APPLICATION FOR EMPLOYMENT

Position applied for: Surname: Name:

Date of Birth: Place of Birth: Nationality:

Family Status: Graduated from: Nearest airport:

Kaliningrad

Home tel: Mobile: Next of Kin:

Home addr: NOK tel.:

+7 4012 71 65 78

Alternative Contacts (e-mails, etc.)

Documents Grade Number Issued Valid Place Issued
National Travel Passport
National Seaman's Book
Other Seaman's Book
Other Seaman's Book

National Licence

Endorsement of License
Other Endorsement
LPG
Tankerman
OIL
Course
CHEM
National Tanker Endorsement
Other Tanker Endorsement
COW (Crude Oil Washing) &
Inert Gas System
Basic Safety Course
Prof in Survival Craft
Advanced Fire Fighting
Medical First aid
Medical Care
Safety Officer Training
GMDSS General / Restricted
/

Radar Observation Course

Automatic Radar Plotting Aids
Bridge Team Management
Bridge Resource Management
Manoeuvring & Ship Handling
ECDIS / Electronic charts
AIS
www.smcrewing.com

Ship Security Officer

Ship Security Staff
Hazardous Cargoes (HazMat)
Medical Examination
Other Medical Examination
Yellow Fever Vaccination
USA Visa C1 / D
Shengen Visa
Other Visa (Country - )

Vsl's type Name of vessel DWT Eng HP Flag Name of Co. Rank Period of Serv

Additional Information : Working Shoes size - ________ ; Boiler Suit size - ________ ;

Height - ________ m. ; Weight - ________ kg. ; Color of Hair - ________ ; Color of Eyes - ________ ;
Additional Special skills (welding, etc.) : __________________________________ . Last Employment : Salary - _____________ USD / EUR;
Duration - ______ months ; Vessel's Condition - _________________ . Crew (nationality) - ___________________________________________________
OFFICE USE ONLY : Date of Registration - Ready to Board - English Level - ; Appearance -

STAFF Management Ltd.

sm@smcrewing.com