OFC06 - Employment Application Form
OFC06 - Employment Application Form
VESSEL:
DATE AVAILABLE: 5/1/2021
Office use only
PERMANENT
Işıkkent Mah. 5616 Sok. No :13 Isparta / Merkez / Turkey
ADDRESS:
CHILDREN
PRE-SEA TRAINING / MARITIME SCHOOL / HIGHEST ACADEMIC QUALIFICATION (Specify School Name / Country, and Year attended)
DOCUMENT STATUS
NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - OIL N/A N/A N/A N/A N/A N/A N/A
NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - CHEM N/A N/A N/A N/A N/A N/A N/A
NATIONAL DANGEROUS CARGO ENDORSEMENT (DCE) - GAS N/A N/A N/A N/A N/A N/A N/A
REVALIDATION OF NATIONAL LICENSE (REV) N/A N/A N/A N/A N/A N/A N/A
S T C W COURSES Mark / Delete GRADE REGULATION NUMBER ISSUE EXPIRY PLACE Authenticated
SURVIVAL AT SEA / PERSONAL SURV. TECH. (SAS / PSST) N/A STCW 11599240 4/12/2021 4/12/2026 TURKEY N/A
FIRE PREV. AND FIGHTING N/A STCW 11599244 4/12/2021 4/12/2026 TURKEY N/A
ELEMENTARY FIRST AID / MEDICAL FIRST AID / MEDICAL CARE N/A STCW 11599243 4/12/2021 4/12/2026 TURKEY N/A
PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES (PSSR) N/A STCW 11599241 4/12/2021 4/12/2026 TURKEY N/A
TANKER FAMILIARIZATION COURSE - OIL N/A STCW 11599242 4/12/2021 4/12/2026 TURKEY N/A
TANKER FAMILIARIZATION COURSE - CHEM N/A STCW 11599242 4/12/2021 4/12/2026 TURKEY N/A
TANKER FAMILIARIZATION COURSE - LPG N/A STCW 10898546 12/21/2017 6/19/2022 TURKEY N/A
ADVANCED TANKER COURSE - OIL N/A N/A 11370103 1/23/2020 1/16/2025 TURKEY N/A
ADVANCED TANKER COURSE - CHEM N/A N/A N/A N/A N/A TURKEY N/A
ADVANCED TANKER COURSE - LPG N/A N/A N/A N/A N/A TURKEY N/A
PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOAT (PSCRB) N/A STCW 11599239 4/12/2021 4/12/2026 TURKEY N/A
ADVANCED FIRE FIGHTING N/A STCW 11370102 1/23/2020 1/23/2025 TURKEY N/A
MEDICAL FIRST AID AND MEDICAL CARE N/A STCW 11370099 1/23/2020 NO EXPIRY TURKEY N/A
BRIDGE TEAM AND RESOURCE MANAGEMENT (BTRM) N/A N/A ITU 3/11/2020 NO EXPIRY TURKEY N/A
ENGINE TEAM RESOURCE MANAGEMENT (ETRM) / ERM N/A N/A N/A N/A N/A TURKEY N/A
RISK MANAGEMENT AND INCIDENT INVESTIGATION COURSE (RMI) N/A N/A N/A N/A N/A TURKEY N/A
SHIP SECURITY OFFICER (SSO) N/A N/A 11392916 2/28/2020 2/6/2025 TURKEY N/A
SDSD-Designated Security Duties = YES N/A N/A 10609327 7/26/2016 NO EXPIRY TURKEY N/A
HIGH VOLTAGE TRAINING COURSE (C/E, 1/AE, 2/AE, 3/AE, E/E) N/A N/A N/A N/A N/A TURKEY N/A
ENVIRONMENTAL OFFICER TRAINING COURSE N/A N/A N/A N/A N/A TURKEY N/A
RADAR OBSERVER (ROC) N/A N/A ITU 12/27/2019 NO EXPIRY TURKEY N/A
ARPA / RADAR SIMULATOR N/A N/A ITU 12/27/2019 NO EXPIRY TURKEY N/A
LIQUID CARGO HANDLING SIMULATOR (LCH) N/A N/A N/A N/A N/A N/A N/A
ENGINE SIMULATOR COURSE N/A N/A N/A N/A N/A N/A N/A
ELECTRONIC MAIN ENGINE COURSE N/A N/A N/A N/A N/A N/A N/A
ME-GI ELECTRONIC ENGINE EXPERIENCE N/A N/A N/A N/A N/A N/A N/A
HIMSEN GENERATOR COURSE N/A N/A N/A N/A N/A N/A N/A
REEFER CONTAINER & MAINTENANCE COURSE N/A N/A N/A N/A N/A N/A N/A
LNG BUNKERING COURSE N/A N/A N/A N/A N/A N/A N/A
Note: For Deck Officer, the COC should be valid for Navigational Watch on ships 500 gross tonnage or more.
PAGE 2 OF 7 OFC06-02/21
Eastern Pacific Shipping Pte. Ltd.
