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CSM STCW & OTHER DETAILS FORMS

The document is an application form for a position, requiring personal details, readiness to join, and family information. It includes sections for licenses and certifications, physical attributes, and references from previous employment. Additionally, it contains a non-disclosure declaration regarding the privacy of the applicant's information.

Uploaded by

Sumit Kumar
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
1 views

CSM STCW & OTHER DETAILS FORMS

The document is an application form for a position, requiring personal details, readiness to join, and family information. It includes sections for licenses and certifications, physical attributes, and references from previous employment. Additionally, it contains a non-disclosure declaration regarding the privacy of the applicant's information.

Uploaded by

Sumit Kumar
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Application Form

Date of Application:
_________________________________
Position Applied:
______________________________________
PHOTO
Readiness to Join:
_____________________________________

Family Name Given Name Indos No Birth Date

Next of Kin Details

Family Name Given Name Middle Name Relationship

N/A

Address Contact Details

Home:

Cell:
Application Form

Licenses Certification Certificate No Issued Validity Issued By Authority

COC/COP/WK

GMDSS (GOC)

GMDSS Endorsement

Oil Endorsement

Chemical Endorsement

Liquified Gas Endorsement

STCW Certification Certificate No Issued Validity Issued By Authority


BST
PST
PSSR
PSCRB
BFF/FPFF/AFF
EFA/MFA/MEDICARE
STSDSD/SSO
BTM/BRM
SHIP HANDLING /MANOEUVRING
Application Form

ECDIS
Height (cm) Weight (kg) Boiler Suit Size Safety Shoe Size

Reference(s) from Previous Employment


No. Company Name of Contact Person Contact Details

APPLICANT NAME DATE SIGNATURE

* Non-Disclosure Declaration: Information pertaining to seafarer which is considered as “seafarers right to privacy and the need to protect one’s own personal data”. This will not be
disclosed by CASM Team to any third party for any purpose, other than related statutory/ regulatory/concerned authorities’ requirements.
* If one page is not enough, please make copies of this page and attach to the application sheet.

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