Arcadia Shipmanagement Co Ltd Form No.

001
SEAMAN’S APPLICATION PRIOR JOINING THE VESSEL
AND ASSESSMENT PROFILE

Part A. APPLICATION FORM OFFICERS & RATINGS

PERSONAL DATA
Applied for the position of: PHOTO
Surname: Forename:
Father’s name: Mother’s name:
Date of birth: Place of birth:
Marital status: Single Married Nationality:
Home address:
Tel.: Tel.: e-mail:
Next of kin:
Surname: Forename:
Home address : Tel:
Dependants (number): Sons: Daughters:
Recommended by:
DOCUMENTS NUMBER ISSUING AUTHORITY Date Issued Expiry Date
Passport (6 months remaining
validity from the estimated
disembarkation time)
Seaman’s book
S T C W Endorsement/ COC
Medical Fitness Certificate
Yellow Fever Vaccination
USA VISA (6 months remaining
validity from the estimated
disembarkation time)
Other required VISA
For HELLENIC Citizens only: ΑΜΚΑ: ΑΦΜ: ΔΟΥ:

QUALIFICATIONS (ref. to SMSM Form No.363, as applicable)

CERTIFICATES YES NO ISSUING AUTHORITY Date Issued Expiry Date

Certificate of Competence / License

Navigational watchkeeping (Officers) A-II/1
Navigational watchkeeping (Masters/Ch Mates) A-II/2
Navigational watchkeeping (Ratings) A-II/4
Able Seafarer Deck A-II/5
Engine Room watchkeeping (Officers) A-III/1
Engine Room watchkeeping (Ch Eng/2nd Eng) A-III/2
Engine Room watchkeeping (Ratings) A-III/4
Able Seafarer Engine A-III/5
Electro-technical Officer A-III/6
Electro-technical Rating A-III/7
GMDSS Radio Operators A-IV/2
Basic Training for Oil Tanker A-V/1-1-1

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 Arcadia Shipmanagement Co Ltd Form No. 001
SEAMAN’S APPLICATION PRIOR JOINING THE VESSEL
AND ASSESSMENT PROFILE

Advanced Training for Oil Tanker A-V/1-1-2

Safety Training A-VI/1-1 to 1-4
Proficiency in surv.craft & RB other than FRB A-VI/2-1
Advanced Fire Fighting A-VI/3
Medical First Aid A-VI/4-1
Medical Care A-VI/4-2
Ship Security Officer A-VI/5
Security Awareness A-VI/6-1
Seafarers with designated Security duties A-VI/6-2
Safety Officer
Bridge Resource/Team Management (BRM/BTM)
Engine Resource Management (ERM)
Risk Assessment
Incident Investigation
Ship handling
OTHER CERTIFICATES YES NO ISSUING AUTHORITY Issue Date Expiry Date

Training needs If YES list the certificates the applicant does not hold in the following section: YES NO
Training to be carried-out up to:
Training to be carried-out up to:
Training to be carried-out up to:
Native language:
English*: Good Basic
Other languages:
*All Officers in direct control of navigation, cargo and/or bunker oil handling operations must have conversational proficiency in English
PREVIOUS SEA SERVICE
SERVICE TIME REASON OF
SHIP’S NAME TYPE ENGINE DWT / BHP OWNER RANK SIGN-OFF
DATE ON DATE OFF

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 Arcadia Shipmanagement Co Ltd Form No. 001
SEAMAN’S APPLICATION PRIOR JOINING THE VESSEL
AND ASSESSMENT PROFILE

APPLICANT
SIGNATURE DATE
(NAME):

CREW MANAGER / MANNING AGENT APPLICATION REVIEW (application’s validity to be reviewed prior each employment)
NAME DATE SIGNATURE

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 Arcadia Shipmanagement Co Ltd Form No. 001
SEAMAN’S APPLICATION PRIOR JOINING THE VESSEL
AND ASSESSMENT PROFILE
Part B. INTERVIEW FORM OFFICERS & RATINGS
ONLY for the accepted applicants. Interview will be carried out by the Department Managers or their deputies / Manning Agent.

