Application Form for Seafarers

Please use latin letters and enter all dates in dd.mm.yyyy format. Thank you.
Fields marked with an asterisk (*) are necessary to be filled in.
You can fill in this form offline and after completion log on again and send the form to us.


Personal Data:
All Data are for our internal use only and will not be made available to others without your permission.

Rank

 *

Birthplace

Name

 *

Date of birth*

1st Name(s)

 *

Marital status

Town

 *

Children(no.)

Street/ No.

 *

Availability*

Email Address

 *

Religion

Nearest Airport

 * Next of kin:

Phone

 * Name*

Mobile

 Phone*

Fax

 Adress

Identity/ Travel/ Medical Documents

Nationality

Number

Place of Issue

Issue

Expiry

Passport*

US Visa

other Visa

Seaman Book*

Seaman Book

Seaman Book

Medical Fitness

Yellow Fever Vacc.

Cholera Vacc.

Typhoid Vacc.

Tetanus Vacc.

Other Vacc.

Certificates/ Courses

Position

Nationality

Number

Place of Issue

Issue

Expiry(if applicable)

Competence*

Competence

Competence

GMDSS GOC

GMDSS ROC

Basic Safety Training

Proficiency Survival Craft

Proficiency Fast Rescue Boats

Advanced Fire Fighting

Medical First Aid

Medical Care

HAZMAT

ARPA

ECDIS

Bridge Resource Management

Engine Resource Management

Shiphandling

Special Requirements Tanker

Tanker Familiarization

Advanced Oil Tanker

Advanced Chemical Tanker

Advanced Gas Tanker

Inert Gas Tanker

Shore Based Fire Fighting

Special Requirements RoRo/ Passenger Vessels

Familiarization

Crowd Management

Safety Training

Passenger and Cargo Safety

Crisis Management

Experience/ Knowledge

Self Evaluation

Language Knowledge*

 English

Language Knowledge

Language Knowledge
Marlins Test Score
Marlins Test Date

Electr. Chart Display System*

Computer Experience Windows*

Computer Experience MS Office*

Stability/ Cargo Planning System Seacos*

Stability/ Cargo Planning System other*

Planned Maintenance System AMOS D*

Planned Maintenance System other*

Working Experience Cranes*

Working Experience Reefer Containers*

Working Experience Automation Systems*

Working Experience Electronics*

Working Experience ISM Systems*

Additional Qualifications and Endorsements*

Sea Service (most recent vessel first)*
Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area

Rank Vessel Type GRT DWT TEU
From (Date) To Main engine Make/ Type Power (kW) Vessel's Flag
Employer Charterer Trading Area


Additional comments and information:

After completion of this form please press Submit once. Your application will be sent to us.
Please inform us immediately if your availability status or other important data change.
Thank you very much for submitting your application.