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K.R. Marine Services Private Limited

This document contains an application form for employment at K.R. Marine Services Private Limited. The form requests personal details such as name, rank, date and place of birth, addresses, family information, passport and certification details, vaccination records, sea service history, and a declaration that no service charges were paid. It also includes a checklist for recruitment that must be completed, verifying documents and qualifications before a seafarer can join a ship.

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himansu panigrahy
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113 views3 pages

K.R. Marine Services Private Limited

This document contains an application form for employment at K.R. Marine Services Private Limited. The form requests personal details such as name, rank, date and place of birth, addresses, family information, passport and certification details, vaccination records, sea service history, and a declaration that no service charges were paid. It also includes a checklist for recruitment that must be completed, verifying documents and qualifications before a seafarer can join a ship.

Uploaded by

himansu panigrahy
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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K.R.

Marine Services Private Limited


An ISO 9001: 2008 CERTIFIED COMPANY
305, Arihant Building, Ahmedabad Street,
Masjid Bunder(East), Mumbai - 400 009. INDIA
Telephone : +91 - 22 - 2348 5936 / 2348 1970
Fax : +91 - 22 - 2348 1970
Email: [email protected]

Ref No: _________________ APPLICATION FORM


Name: Rank:
Date & Place of Birth: Nationality:
Permanent Address: Mailing Address:

Next Of Kin /
Nominee:_______________________________Relationship:__________________
Address:_________________________________________________________________
________
_________________________________________________________________________
________
Tel No:
Family Data Name Age
FATHER
MOTHER
CHILD M/F
CHILD M/F
CHILD M/F
CHILD M/F
INDOS NO: PAN CARD NO.
Passport No. : Issued at : Expiry Date :

CDC No: Issued at : Expiry Date :

Vaccination Book: Yellow fever date: Expires on:

Watch-Keeping Certificate ( Deck & Engine Ratings ) :


Rank: Cert No: Date of Issue: Place of Issue:

DETAILS OF CERTIFICATE OF COMPETENCY


Certificate of Rank Cert. No. Date & Place Expiry Date
Competency of Issue
National:

1
Other:

RECORD OF STCW CERTIFICATES HELD


NAME OF CERT CERT. NO. PLACE OF ISSUE
ISSUE DATE
PST / PSRB
EFA / MFA / MEDICARE
PSSR
FP & FF / AFF
ROC
ARPA
RADAR SIMULATOR
GMDSS INDOS
RTG, RTIM / GOC
SSO
ISPS
REVALIDATION / UPGRD
SHIP MANOUVRING SIM.
OTHER
SEA SERVICE RECORD (START FROM LAST SHIP)
SHIP NAME TYPE GRT / BHP RANK FROM TO

I hereby declare that all the information specified above in this


application form is true and correct to the best of my knowledge & Confirm
that I have not paid any service charges either in cash or in kind for the
purpose of recruitment.

Date: _______________

Place: _______________

_________________________________
Signature of the Seafarer

CHECKLIST FOR RECRUITMENT OF CREW


NAME RANK NEW / OLD HAND

2
SHIP JOINING RELIEVING

S. DOCUMENT TO BE CHECKED DETAILS YES NO


NO.

01 FILE COMPLETE IN ALL RESPECT

02 ALL CERTIFICATES CHECKED

03 PASSPORT NO.

04 CDC NO

05 CERTIFICATE OF COMPETENCY

06 STCW OFFICER

07 STCW ENGINEER

08 STCW CREW

09 WATCH KEEPING CERTIFICATE


DECK
10 WATCH KEEPING CERTIFICATE
ENGINE
11 ANY OTHER QUALIFICATIONS

12 WELDING TEST CERTIFICATE

13 MEDICAL CERTIFICATE
(VALIDITY 1 YEAR)
14 VACCINATION CERTIFICATE

15 RIGHTS & DUTIES OF CREW


EXPLAINED
16 GRIVANCE REDRESSAL EXPLAINED

17 SAFETY SHOE GIVEN

18 BOILER SUIT GIVEN

19 DECLARATION CARRYING ALL


ORIGINALS ON BOARD
20 RANDOM CHECK CARRY OUT FOR
AUTHENTICITY (ATTACH
CERTIFICATE FROM ISSUING
AUTHORITY )
CHECKED THE APPRAISAL REPORTS I HAVE INTERVIEWED AND CHECKED THE
APPROVED / REJECTED ORIGINALS

SIGNATURE OF MANAGER OPERATIONS / SIGNATURE OF MANNING DEPT.


FLEET PERSONAL MANAGER

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