Quality Confidence Professionalism
Document
Application form
Date:
07/02/2012
Date of availability*
Position applied for*
Desired salary (min)*
USD/EUR
Desired contract duration (MAX)
month
week
English knowledge
Very good
Good
Satisfactory
Fair
Name*
Surname*
Height
cm
Weight
kg
Shoes
Overalls
Hair color
Eyes color
Date of birth*
Citizenship
Place of birth (city, country)*
Education institution
Education institution (city, country)
From (day/month/year)
To (day/month/year)
Permanent address*
Phone, mobile phone*
E-mail
Marital status
Single
Married
Divorced
Widower
Next of kin name, surname, tel.
Relationship of next of kin
Wife
Mother
Father
Brother
Sister
Child`s name
Child`s surname
Child`s birth date
(Children under 18 years old)
(day/month/year)
Passport data*
Seaman`s book data*
Passport number*
Seaman`s book number*
Date of issue* (day/month/year)
Place of issue (city, country)*
Date of expiry* (day/month/year)
Personal number
US visa expiry (day/month/year)
Documents, Licences, Certificates
Document No
Date of issue(day/month/year)
Place of issue (city, country)
Date of expiry(day/month/year)
Sea service at least for last 5 years*
Ship’s Name
Flag
Company
GRT
KW / HP
Engine Type
Ship Type
Rank
From(day/month/year)
To(day/month/year)
