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Bulk Application Form1

Bulk

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18 views

Bulk Application Form1

Bulk

Uploaded by

tusharkatua91
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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COMPANY WORK APPLICATION FORM – MANNING OFFICE Form No. F.6.

2
FORM (DRY) Issue B Date 15/03/17
Authorised By MD

DATE AVAILABLE:. 01 Feb 2023


POSITION APPLIED FOR: 4th Engineer
FULL NAME: Arun Sahrawat ATTACH
SURNAME: Sahrawat PHOTO
FIRST NAME: Arun HERE
MIDDLE NAME(S)
PERSONAL DETAILS
DATE OF BIRTH 20.03.1994 PLACE OF BIRTH NATIONALITY: HEIGHT 175 cm
: Delhi Indian

WEIGHT 75 HAIR COLOUR Black EYE Black


COLOUR
MARITAL STATUS Single SPOUSE’S NAME No. of
Children
FATHER’S NAME Rajkumar MOTHER’S NAME Kamlesh NEXT OF Rajkumar
KIN
HOME ADDRESSHouse no.145,V.P.O.- Birohar,Jhajjar,Haryana-124106 TEL. No. 9813711235
(PERMANENT)
OTHER ADDRESS TEL. No.

E-MAIL: [email protected] Skype: Homeport:Delhi Mob No. 9813711235

LICENCES / DOCUMENTS HELD


ITEM No. I S S U E D EXPIRIN GRADE
DATE PLACE BY G
NATIONAL LICENCE DATE
STCW ENDORSEMENT
LIBERIAN ENDORSEMENT
MARSHALLS ISL ENDORSEMENT
MALTESE ENDORSEMENT
OTHER LICENCE
PASSPORT
NATIONAL SEAMAN’S BOOK/CDC
OTHER SEAMAN’S BOOK / CDC
U.S.VISA
YELLOW FEVER VACCINATION
P.R.C. No. (Filipino Crew only)
National data base of seafarers INDOS
Certificate No. (Indian personnel only)
CERTIFICATES HELD
ITEM No. ISSUED EXPIRING ISSUED BY
BASIC SAFETY TRAINING (*IF ONE CERTIFICATE)
PERSONAL SAFETY & SOCIAL RESPONSIBILITIES*
PERSONAL SURVIVAL*
SURVIVAL CRAFT HANDLING*
FIRST AID AT SEA (ELEMENTARY LEVEL)*
PROFICIENCY IN SURV.CRAFT/ RESCUE BOAT (PSCRB)
ADVANCED / SHORE-BASED FIREFIGHTING
MEDICAL CARE
SHIP MASTERS MEDICARE/ADVANCED MEFA
STCW ENDORSEMENT
ARPA
R.O.C. / RANSCO / RADAR SIMULATOR
SATCOM

APPLICANTS NAME: _________________________________________________________

Original to be kept at Manning Office/ Agent – Copy to be sent to Crew Dept. 1 of 3


COMPANY WORK APPLICATION FORM – MANNING OFFICE Form No. F.6.2
FORM (DRY) Issue B Date 15/03/17
Authorised By MD

CERTIFICATES HELD (CONTINUED)


ITEM No. ISSUED EXPIRING ISSUED BY
GOC / GMDSS
ECDIS
SHIP MANOEUVERING/SHIP HANDLING SIMULATOR
SHIP SECURITY OFFICER
ISPS FAMILIARISATION
SHIPBOARD SAFETY OFFICER
ENGINE ROOM SIMULATOR
ENGINE ROOM RESOURCES MANAGEMENT
HUMAN RELATIONS
QUALITY AND SAFETY MANAGEMENT
RISK ASSESSMENT / RISK MANAGEMENT
MARINE ACCIDENT/INCIDENT INVESTIGATION
MANAGEMENT OF CHANGE
ENVIRONMENTAL COURSE / ISO 14001
MLC/LSC MARITIME LEADERSHIP COURSE
MARPOL I
MARPOL II
MARPOL VI
MARITIME ENGLISH
MLC 2006
BRIDGE TEAM MANAGEMENT
BRIDGE RESOURCES MANAGEMENT

RECORD OF PREVIOUS SERVICE (VERIFIED AGAINST SEAMAN’S BOOK ENTRIES)


COMPANY VESSEL’S TYPE/ DWT M/ENGS
’ BHP/ UMS RANK FROM TO MONTH
S
NAME BUILT TYPE ( Y-

Original to be kept at Manning Office/ Agent – Copy to be sent to Crew Dept. 2 of 3


COMPANY WORK APPLICATION FORM – MANNING OFFICE Form No. F.6.2
FORM (DRY) Issue B Date 15/03/17
Authorised By MD
APPLICANT’S NAME: ____________________________
ACTUAL TIME SERVED IN MONTHS
RANK CRUDE CARRIER OBO PRODUCT RO-RO/ BULK
TANKER CONTAINER CARRIER
MASTER OR CH. ENG.
C/OFF OR 1A/E
2/OFF OR 2A/E
3/OFF OR 3A/E
CADET/JR.ENG
ELEC OFF
FITTER
OTHER RANK

ALLOTMENT DETAILS
SURNAME
NAME
MIDDLE NAME
DATE OF BIRTH
RELATIONSHIP
ADDRESS
NAME OF BANK
ACCOUNT No.
SSS No. (Filipino crew
only)
TIN No. (Filipino crew
only)
WIFE & CHILD/RENs
’ DOB POB PASSPORT NO DATE OF Issued at
NAME(s) ISSUE
EXPIRY

How long did you stay at your previous company?


Wages on last vessel?
Trade route of vessels?
Who referred you to the company?
Any relatives with the company?
If yes, who?
ANY OTHER INFORMATION ABOUT YOURSELF:

UNION MEMBERSHIP NO.: DATE :

DOE:
ALL APPLICANTS
DATE APPLICATION FILLED OUT

SIGNATURE OF APPLICANT

FULL NAME IN BLOCK CAPITALS

Original to be kept at Manning Office/ Agent – Copy to be sent to Crew Dept. 3 of 3

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