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VacanciesOnline Application

Online Application

 

Document

Application form

Date:

20/10/2017

 

Date of availability*

Position applied for*

Desired salary (min)*

 USD/EUR

Desired contract duration (MAX)

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)

Date of issue* (day/month/year)

Place of issue (city, country)*

Place of issue (city, country)*

Date of expiry* (day/month/year)

Date of expiry* (day/month/year)

Personal number

US visa expiry (day/month/year)

 

Documents, Licences, Certificates

Document

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)

 
 

* - Necessary to enter

 

 

Rupeksa - Company code 141524783 VAT Code: 1415247811 Malunininku str. 3  LT - 92264 Klaipeda
Established March 1997 - Marine Recruitment Experts crewing@rupeksa.com | www.rupeksa.com

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