritte%7 fluent / good / average / poor
Ot#er Foreig% La%g&ages
Professio%al S$#ool 8 A$a(emy
- Name . Perio( From - To!
Foreig% Cre9 E1,erie%$e
s,e$ify %atio%alities!
Ot#er S+ills
F&rt#er Remar+s
Please a(-ise #o9 yo& #ear(
a0o&t Marlo9 Na-igatio%7
&%(erli%e a,,ro,riate o,tio%!
Newspaper / Advert / Google / Internet / Relative / Other Seafarer
School / niversit! / Other sources """"""""##

I #ere0y affirm t#at all t#e i%formatio% ,ro-i(e( 0y me i% t#is a,,li$atio% is tr&e a%( $orre$t to t#e 0est of my +%o9le(ge'
5ate) Signature)
Note) This form can be returned per email without signature - please ensure however to send a signed printout for our records afterwards per
mail (e.g. with the passport photos and photo copies required). Please sign all 3 pages of the application form separately.
Attn.) Marlow Navigation # Crew 5e't. ,A60 # 1ax) *35!#$5++$522 # 7%ail) re-ruit%ent8%arlow.-o%.-&
SEAFARER'S APPLICATION FORM - Page : of 3 - LIST OF DOC;MENTS
Please %ote t#at (&e to legal re5&ireme%ts em,loyme%t is o%ly ,ossi0le o%$e 9e are i% ,ossessio% of
ele$tro%i$ $o,ies of yo&r (o$&me%ts a%( li$e%ses ,lease refer to t#e Cover etter for f&rt#er i%str&$tio%s!'
Family
Name
First
Names!
Ra%+
A' TRA6EL DOC;MENTS AND MEDICAL CERTIFICATES
Do$&me%t Name Des$ri,tio%! Do$&me%t N&m0er Co&%try Iss&e Pla$e Iss&e Date E1,' Date
Passport
Sea$an%s &oo' (national)
Sea$an%s &oo' (flag state)
Sea$an%s &oo' (flag state)
(isa - nited States (t!pe )*/+)
(isa - Others (,or'/Resid# Per$its)
-edical ./a$ination Report
+rug 0 Alcohol 1est
(accination against 2ellow 3ever
(accination against )holera
Passport Photos please e$ail a high 4ualit! cop! of a recent passport photo#
"' CERTIFICATES OF COMPETENC< . ENDORSEMENTS/ CO;RSE CERTIFICATES
- dec' 0 engine certificates 0 endor-
se$ents (officers / ratings)
- electrical 0 reefer certificates
- coo' 0 steward certificates
- radio certificates 0 endorse$ents
- safet! training (surv#5 fire5 $edical)
- tan'er courses (oil5 che$#5 gas)
- passenger vsl5 roro5 ha6$at courses
- nav#5 dec'5 technical 0 $anage$ent
courses (radar/ARPA5 IS-5 -arpol5
si$ulators5 co$puter5 welding etc#)
- an! flag state certificates
Do$&me%t Name Des$ri,tio%! Do$&me%t N&m0er Co&%try Iss&e Pla$e Iss&e Date E1,' Date
5ate) Signature)
Attn.) Marlow Navigation # Crew 5e'art%ent ,Ad%inistration 6rou'0 # (el) *35!#$5++$$3 # 1ax) *35!#$5++$522 # 7%ail) re-ruit%ent8%arlow.-o%.-&
SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SER6ICE LAST 1= <EARS!
Please indicate !our sea service in the last *7 !ears as e/actl! as possi8le - re4uired are the actual sign-on and sign-off dates according to the service certificates resp# sea$an%s 8oo' entries# 1o speed
up processing 'indl! indicate phone and/or fa/ nu$8ers of !our previous e$plo!ers# Ship si6es are to 8e indicated in gross tons5 total engine output in 'ilo ,att (* ', 9 *#:; 8hp) to go along with
S1), li$itations# Please attach evidence for the listed sea service (copies of sea$an%s 8oo' entries5 service certificates etc#)# 1he infor$ation provided $a! 8e passed on to our clients and to flag
state ad$inistrations to allow for verification of ran' e/perience# Please use the .uropean date for$at (++#--#22)#
Family Name7 First Names!7 Date of "irt#7
6essel's Name IMO No' Flag >T +*S#i, Ty,e E%g'Ma+e Ra%+ S8O% Date S8Off Date Em,loyer $om,a%y to $o%ta$t for refere%$e!