PERIOD OF SERVICE
Vessel Details
(For Engine Staff : Vessel Type / Engine
YEAR details : Example : Container Carrier / DWT NAME OF OWNERS / MANAGERS
NAME OF VESSEL
BUILT
FLAG
B&W - 12K98MC-C) H.P.*
RANK
AND THEIR CONTACT DETAILS Period in Months
FROM TO
(For Deck Officers : Vessel Type / ECDIS. (DD/MM/YYYY) (DD/MM/YYYY)
Example: Container, JRC 201C)
Can Yücel 1995 Turkish Bulk 38852 D/Cadet 1/18/2016 2/19/2016 Statu Shipping 1.1
Southport 2008 Mars.Islands Oil Tanker 115.396 D/Cadet 2/23/2018 9/28/2018 Thome Ship Management PTE LTD. 7.2
Pacific Sky 2008 Mars.Islands Oil Tanker 115.396 3rd Officer 7/14/2020 3/14/2021 Thome Ship Management PTE LTD. 8.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1. APPLICANTS TO ENSURE THAT COMPLETE SEA SERVICE FROM THE BEGINNING OF SEA CARRIER IS GIVEN. IF THIS PAGE IS INSUFFICIENT, PLEASE MAKE A PHOTOCOPY OF THIS PAGE AND WRITE THE SEA SERVICE.
2. ENGINE DEPARTMENT APPLICANTS ESPECIALLY ENGINEERS TO ENSURE THAT HORSE POWER & DEAD WEIGHT IS WRITTEN UNDER COLUMN (TYPE OF VESSEL/MAN ENGINE DETAILS).
3. MANNING OFFICE TO VERIFY AND ENSURE THE ABOVE SEA-SERVICE IS TALLYING AGAINST CANDIDATE'S NATIONAL SEAMAN BOOK.
4. CANDIDATES APPLYING FOR LPG FLEET PLEASE SPECIFY WHICH SHIPS WERE FULLY PRESURIZED, SEMI-REFRIGERATED AND FULLY REFRIGERATED UNDER COLUMN (TYPE OF VESSEL/MAN ENGINE DETAILS).
5. PLEASE DO NOT CHANGE THE PAGE LAYOUT AND MARGINS.
Example : BSN, A/B x 3, O/S x 2, PMN 7
Manning Info of last vessel : Please specify ranks and number onboard Count
Deck Officers : MST, C/O, 2/O, 3/O
Deck Ratings : BSN, A/B, O/S, PMN
Engineers : C/E, 1A/E, 2A/E, 3A/E,E/E,G/E) Was last vessel running in UMS ?
Engine Ratings : OLR, WPR, FTR) _______
Catering : (Cook, STW, MSB/CBY)
Cadets : (DCT, ECD. ELC)
Total 0
PAGE 3 OF 7 OFC06-02/21
Eastern Pacific Shipping Pte Ltd.
MASTER C/E
C/O 1/AE
2/O 2/AE
G/E E/E
TOTAL
PURIFIERS TRANSAS
REASON FOR LEAVING LAST COMPANY: YES / NO IS APPLICANT 18 YEARS OR ABOVE? YES
AGREEABLE TO ACCEPT ONE RANK LOWER : YES / NO YES AGREEABLE TO JOIN VSL PLYING IN WAR ZONE HIGH RISK AREA: YES
MEDICAL HISTORY:
ALL PREVIOUS ILLNESSES OTHER THAN MINOR ILLNESSES SHOULD BE STATED BELOW OR UPDATED. IF NOT PREVIOUSLY DISCLOSED, THE COMPANY IS ENTITLED
TO REFUSE ANY REIMBURSEMENT OF MEIDCAL COSTS, CLAIM FOR TREATMENT OR FOR ANY OTHER INSURED BENEFITS.
C. HAVE YOU EVER SIGNED OFF A SHIP DUE TO MEDICAL REASONS?NO
IF YES, PLEASE PROVIDE FOLLOWING DETAILS (IF SPACE IS INSUFFICIENT, ATTACH ADDITIONAL SHEETS) :
NAME OF VESSEL DATE OF OCCURRENCE PLACE OF OCCURRENCE
N/A N/A N/A
BRIEF DESCRIPTION OF ILLNESS / INJURY / ACCIDENT N/A
D. HAVE YOU UNDERGONE ANY OPERATION IN THE PANO IF YES, PLEASE PROVIDE FOLLOWING DETAILS :
DETAILS OF OPERATION DATE PERIOD OF DISABILITY PRESENT CONDITION
N/A N/A N/A N/A
E. FOR WHAT ILLNESSES OR ACCIDENTS HAVE YOU CONSULTED A DOCTOR DURING THE LAST 12 MONTHS?
DETAILS OF ILLNESS / ACCIDENT DATE THERAPY / TREATMENT
N/A N/A N/A
I hereby confirm that all my certificates [Certificate of Competency, STCW certificates and other qualifications] are genuine and authentic. I confirm that I am NOT holding any fake
certificates.
I declare that all information provided herein is to the best of my knowledge is true and correct. I am fully aware that witholding or providing wrong information will lead to termination of
employment and commencement of criminal proceedings.
I have read and understood the Recruitment Privacy Notice.
4/16/2021
Signature Date of application
I have confirmed the applicant is holding the certificates require as per QSP0912/0913 applicable for his position.
PAGE 4 OF 7 OFC06-02/21
Eastern Pacific Shipping Pte Ltd.
EVALUATIONS
(For All Ranks)
Date :
Manning office :
Applicant’s name :
Rank :
Biodata Number :
PAGE 5 OF 7 OFC06-02/21
Eastern Pacific Shipping Pte Ltd.
Pipe fabrication including T-joints and Flange joints TIG Welding proficiency
Ability to carry inter-tank repairs & stainless steel repairs Ability to Repair & overhaul Machineries
Operational knowledge of engine overhaul & pump overhaul Other Skills - please mention in details
Carpentery Skills
PAGE 7 OF 7 OFC06-02/21