Ship Job Application

General Information

1. Family name, first name:
   
2. Date of Birth:
   
3. Place of Birth:
   
4. Sex:
5. Resident of: (country)
   
6. Nationality:
   
7. Marital Status:
   
8. Number of Children < 21 years old: (dependants)
   
9. Next of Kin: (Name)
   
   • Address:
     
   • Telephone:
10. Religion:
    
11. Home Address:
    
12. Telephone: (current contact number)
    
13. Web site URL: (if no, delete this)
    
14. e-mail:
    
15. Nearest airport:
    
16. Date when available:

Career Objective:

1. The Marine position(s) applied for:
   
2. The Cruise Liner position(s) applied for:
   
3. The Fishing position(s) applied for:
   
4. The Offshore position(s) applied for:
   
5. The Cadet position(s) applied for:

Desired Salary (US $):

Passport(s):

1. Country:
   
2. Number:
   
3. Issued: (date and place)
   
4. Valid until:
   
5. Image (file name)

Seaman's Book(s):

1. Country:
   
2. Number:
   
3. Issued: (date and place)
   
4. Valid until:
   
5. Image (file name)

Education and Training:

1. Period: (from - to)
   
2. Education Institute Name:
   
   • Address:
     
   • Telephone:
     
   • Web site URL:
     
   • email address:
3. Course Name:
   
4. STCW-95 designation, if any:
   
5. Diploma (Degree) or Certificate Name:
   
6. Diploma Image (file name):

(Licenses) Certificates of Competence:

1. Country:
   
2. Licence number:
   
3. Date Issued:
   
4. Place of Issue:
   
5. Issued by (Name of Authority):
   
   • Address:
     
   • Telephone number:
     
   • Web site URL:
     
   • email:
6. Certificate Image (file name):
   
7. Endorsements:
   
   • Country:
     
   • Number:
     
   • Capacity or Limitations:
     
   • STCW-95 Reference:
     
   • Valid until:
     
   • Place of Issue:
     
   • Issued by (Authority name):
     
     • Address:
       
     • Telephone number:
       
     • Web site URL:
       
     • email address:
   Repeat each endorsement for each separate country

Previous Seagoing Experience:

1. Vessel name:
   
2. Vessel type:
   
3. Built (when and where):
   
4. LOA:
   
5. DWT:
   
6. GRT:
   
7. NRT:
   
8. Main engine type:
   
9. Main engine horsepower / KW:
   
10. Flag:
    
11. Vessel Operator [or Manager or Owner](name):
    
    • Address:
      
    • Telephone number:
      
    • Web site URL:
      
    • email address:
12. Reference documents (file names):
    
    • Person's (ref.) name and position:
      
    • Telephone number:
13. Rank (position onboard):
    
14. Period (From - to):

Previous Non-Seagoing (land based) Experience:

1. Period: (From - to)
   
2. Employer's name:
   
   • Address:
     
   • Telephone number:
     
   • Web site URL:
     
   • email address:
3. Job description (Including responsibilities):

Languages:

1. Language name: (Mother tongue first)
   
2. Test result:
   Name, tel. number, and e-mail address of tester: (if no test available, delete this point)
   
3. Self evaluation: (fluent, good,fair,basic)

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