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    C-121 CV From

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    aungkyawsintdp
    This document is a seafarer's employment application form that collects personal and professional details. It requests information such as name, date of birth, address, passport and certification details, past ship experience including vessel names and dates of employment, and a declaration answering health, conduct and reference questions. If selected, the form will be used to verify details and assess suitability for a position through an interview and reference check process.

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    © All Rights Reserved
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    C-121 CV From

    Uploaded by

    aungkyawsintdp
    17 views2 pages
    This document is a seafarer's employment application form that collects personal and professional details. It requests information such as name, date of birth, address, passport and certification details, past ship experience including vessel names and dates of employment, and a declaration answering health, conduct and reference questions. If selected, the form will be used to verify details and assess suitability for a position through an interview and reference check process.

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    C-121 CV FROM

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    This document is a seafarer's employment application form that collects personal and professional details. It requests information such as name, date of birth, address, passport and certification details, past ship experience including vessel names and dates of employment, and a declaration answering health, conduct and reference questions. If selected, the form will be used to verify details and assess suitability for a position through an interview and reference check process.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    17 views2 pages

    C-121 CV From

    Uploaded by

    aungkyawsintdp
    This document is a seafarer's employment application form that collects personal and professional details. It requests information such as name, date of birth, address, passport and certification details, past ship experience including vessel names and dates of employment, and a declaration answering health, conduct and reference questions. If selected, the form will be used to verify details and assess suitability for a position through an interview and reference check process.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Seafarer's Employment Application Form cum Checklist

    Rank Applied For Recommended By Relationship to seafarer Date of Application (PHOTO)

    NAME Education/Year Nationality Height Weight Body


    Mass
    Index

    Date of Birth / Age Place of Birth Blood Group Overall Size Safety Shoe Size Sex Religion No. of Marital Status
    * Dependents

    Father Name Mother Name NRC NO. Wife Name

    Number of child Name / DOB

    Seafarer's Permanent Address Next of Kin, Relationship and Address Alternative Next of Kin, Relationship and Address

    tick

    Tel. No.(HOME)
    Mobile

    Document Number Issued by Date of Issue Date of Expiry


    International Passport
    Seafarer's Passport
    VISA - USA (Please circle : Type B / C1 / D)
    Seaman's Discharge Book
    Medical Fitness Certificate ( as per STCW / FLAG STATE )
    STCW95 & Flag State Doucments STCW Regulation No. Number Issued by Date of Issue Date of Expiry
    Officers' Certificate of Competency - COC
    Electro Technical Officer ( S TCW 2010 ) A-III/6
    Singapore Certificate or Endorsement - COE
    Panama Licence / Seaman's Discharge Book
    Malaysia Certificate of Recognition
    Malaysia Seaman's Identification
    STCW Endorsement for Officers
    STCW Watchkeeping Certificate for Ratings
    STCW Special Training (V/1. V/2)
    STCW Familiarisation Training
    STCW Personal Survival Techniques -PST A-VI/1-1
    STCW Fire Prevention and Fire Fighting - FPF A-VI/1-2
    STCW Elementary First Aid - EFA A-VI/1-3
    STCW Personal Safety & Social Resp.-PSSR A-VI/1-4
    STCW Prof in Survival Craft / lifeboat - PSCRB A-VI/2
    STCW Prof in Fast Rescue Boats - FRB
    STCW Advanced Fire Fighting - AFF A-VI/3
    STCW Medical First Aid - MFA A-VI/4-2
    STCW Medical care on board ( Ship Captain ) A-VI/4-1
    GMDSS General Operator's Certificate A-IV/2
    GMDSS Restricted Operator's Certificate IV/2

    Designated Security Duties ( STCW 2010 ) A-VI/6-2

    Security Awareness ( STCW 2010 ) A-VI/6-1

    ECDIS ( STCW 2010 )


    Able Seafarer Certificate ( STCW 2010 )
    Ship Security Officer - SSO A-VI/5
    Cook's Training Certificate ( MLC, 2006 )
    Other Supplementary
    Certificates & / Or Qualifications

    Name of Maritime Academy graduated from


    NAME : RANK : *AGE : Apex Ship Management Pte Ltd - Seafarer's Employment Application Form

    No Type Vessel Name DWT / GRT / Engine Type / KW Rank From To Mos. Manning Agency Principal Sign Off Reason
    (1) Plese fill up the lastest service on top. (2) For Deck officers & ratings, indicate DWT/GRT. For Engine officers & ratings, indicate Engine Type/KW.
    INSTRUCTIONS:
    (3) Please include all your services or the last 10 ships for those who has long experiences. You may use additional pages to show your earlier experiences.

    10

    APPLICANT'S DECLARATION
    Please answer the following questions Yes / No If yes, please provide details.
    * The minimumage for any seafarer ( including ship’s cook ) to be employed, engaged or work
    Are you below 18 years old ?
    on board Apex managed vessels shall be 18 years old and above.
    Have you previous injuries or sickness ? I certify that the information given by me herein are true and correct to the best of my
    Premature termination of contract ? knowledge. Any false information may be subjected to legal actions ( including dismissal ).
    Have been dismissed or logged for mischief ?
    Have bee involved in industrial dispute ?
    Any criminal offence ?
    Have been refused entry by any country ?
    Any special diet or religious restrictions ?
    Any medical restrictions / drugs / allergies ?
    Any alcohol drinking habits ? Signature of seafarer
    Any past history medical / mental condition?
    Can we make reference check with ex employers ?
    FOR OFFICIAL USE ONLY

    Interview assesment Reference check done by / Date Please provide details Manning Agency's Interview report to describe seafarer's technical competence & experience

    English Poor Ave. Good Previous employment /agent PIC ?


    Speak/ Read Verify service record
    Write Verify reason for leaving
    Physical Verify overall appraisal
    Personality Verify relationship / habits
    Intelligence
    Attitude
    Co-Operations Interviewer's Name / Date VERIFIED BY : Name : ____________________ Position :_____________ Signature:_______________
    Motivation Suitability * Manning Agency to check AGE against valid ORIGINAL Passport and confirm the seafarer is NOT below 18 years old.

    Learning ability Type of ships * Manning Agency to tick against the no. column to verify sea service against original sea service record book

    Safety Type of Trade / Principal Proposed / Assiged to principal / Ship / Date


    Last Drawn Wages
    VERIFIED BY : APEX Crewing Dept : Name ___________________ Signature __________________
    * APEX Crewing Dept to check the AGE against COPY of the valid Passport and confirm seafarer is NOT below 18 years old.

    Revision No. : 0 Revised Date : Decmber 2019 Page 2 of 2

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