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W L S Company (PVT) LTD.: Application Form QP 3A

This document is an application form for W L S Company (Pvt) Ltd. It requests information such as the applicant's personal details, passport information, academic and sea service qualifications, training undertaken, and availability. The form collects details to assess candidates for job placements and maintains records of their certifications and experience.

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kavaskar
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Download as DOC, PDF, TXT or read online on Scribd
75 views

W L S Company (PVT) LTD.: Application Form QP 3A

This document is an application form for W L S Company (Pvt) Ltd. It requests information such as the applicant's personal details, passport information, academic and sea service qualifications, training undertaken, and availability. The form collects details to assess candidates for job placements and maintains records of their certifications and experience.

Uploaded by

kavaskar
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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W L S Company (Pvt) Ltd.

No 18, Nugegoda New Bus Stand Shopping Complex, Nugegoda, Sri Lanka

Tel : 0094117922605/ 0094773059195 Fax : +94 11 2055164


Email: [email protected] / [email protected] Web: www.wls.lk
L. C. No: 002767

YY MM DD APPLICATION FORM QP 3A
Post Applied Reference No

PASSPORT
SIZE PHOTO

Name as per Passport


First Name Middle Name Last (or) Surname

Date Of Birth Place Of Birth Nationality Contact Number


SRI LANKAN #1
#2
NEXT OF KIN
Full Name Relationship WIFE
Contact Number
PASSPORT DETAILS
OFFICE
Passport No Issue Date Expired Date Issue Place USE ONLY
COLOMBO

ACADEMIC QUALIFICATION: (ENTER DEGREE/ DIPLOMA/ SCHOOL)


Degree University Yr. Passed Grade

TRAINING INSTITUTE
Content Details Date Commenced Date Completed

HIGHEST CERTIFICATE OF COMPETENCY NOW HELD


OFFICE
Authority Comp. Cert Cert No. Date Of Issue Valid Till Place Of Issue USE ONLY
Indian
UK
Panama
Singapore
Sri Lanka
Liberian
Belize

CDC DETAILS
OFFICE
Document CDC Number Date Of Issue Valid Till Place Of Issue USE ONLY
CDC (Sri Lanka) COLOMBO
CDC
CDC

STCW COURSES ATTENDED AND CERTIFICATES HELD


Date Of Place Of OFFICE
Course/ Certificate Certificate No. Valid Till USE
Issue Issue ONLY
Personnel Survival Technique / PSC &
Rescue Boat
Elementary/ Medical First Aid/ Ship
Master Medicare
Fire Prevention & Fire Fighting / AFF
Personnel Safety and Social
Responsibilities
MMD Watch Keeping Certificate (for
Crew)
ISPS / SSO / SSA (Ship Security)
Proficiency In Survival Craft and Rescue
Boats other than Fast Rescue Boats
BRM / BTM Certificate
Radar Simulator / ARPA
Radar Observer / RANSCO
RCC / RT
GMDSS (IND - UK)
GMDSS Endorsement (IND - UK)
Oil Tanker Familiarization / DCE
Chemical Tanker Familiarization / DCE
CHEMCO / GASCO
Yellow Fever Vaccination
Support Level English
Automatic Radar Plotting AIDS
Navigation Watch Keeping BIMO
US Visa

SAILING EXPERIENCE: (STARTING WITH MOST RECENT)

Actual Sea Service


BHP
DWT / From Date To Date
Company Vessel Name Vessel Type / Rank Total
GRT
Engine Month
DD MM YY DD MM YY

Available to join from Expected Salary

I do hereby declare that all information furnished above is correct to the best of my knowledge and belief

Issue no. 01 Reviewed By: MR Approved By: MD


Date of issue 20
Revision no. 00
Date of rev. --

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