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Seafarer Application Form: Photo

This document is a seafarer application form requesting information such as personal details, certifications, professional experience, and minimum salary requirements. It collects the applicant's name, date of birth, citizenship, contact details, passport and medical information. It also requests the applicant's marital status, education history, certificates, and details of their professional experience over the last 5 years including rank, shipowner details, vessel name and type. The final sections are for the applicant's signature and any remarks from a crew manager.

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93 views

Seafarer Application Form: Photo

This document is a seafarer application form requesting information such as personal details, certifications, professional experience, and minimum salary requirements. It collects the applicant's name, date of birth, citizenship, contact details, passport and medical information. It also requests the applicant's marital status, education history, certificates, and details of their professional experience over the last 5 years including rank, shipowner details, vessel name and type. The final sections are for the applicant's signature and any remarks from a crew manager.

Uploaded by

bob
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Tel: +380-629-530158

пр. Лунина 13 13, Lunina ave.


Fax: +380-629-530159
87510 Мариуполь 87510 Mariupol,
E-mail: [email protected]
Украина Ukraine
www.sifservice.com

SEAFARER APPLICATION FORM


Position applied for: ________________

1 Surname : __________________ 4 Date of birth : ________________ Photo


2 Name : __________________ 5 Place of birth : ________________
3 Given name : __________________ 6 Citizenship : ________________

7 Address : _______________________________________________________________
8 Phone No.(home) : _______________ 9 Phone No.(contact): ________________

10 Seaman's ID No. : _______________ 14 InterPassport No.: ________________


11 Place of issue : _______________ 15 Place of issue : ________________
12 Date of issue : _______________ 16 Date of issue : ________________
13 Date of expiry : _______________ 17 Date of expiry : ________________

18 Marital status (celibatarian - married - divorced – widowed)


19 Wife’s name : _______________ 20 Weight/Height : ________________
21 Mother’s name : _______________
22 Approved Education: ________________________________________________________
23 CERTIFICATES
Description Registration No. Place of issue Date of issue
Certificate of Competency
Endorsement to the CC
Ship’s Safety Officer (ISM Code)
Basic safety training STCW’ 78/95
* Medical Care
* Fire Fighting
* Survival Craft
* Medical First Aid
Chemical Tanker
Oil Product Tanker
Liquefied Gas Tanker
Ro-Ro Passenger Ship
HAZMAT / Dangerous Cargoes
C.O.W. / I.G.S.
ARPA
GMDSS / GOC
Radar Simulator
Medical Examination
Vaccination Yellow Fever

24 PROFESSIONAL EXPERIENCE DURING LAST 5 YEARS (in backwards order)


RANK MISSION MISSION SHIPOWNER/Nationality VESSEL DWT ME
STARTED COMPLETED Tel/Fax/e-mail Name & Type Type/BHP

Minimum acceptable salary USD _________________

I, undersigned, confirm all above information to be true and correct to my best knowledge:
Signature of the Applicant ____________________

CREW MANAGER REMARKS 1 2 3 4 5


English:

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