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NEXT OF KIN
Surname, Name Relation
Address Phone
Street name + No Mobile
City E-mail
Postal code Skype
Country Other
CHILDREN
Surname Name DOB
1
2
3
EDUCATION
Education:* University (4-5 years) Profession obtained:
*(select from dropdown list)
GENERAL QUESTIONS
What wages do you expect per month? depends of ship and who will pay tasks
What contract duration you consider acceptable? 6 months
Would you consider joining in lower rank?
Why did you leave your last employer?
Last wage (inclusive of leave pay):
How did you learn about us? friends
Vessel type you are interested in (in order of priority): 1. Oil/Chemical Tanker
2. LPG/LNG Tanker
3. VLCC/ULCC
4.
REFERENCES
Company Contact Person Position Contact numbers (phone and mobile) and email
T: M: E:
T: M: E:
T: M: E:
Do you agree that we contact your previous employers for references? Please write YES or NO as applicable.
FLAG STATE DOCUMENTS - please list any valid flag state Endorsements and Seamans' Books that you hold
Document Number Date of issue Valid till Place of issue
Advanced training in fire fighting STCW VI/3 400386529 7/12/2017 7/12/2022 Rijeka
1.
2.
3.
4.
DP CERTIFICATES/LOG BOOK
Certificate Number Date of issue Valid till Place of issue
DP Basic (induction)
DP Advanced
DP Limited
DP Unlimited
DP Log Book
OTHERS:
Certificate Number Date of issue Valid till Place of issue
Energy Conservation
Risk Assessment
Tank Inspection
AMOS2
Ship to Ship
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