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Application Form for ONMA Cadet

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Family Name First Name Middle Name

Date of birth Birth Place Nationality

Educational Institution Faculty

Home Address Mobile Phone

Fax Email

PHOTO

Address of Next Kin Relation of Next Kin

Family Name of Next Kin First Name of Next Kin

Phone of Next Kin Fax of Next Kin

Travel

Documents	Number	Date Issued (dd/mm/yyyy)	Date Expire (dd/mm/yyyyy)
Travel Passport
Seaman's Book (Ukraine)
Seaman's Book (Panama)
Seaman's Book (Liberia)
U.S. Visa (C1/D)
Yellow Fever

Training certificates

Documents	Number	Date Issued (dd/mm/yyyy)	Date Expire (dd/mm/yyyyy)
Basic Safety Training
Proficiency in S/C and R/B
Advance Fire Fighting
Medical First Aid
Medical Care
Rader Obs. & Plotting
ARPA
Ship Security Officer
Designated security duties

Experince of onboard practice

Documents	Number	Date Issued (dd/mm/yyyy)	Date Expire (dd/mm/yyyyy)
Rank
Name of Vessel
Vessel Flag
Type of Vessel
Gross Tonnage
M/E BHP
Model of M/E
Model of D/G
Crewing Agency
Vessel Operator
Sign On Date (dd/mm/yyyy)
Sign Off Date (dd/mm/yyyy)
Term (mm-dd)
Total onboard Experience

*Recomandation Letter from ONMA shall be attached

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