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Application Form

This document is an application for employment with AV Marine Ltd. It requests personal information such as name, address, citizenship, education and training details. It asks for information on certificates and endorsements held, marine education history, foreign visas, sea experience over the last 5 years and languages spoken. Additional questions ask about past denials of foreign visas, marine accidents, airports of departure and last salary. Space is provided for additional details such as experience with bananas/fruits, next of kin, physical characteristics and availability to start.

Uploaded by

Oleksii Pudovkin
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136 views2 pages

Application Form

This document is an application for employment with AV Marine Ltd. It requests personal information such as name, address, citizenship, education and training details. It asks for information on certificates and endorsements held, marine education history, foreign visas, sea experience over the last 5 years and languages spoken. Additional questions ask about past denials of foreign visas, marine accidents, airports of departure and last salary. Space is provided for additional details such as experience with bananas/fruits, next of kin, physical characteristics and availability to start.

Uploaded by

Oleksii Pudovkin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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AV MARINE LTD

insert 4, Kerchenskaya str, off 1, Sevastopol, Crimea,


PHOTO 99011 Ukraine
here
Phone +380 692 557824 Fax +380 692 557824
e-mail: [email protected]

APPLICATION FOR EMPLOYMENT Rank:


1. Personal Data
Surname Name Father's Name Permanent address:

Citizenship Date of birth Place of birth Phone:


Mobile/e-mail
Valid
Document No. Date of issue Place of issue
until
Passport (Travelling)
Seaman’s Book
Liberian S. B.
Panamanian S. B.
Ukrainian Civil Passp.
Other
2. Marine Education
Full Name of School From Till

3. Certificates/Courses
Highest Competency certificate held:
Grade/ STCW’95 Certificate Date/Place Valid
Issuing authority
Capacity No. issued until
National Certificate of Comp
STCW 78/95 Endorsement
Liberian
Panamanian
Other
Dangerous cargo certification
Valid
A. Endorsement on national certificate Number Date/ Place issued
until
Oil tanker V/1
Liquefied gas tanker V/1
Liquid Chemical tankerV/1
Valid
B. Courses Training center Number Date/ Place issued
until
Crude Oil Washing
Inert Gas Systems
Hazardous Cargoes B-V/4;5
Tanker Special. (Oil) V/1-2
Tanker Special.(Chem)V/1-2
Tanker Special.(L Gas)V/1-2
Tanker familiar. (Oil) V/1
Tanker familiar. (Chem)V/1
Tanker familiar. (Gas) V/1
Ro-Ro passenger V/2-3

Other Certificates held and courses attended (include Liberian Special Qualification)
Valid
Courses/Certificate Certificate N Date/ Place issued
until
Basic safety training and instruct. VI/I
Proficiency in Survival Craft VI/2
Fire Fighting advanced VI/3
Medical first aid VI/4-1
Medical care VI/4-2
Radar Observer Radar Simulator
ARPA
Restricted R.T Comm.Course
GMDSS GENERAL IV/2
GMDSS RESTRICTED
GMDSS ENDORSEMENT
Bridge Team mgmt
Ship’s Handling Certificate
ECDIS VI/4-1
Engine room management
Electrical & Electronic equipment
Ship security officer (ISPS code)
Ship safety officer IMOA741(18)
ISM code
Yellow Fever Vaccination Certif.
4. Visas
Country Visa Type/Class No. Date Issued Place Issued Valid Until
USA
Shengen
5. Sea Experience: (Last 5 years - Most recent experience on top line)
Vessel Engine Date
Company Vessel Flag DWT HP Rank Date from
Type type to

4. General
(A) Have you ever been denied a foreign visa? If yes, state which country and reason.
(B) Have you been the subject of a court of inquiry or involved in a marine accident?
(C) Nearest airport
(D) Knowledge of language (good, fair, satisfactory, standard marine) Last salary: ___________USD
Spoken Written Understanding
English
Any additional useful info
1. Banana/Fruits Experience
2. Next of kin and relationship
3. High / Weight / Shoes / Boilersuit

Date/ signature Date availability for service

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