CERTIFICATE OF COMPETENCY .....................
ENDORSEMENT .....................................................
G.M.D.S.S. OPERATOR CERTIFICATE .............. IV / 2
G.M.D.S.S. OPERATOR ENDORSEMENT ......... IV / 2
GENERAL OPERATOR G.M.D.S.S.  .................... A-IV/2, B-IV/2
BASIC SAFETY TRAINING ................................. A - VI / 1
PROFICIENCY IN SURVIVAL CRAFT ............... A - VI / 2
ADVANCED FIRE FIGHTING .............................. A - VI / 3
MEDICAL CARE ON BOARD ............................. A - VI / 4
MEDICAL FIRST AID ........................................... A - VI / 4
A.R.P.A. (RADAR SIMULATOR) ....................... A - II / 1
SECURIY AWARENESS TRAINING .................. A - VI / 6-1
TRAINING FOR SEAFARERS WITH   
DESIGNATED SECUIRITY DUTIES ..................
.
A - VI / 6-2
TANKER FAMILIARIZATION ........................... V / 1
OIL TANKERS SAFETY ....................................... V / 1
GAS TANKERS SAFETY .................................... V / 1
CHEMICAL TANKERS SAFETY ....................... V / 1
CRUDE OIL WASHING ....................................... MARPOL-73/78
INERT GAS SYSTEM ........................................... MARPOL-73/78
HAZARDOUS CARGOES ................................... B-V/4&B-V/5
BRIDGE TEAM MANAGEMENT ...................... 1.22
ENGINE/BRIDGE RESOURSE MANAGEMENT
ISM (INTERN. SEAMAN’S CODE) ..................... A/1441 (18)
RO-RO PASSENGER SHIPS .................................. A - V / 2
SHIP’S SAFETY OFFICER ....................................
SHIP’S SECURITY OFFICER ................................
ECDIS .......................................................................
SHIP HANDLING ARRANGEMENTS ................ A-II/2
BREATHING APPARATUS .................................  
ELECTICAL & ELECTRONIC  EQUIPMENT .....          
HEALTH LIST .........................................................          
DRUG TEST .............................................................          
ALCOHOL TEST .....................................................          
YELLOW FEVER VACCINATION .......................          
Position applied for
Date of availability
Expected salary:
                   EMAIL:
STCW CERTIFICATES
REGULATION
NUMBER
ISSUED
VALID
PLACE OF ISSUE
SEA SERVICE (Last 5 years)
OTHER PASSPORTS
NUMBER ISSUED VALID
LIBERIAN PASSPORT:
LIBERIAN ENDORSEMENT:
PANAMA PASSPORT:
PANAMA ENDORSEMENT:
       
MARITAL STATUS:
HOME ADDRESS: 
NEAREST AIRPORT:
E- MAIL:
NEXT OF KIN: 
ADDRESS/TEL OF THE NEXT OF KIN:  
CHILDREN: SONS__ DAUGHTERS___
HEIGHT: 
SHOES: 
EYE COLOR:
MARLIN’S TEST:
PERSONAL INFORMATION
PHONE NO:
MOBILE NO:
CONTACT NO:
NAMES OF CHILDREN: 
WEIGHT: 
OVERALL SIZE: 
HAIR COLOR:
SKYPE NAME:
PRE-SEA EDUCATION
NAME OF SCHOOL OR ACADEMY DEPARTMENT FROM
(YEAR)
TO
(YEAR)
 
I hereby affirm that all the information provided by me in this form is true and correct to the best of knowledge.

NAME OF VESSEL

TYPE OF VESSEL

D.W.T.

FLAG

NAME OF
COMPANY

TYPE OF ENGINE / HP

YEAR OF BUILT

RANK
DURATION OF
SERVICE
   
                   
                   
                   
                   
APPLICATION FORM
FROM                    TO
   SURNAME: ............................
   DATE/PLACE OF BIRTH: ...
   MOBILE NO:...........................
....ISSUED: ..................................
....ISSUED/VALID: ....................
....ISSUED/VALID: ....................
....ISSUED/VALID: ....................
....ISSUED/VALID: ....................
   ENGLISH: ...............................
NAME: ...........................................
FATHER NAME: ..........................
NATIONALITY: ...........................
UKRAINIAN PASSPORT: ..........
INTERNATIONAL PASSPORT: .
SEAMAN’S BOOK: .....................
US VISA: ........................................
SHENGEN VISA: ...........................
MIXED CREW EXPERIENCE: ....
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