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EMPLOYMENT APPLICATION FORM


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EDUCATIONAL ATTAINMENT

Years Name of Marine School or Academy Department

TRAVEL PASSPORT

No Date of Issue Valid Until Place of Issue

SEAMAN'S BOOK

No Date of Issue Valid Until Place of Issue

CERTIFICATES OF COMPETENCY

Grade Number Date issued Date expire Place of Issue

National

Endorsement

Endorsement

Endorsement

Select Endorsement Type

US VISA

Issued Valid Place of Issue

Sea Service (WITHIN THE LAST FIVE YEARS)Listing most recent vessel last

Rank Vessel Name Flag/Year Type Gross Tonage Engine Type BHP Ship manage Crewing Agency Sign on Sign off

STCW CERTIFICATES

Document Number Date issued Date expire Place of Issue

Basic Safety

Proficiency in survival

Advanced Fire Fighting

Medical First Aid

Medical Care

Automatic Radar

Radar Observation

Dangerous substances

ISPS Code

ISM Code

GMDSS operator

Endorsement GMDSS

ECDIS

Tanker Familiarization

Oil Tanker

Chem. Tanker

Gas Tanker

ADDITIONAL INFORMATION

Foreign Languages:

English Evaluation

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