SEAFARER’S NAME: RANK: INTERVIEW DATE:

COLOR CODE
Master, Ch.Officer, Ch.Engneer, 2nd Eng, Bosun, Pumpman, Deck Cadet, Cook, 2nd Cook,
2nd Off, 3rd Off 3rd Eng, 4th Eng, El/cian AB, OS, Oiler, Wiper Engine Cadet Messman

CREW MANAGER / MANNING AGENT

Appearance.
Personality.
Contract period.
Nautical college / year graduated.
Previous Companies employed.
Type of vessels.
Training courses above STCW requirements.
Knowledge of English language (interview is conducted in English language).
Personal Survival Techniques / Fire Prevention and Fire Fighting
First Aid, Personal Safety and Social Relationships
Salaries and other benefits.
Uniforms and Insignia.
Which are your views on health, safety, security, quality and environmental policy (expand)?
Which are your views on Leadership and Team Building?
How would you ensure that all crew onboard are kept motivated to improve Company’s health,
safety, security, quality and environmental policy (expand)?
Knowledge of SSP
Candidate’s comments on HSSQEEn awareness, sensitivity and training.
Which are your views on D&A policy?
Which are your views on Drug Smuggling?
Why did you have short contract duration with previous Company (where applicable)?
What does the term DPA mean and which are his responsibilities?
Which are your views on Safety Committee meetings and how frequently should they be
conducted?
Handling of critical equipment
Dry docking and major repairs
Have you experienced any accidents? What lessons have you learned?
How would you ensure teamwork onboard?
What will be your efforts that good housekeeping is being applied onboard?
What actions should be taken on incorrect deliveries?
How do you deal with each of the following scenarios under pressure? Commercial pressure,
handling conflict onboard (expand)?
Familiarization with onboard computer system and GDP Regulation
Are you familiar with the use of Electronic PMS?
When would you be available?
Have you any definite plans for your career?
Have you previously worked in multinational workforce? What nationalities? Did you have
smooth cooperation?

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 Arcadia Shipmanagement Co Ltd Form No. 001
SEAMAN’S APPLICATION PRIOR JOINING THE VESSEL
AND ASSESSMENT PROFILE
Do you have any eating habits/rituals that are specific to your culture/religion?
Define and describe the most important (or most celebrated) holiday of your culture /religion.
What is considered most disrespectful/respectful in your culture?
Have you ever experienced racism? In what form?
Have you ever felt excluded based on your gender or culture?
Do you remember excluding others based on culture or gender?
Have you experienced any difficulties on this?
Do you believe that you are obliged to make suggestion for improvement of the Company’s
operations / performance?
Which particular aspects of work are you consider harder/more stressful?
Would you expect your wife / family to travel with you?
Have you experienced any medical operation / serious illness in the last 12 months?
Is scheduled to be carried out, any medical operation in the next 12 months?

SEAFARER NAME/SIGNATURE DATE

CREW MANAGER / MANNING AGENT NAME/SIGNATURE DATE

REFERENCES/INFORMATION, ETC. FROM PREVIOUS EMPLOYERS (to be completed by Crew Manager/Manning agent)

Background Security Document (e.g. Criminal Record) Provided by the Seafarer

DATE:
Name / Position / Signature:
Name / Position / Signature:

CREW MANAGER / MANNING AGENT

NAME/SIGNATURE ACCEPTED YES NO
COMMENTS
DATE

OFFICERS ARE TO BE INTERVIEWED ON SPECIFIC TOPICS AS DESCRIBED IN HSQEMS FORM NO. 014 “BRIEFING FORM
FOR OFFICERS” INTERVIEWERS TO SIGN BELOW AS APPLICABLE:
COMPANY DEPARTMENTS
DPA NAME/SIGNATURE ACCEPTED YES NO
COMMENTS
DATE

TECHNICAL NAME/POSITION/SIGNATURE ACCEPTED YES NO

COMMENTS
DATE

OPERATIONS NAME/POSITION/SIGNATURE ACCEPTED YES NO

COMMENTS

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 Arcadia Shipmanagement Co Ltd Form No. 001
SEAMAN’S APPLICATION PRIOR JOINING THE VESSEL
AND ASSESSMENT PROFILE
DATE

CEO (only for Senior Officers) SIGNATURE FINAL ACCEPTED YES NO

COMMENTS
DATE

Note: 1) Any comments shall be recorded in the relevant fields 2) Final approval as per SMM QP05 para 5.3.2

CERTIFICATES’ AUTHENTICITY CHECK Completed by the Crew Manager, when recruitment is conducted directly by the Company.
Completed by the Manning Agent, when the recruitment is conducted by the Manning Agency and verified by the Crew Manager.

Authenticity check conducted for certificates:

CONDUCTED BY CREW DEPARTMENT (Name/Position)
CONDUCTED BY MANNING AGENT (Name/Position)
DATE RESULTS Satisfactory Unsatisfactory
VERIFIED BY CREW MANAGER (Name)
DATE RESULTS Satisfactory Unsatisfactory

MEDICAL EXAMINATIONS TO BE CONDUCTED PRIOR TO SEAFARER’S ENGAGEMENT

MEDICAL EXAMINATIONS AND D&A TEST COMPLETED SATISFACTORY? YES NO

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