APPLICATION FOR EMPLOYMENT

3RD Flr. Delgado Bldg. 637 Bonifacio Drive, Port Area, Manila, Philippines
Tel. Nos. 6686151 / 6681256 / 404-1252
E-Mail: manning@sssi.com.ph / operation_group@sssi.com.ph PICTURE
Date__________________________ Contact No._____________________
Position Applied________________________________ License_____________________

PERSONAL INFORMATION
Name ___________________________________________________________________________________
Last Name First Name Middle Name
Address ________________________________________________________________________________________________
__________________________________________________________________________________________________________
Date of Birth_______________Age _____________ Place of Birth______________Email Address: _______________________
Height ________ Weight________ Blood Type________ Civil Status__________________________
-__
Name of Spouse (Parents if not married) ________________Contact No.______________________ No. of Children_______
SSS No. __________________ Tin _________________ Marina ID No. _________________ SRN (POEA) _________________
Highest Education Attainment(Course) __________________________________________________________________________
School _______________________________________________________________ Year Graduated_____________
Size of Safety Shoes _______(inches) Size of Working Clothes_______ Smoking? _________
LICENSEs / CERTIFICATEs / TRAININGs / OTHERs :________________________________
Seaman’s Book No. _____________________ Date Issued _____________________ Validity _____________________
Passport No. _____________________ Date Issued _____________________ Validity _____________________
US Visa _____________________ Date Issued _____________________ Validity _____________________
MCV No. _____________________ Date Issued _____________________ Validity _____________________
Phil. License _____________________ Date Issued _____________________ Validity _____________________
Panama License _____________________ Date Issued _____________________ Validity _____________________
Panama GMDSS _____________________ Date Issued _____________________ Validity _____________________
C.O.C./License No. _____________________ Date Issued _____________________ Validity _____________________
C.O.E. No. _____________________ Date Issued _____________________ Validity _____________________
GOC License No. _____________________ Date Issued _____________________ Validity _____________________
AIS Certificate No. _____________________ Date Issued _____________________ Validity _____________________
SSO/SSA/ Cert. No. _____________________ Date Issued _____________________ Validity _____________________
SSBT with BRM _____________________ Date Issued _____________________ Validity _____________________
BT _____________________ Date Issued _____________________ Validity _____________________
PSCRB _____________________ Date Issued _____________________ Validity _____________________
AFF _____________________ Date Issued _____________________ Validity _____________________
Yellow Fever _____________________ Date Issued _____________________ Validity _____________________
MEFA _____________________ Date Issued _____________________ Validity _____________________
MECA _____________________ Date Issued _____________________ Validity _____________________
ECDIS Generic _____________________ Date Issued _____________________ Validity _____________________
ECDIS Specific _____________________ Date Issued _____________________ Validity PERMANENT
SRRO Cert. No. _____________________ Date Issued _____________________ Validity PERMANENT
GMDSS Cert. No. _____________________ Date Issued _____________________ Validity PERMANENT
ARPA Cert. No. _____________________ Date Issued _____________________ Validity PERMANENT
SATCOM _____________________ Date Issued _____________________ Validity PERMANENT
MARPOL _____________________ Date Issued _____________________ Validity PERMANENT
CHCC _____________________ Date Issued _____________________ Validity PERMANENT
MLSO _____________________ Date Issued _____________________ Validity PERMANENT
Welding Course _____________________ Date Issued _____________________ Validity PERMANENT
BT COP _____________________ Date Issued _____________________ Validity PERMANENT
PSCRB COP _____________________ Date Issued _____________________ Validity PERMANENT
AFF COP _____________________ Date Issued _____________________ Validity PERMANENT
MEFA COP _____________________ Date Issued _____________________ Validity PERMANENT
MECA COP _____________________ Date Issued _____________________ Validity PERMANENT

Referred by:___________________________________ Relationship:_________________________

 Embarked Disembarked
Vessel Manning Trading Length of Reason of
Position Type Engine Flag Principal GRT KW
Name Agency Area service Discharge
(mm/dd/yyyy) (mm/dd/yyyy)

SEA SERVICE RECORDS / SERVICES (LATEST)

Character References
Name Position Company/Address Contact Number

Beneficiary / Allotee Beneficiary in case of Accident/Death

Name: ____________________________________ Name: ____________________________________
Relationship: ____________________________________ Relationship: ____________________________________
Address: ____________________________________ Address: ____________________________________
Contact No.: ____________________________________
Name of Father (If Living) ____________________________________ Notify in case of Accident/Death
Name of Mother (If Living) ____________________________________ Name: ____________________________________
Relationship: ____________________________________
I, hereby, certify that all data/information contained in this application are complete and correct.
Address: ____________________________________
Misinformation or omission which tend to mislead will be considered a cause for my dismissal at the same
time discovered and unqualifiedly waive my rights I have to contest dismissal on such basis. All expenses
Contact No.: ____________________________________
that will incurred for my repat/reliever will be for my account including airfare.

I, ___________________________________ am willing and voluntarily allowing any and all SSSI Interviewed by: ________________________________
personnel, staff and officers and its counterparts to view, review, process and share the information to all Date:
concern counterparts as a matter of procedure in the Recruitment process and shall relieve from any
_________________________________ Remarks:
administrative, civil and criminal liabilities including the provision of Data Privacy Act.

_______________________
Signature