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Seafarer Application Form

This document contains a bio data form for Ruben Mabuyo Rosal applying for the position of Master. It includes personal details like name, date of birth, address, education qualifications, professional licenses, passport and visa details, safety and training certificates, and extensive sea experience as captain on various ship types and flags over the past 20+ years. The form is intended to provide full details of the applicant's qualifications and experience for the role of ship Master.

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summer07
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6K views4 pages

Seafarer Application Form

This document contains a bio data form for Ruben Mabuyo Rosal applying for the position of Master. It includes personal details like name, date of birth, address, education qualifications, professional licenses, passport and visa details, safety and training certificates, and extensive sea experience as captain on various ship types and flags over the past 20+ years. The form is intended to provide full details of the applicant's qualifications and experience for the role of ship Master.

Uploaded by

summer07
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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EXPEDO SHIP MANAGEMENT (CANADA) LTD.

BIO DATA FORM (New Applicants)

Date 16-Mar-10

POSITION applied for Master


SCANNED PHOTO
(50x50 mm)

INDOS No.: (National


Seafarers Databse No.)

(Note: Please do not change the formatting in this Form)


A). PERSONAL DATA
Name (First / Middle /
Last) Ruben Mabuyo Rosal Marital Status:
D.O.B 24-Aug-61 Single ✘ Married Separated Widowed
Place of Birth Silang Cavite, Philippines
Nationality Filipino Religious Affiliation:
Height (Cms)
Roman Protestant Islam
Weight (Kgs) 85 kgs ✘
Catholic
Others
Address Barangay Pulong Bunga, Silang Cavite
Philippines

Phone
Mobile
Fax
Email [email protected]
B). NEXT OF KIN / DEPENDENTS - wife, children..or parents
Name Relationship DOB Address

C). EDUCATIONAL QUALIFICATIONS School, College.


Name / Location of Institution From To Examination Passed

D). PRE SEA TRAINING & APPRENTICESHIP …(Marine University/Institution/Company / Period)

E). PROFESSIONAL LICENSES (Highest Certificate Of Competency held)

Date Exam. Date COC


Passed issued Expiry
Country Grade Number (dd/mmm/yy) (dd/mmm/yy) (dd/mmm/yy)
National
Marshall Island
Others
F). SEAFARERS IDENTIFICATION BOOK (CDC)
Issued Expiry
Country No. (dd/mmm/yy) (dd/mmm/yy)
National
Marshall Island
Others

G). PASSPORT DETAILS


Issued Expiry
Number Issue place (dd/mmm/yy) (dd/mmm/yy)

H). VISA DETAILS

Issued Expiry
Country/type Issue place (dd/mmm/yy) (dd/mmm/yy)
USA C1/D
Others
I). STCW95 MANDATORY COURSES / ENDORSEMENTS
Course / No. Remarks (Basic / Advanced /
Endorsement Issued Expiry Level 1 or 2 etc.)
(dd/mmm/yy) (dd/mmm/yy)
Advance Fire
Fighting
Medical Emergency
First Aid
Medical Care
PSC & RB
PSSR
Oil Tanker
Endorsement (DCE)
Chemical Tanker
Endorsement (DCE)
Gas Tanker
Endorsement (DCE)
Oil Tanker safety
Course
Chemical Tanker
Safety Course
Gas Tanker Safety
Course
GMDSS - National
Cert.
GMDSS - STCW
endorsement
Radar Observer
ARPA
RANSCO

Ship Mvrng Simulator


& Bridge Team Work
COC Refresher &
Updating

J). OTHER SPECIALISED COURSES, TRAINING & EXPEIRNCE


Issued Expiry
Course / Training CERT. NO. (dd/mmm/yy) (dd/mmm/yy) Remarks
Bridge Team
Management Refresher Course every 5 years
Marine Resource
Management Refresher Course every 5 years
Liquid Cargo
Handling Simulator
ECDIS
Collision Avoidance
Framo Pumps
ISM Code
Environment
Maangement System
Ship Security Officer

NABCO (M/E Mvrng

& Automation)
Hydraulics &
Pneumatics
PMEW (Marine
Electrical)

K). SEA EXPERIENCE (starting from last vessel, in present rank and previous ranks)
Date On Date Off Sea Service
Ship
Employer Ship Flag Type Ship Name Rank DWT (dd/mmm/yy) (dd/mmm/yy) months/days
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
Please enter all dates in dd/mmm/yy format only.
Please fill in DWT for each vessel served compulsorily - enter approx. DWT if exact figure not known, to enable
automatic calculation of sea service..
L). EXPERIENCE ON TYPE OF M/E's and A/E's: (FOR ENGINEER OFFICERS ONLY):

MAIN ENGINES:

AUX. ENGINES:

M). REMARKS
1. DATE AVAILABLE TO JOIN VESSEL
2. YELLOW FEVER VACCINATION CERTIFICATE: issued expiry
3. Experience with Computerised Planned Maintenance Systems:
4. Membership in professional Organisations:
5. Any other Comments:

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