!"ample #essel $%3&'() *ntigua &+(,, &+',, -ulti-Purp -*. /01 %2!ng $$.,3.43 $).,'.4& -arlow .avigation+ Cyprus (53')-%'-33%'33)
6ate7 8ignature7
SUBJECT: YOUR APPLICATION FOR EMPLOYMENT AS A SEAFARER
Dear Sir / Madam,
We have received your application and thank you for your interest regarding
employment opportunities with Marlow Navigation. In order to evaluate your
suitaility for open Marlow vacancies you are herey re!uested to fill in
and return the attached application forms considering the following
guidance"
Page 1 of the Applicatio Fo!" # Pe!$oal %ata
#. Make sure to advise the telephone numers complete with country and
area code as re!uired to call you from aroad.
$. %ou need to advise us an email address or fa& numer to contact you '
mail address and phone numer are not sufficient for crew without a
local agent (the transmission of the contract, travel instructions,
flight details etc. would re!uire up to two weeks y regular mail).
*. Ne&t of kin is the person to e notified in case of an accident and
to receive insurance enefits in case of death ' therefore carefully
consider who is entered here.
Page & of the Applicatio Fo!" # Li$t of %oc'"et$
#. +pplicants without complete certification as per international S,-W'
./ standards cannot e considered for employment. If you are not sure
please contact your national maritime administration to check that
your certification is up'to'date.
$. 0nlist all re!uired documents with utmost care for the details (see
guidance on the page).
*. +ttach !uality scanned electronic copies of all listed documents
(multiple pages if needed) showing at least
your name,
document name, document numer, issue date and e&piry
date,
issuing maritime training provider or authority and
any limitation remarks (also if empty to prove there are
no limitations).
' Scanned copies should be sent in either Jpeg or PDF
format. Each image should be preferably under 600kb in
file size. ll images should be readable !te"t # numbers
should be clear and distinguishable$.
1. +ttach scanned electronic copies of all flag state seaman2s ooks and
endorsements you hold.
/. +ttach a scanned electronic copy of your passport photo (1&/cm"
134&/.4 pi&els).
Page ( of the Applicatio Fo!" # Sea Se!)ice *La$t 1+ Yea!$,
#. 0nter the ship2s details to your est knowledge and in accordance
with your records ' convert hp into kW (# kW 5 #.*1 67 ' not
necessary for deck crew).
$. We re!uire the e&act period of your stay on oard (without leave).
8or repeated contracts on the same vessel list each stay separately.
*. +ttach scanned copies of any proof of sea service in your possession
(copies of service certificates, seaman2s ook entries or similar).
1. +dvise details of the company that signed the contract of employment
with you (2employer2), not the charterer or operator of the ship.
+dvise telephone numers of persons who can confirm your sea service
at these companies. Plea$e -e ifo!"e. that any information provided
here will e used to otain references from your previous employers.
9ast ut not least ' the forms are to e filled in y computer, or in clea!
ha./!itig. We prefer to communicate via email. :ur company language is
0nglish ' we will ignore any written communication provided in any other
languages.
We regret to advise that we will cease to pursue applications for economic
reasons if aove criteria are not met and trust that a fast and smooth
processing is in the est mutual interest.
%ours sincerely,
Ma!lo/ Na)igatio Co0 Lt.0
C!e/ %epa!t"et # A."ii$t!atio 1!o'p
Tel: 2(34#&355&&(+
Fa6: 2(34#&355&377
E"ail: !ec!'it"et8"a!lo/0co"0c9