EMPLOYMENT  APPLICATION  FOR  SHIP  PERSONNEL     ISI  ODESSA
 
 Application For Employment As:

 Date Available for Joining:

 

 Last Salary ($):

 
 Type of vessel applying for:  U.S. Visa:

 AUS Mcv:
 SURNAME:  Name:
 Middle Name:  Nationality:
 Date of  Birth:   [27.05.1984]  Place of  Birth (City and Country):
 Marital Status:  Name of  Spouse:
 Permanent Address, E-Mail:

Height:

   cm

Weight:

   kg

Color Of Eyes:

Color Of Hair:
 Telephone No (Code+Country):  Nearest International Airport:
 Travel Passport No:  Place of Issue:
 Date of Issue:   [27.07.2007]  Date of Expiry:   [27.07.2017]
 Seaman's Book No:  Place of Issue:
 Date of Issue:   [27.07.2007]  Date of Expiry:   [27.07.2017]

Give  particulars  of  your  immediate  family  members  and  indicate  your  relationship  with  them
 Names:    1st    2nd    3rd
 Relationship:    1st    2nd    3rd
 Occupation:    1st    2nd    3rd

EMERGENCY
 Next of  Kin:  Relationship:
 Address, Tel, E-Mail:
 

LICENCE  PARTICULARS

 Date/Place of  Issue

 Validity
 National Licence  Grade  Cert No

 U.K.  Grade  Cert No

 Liberian  Grade  Cert No

 Bermuda  Grade  Cert No

 Other:  Grade  Cert No

S. T. C. W.   COURSES
 Basic Safety Training   Ref No

Date of Issue:
 Survaval Craft and Rescue Boat   Ref No

Date of Issue:
 Fire Fighting     Advanced Fire Fighting     Ref No

Date of Issue:
 First Aid Sea     Advanced Medical Care    Ref No

Date of Issue:
 A.R.P.A (Radar)   Ref No

Date of Issue:
 G.M.D.S.S. – G.O.C.   Ref No

Date of Issue:
 Tanker Familiarisation     Advanced Program    Ref No

Date of Issue:
 Tanker Safety   Ref No

Date of Issue:
 Crude Oil Washing (COW)   Ref No

Date of Issue:
 Insert Gas System (IGS)   Ref No

Date of Issue:
 Chemical Certificate   Ref No

Date of Issue:
 Dangerous Cargo   Ref No

Date of Issue:

 LPG Certificate   Ref No

Date of Issue:
 Ship Security Officer   Ref No

Date of Issue:
 Bridge Team Management   Ref No

Date of Issue:

Professional  Qualifications

ESTABLISHMENT  Name (Nautical College / Institute)

Date Attended

QUALIFICATIONS - Grade of  Diploma / License

Date Passed

DETAILS  OF  PREVIOUS  SEA  SERVICE

Name of Vessel

Year Built

Flag

Type of Vessel
 and Engine
 (Type, Modification)

DWT and HP

Rank

Period of Service

From

To

 Name of Owners Or Other Remarks

 Name of Owners Or Other Remarks

 Name of Owners Or Other Remarks

 Name of Owners Or Other Remarks

 Name of Owners Or Other Remarks

 Name of Owners Or Other Remarks

 Name of Owners Or Other Remarks

 Name of Owners Or Other Remarks

SUMMARY  OF  OFFICER’S  EXPERIENCE
 In months
Experience As Bulk Carrier Ore Carrier Container
Carrier		 Chemical
Tanker		 Reefer Oil Tanker General
Cargo		 Others
CPT C/E
C/O 1/E
2/O 2/E
3/O 3/E
CDT   E/E*

ENGINEER  APPLICANT

NAVIGATING  APPLICANT

Type  Of  Engine

Duration  (Months)

Type  Of  Vessel

Duration  (Months)

 Bulk Carrier

 Ore Carrier

 Container Carrier

 Chemical Tanker

 Reefer

 U.M.S.

 Oil Tanker

 CRANE EXPERIENCE (Type/Make)

 Others (Specify)

 Experience With Immarsat  Duration  (Months):

 Experience With Multinational Crew  Nationality: Months:
 Last Company contact address/ph. nmbr:
 

 Date of Application [27.07.2007]

 

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