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    Boris

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    bodka818
    This document is an application form for a seafaring position that collects personal and professional information. It requests information such as name, date of birth, passport details, license details, sea time experience, medical information, and references. The applicant agrees to allow their personal data to be processed and used for recruitment purposes. The form is 3 pages and collects comprehensive information to evaluate candidates for crew positions.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Boris

    Uploaded by

    bodka818
    25 views3 pages
    This document is an application form for a seafaring position that collects personal and professional information. It requests information such as name, date of birth, passport details, license details, sea time experience, medical information, and references. The applicant agrees to allow their personal data to be processed and used for recruitment purposes. The form is 3 pages and collects comprehensive information to evaluate candidates for crew positions.

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    Frfgh

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    This document is an application form for a seafaring position that collects personal and professional information. It requests information such as name, date of birth, passport details, license details, sea time experience, medical information, and references. The applicant agrees to allow their personal data to be processed and used for recruitment purposes. The form is 3 pages and collects comprehensive information to evaluate candidates for crew positions.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    25 views3 pages

    Boris

    Uploaded by

    bodka818
    This document is an application form for a seafaring position that collects personal and professional information. It requests information such as name, date of birth, passport details, license details, sea time experience, medical information, and references. The applicant agrees to allow their personal data to be processed and used for recruitment purposes. The form is 3 pages and collects comprehensive information to evaluate candidates for crew positions.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    You are on page 1of 3

    Title: Form Manual

    Operational Procedures Form

    MSC CREWING SERVICES


    MSC House, 92-v Lustdorfskaya road, Odessa 65088, Ukraine
    Tel.: +38 (0482) 333 891

    Fax.: +38 (048) 7055 200 / E-mail: info@msccs.com


    APPLICATION FORM
    (Personal Data)

    Position applied for __________________ License hold ___________________ Date Available __________

    Family Name: Naumenko Name: Borys Father's name: Sergey

    Date of birth: 11.10.2003 Place of birth: Kherson Nationality: Ukrainian Marital status:single
    Address: Nearest Airport: Home phone:+380660429213
    E-mail: vtankes2003@gmail.com Mobile phone:+380991170483
    Next of kin and relationship:mother , sister Children (name & DOB):-
    Next of kin’s address: nova zburivka dekabristov 15 Next of kin tel:
    Inter. P’port No : FX 837145 Date of issue: 13.11.2019 Valid: 13.11.2019 Place of issue: 6521
    Seaman's book No : AB 669420 Date of issue: 10.11.2020 Valid: 10.11.2025 Place of issue: PORT Kherson
    Civil P’port No :001824662 Date of issue: Place of issue: 6521
    USA visa No : Date of issue: Valid: Place of issue:
    TOSE : Date of issue: MARLINS, %: Date of issue:

    SEA GOING EXPERIENCE FOR THE LAST 7 YEARS


    (MOST RECENT VESSEL LAST)
    Company
    Name of Type of ME type / From To
    Year of built Owner / Flag DWT / TEU BHP Rank
    vessel vessel Model DD/MM/YYYY DD/MM/YYYY
    Ship Manager

    Version 00/01 Feb 19 Page 1 of 2


    Form CD-P03-1
    Title: Form Manual
    Operational Procedures Form

    Name of Maritime Institution attended Address of institution From To Degree of Diploma

    STCW Certificates Number Issued Valid Place of issue STCW Certificates Number Issued Valid Place of issue
    Certificate of competency BRM or ERRM Course
    Endorsement Basic safety for all
    seafarers
    GMDSS Endorsement Advanced fire fighting
    Radar obs./ARPA operator Prof. in survival craft
    ECDIS course Fast rescue boat
    Security officer (ISPS) Medical first aid
    Security Designated Duties Medical care
    Hazardous cargoes Training pers on pass.ships

    Medical examination Issued: Valid: Weight, kg:80 Height, cm:181


    Drug & alcohol test Issued: Valid: Eyes:green Hair:dark
    Yellow fever Issued: Valid: Overall size:m Safety shoes:44

    Another States Rank Document No Issued Valid Another States Certificates of Rank Document No Issued Valid
    Seamen’s Books competency
    Liberia Liberia
    Panama Panama

    Please complete addresses of your previous employers for references

    Version 00/01 Feb 19 Page 2 of 2


    Form CD-P03-1
    Title: Form Manual
    Operational Procedures Form

    Company Tel Company Tel


    Address Address
    Мій підпис підтверджує мою остаточну та безсуперечну згоду на обробку (збір, накопичення, зберігання, прийняття, систематизацію, використання, розподіл, поновлювання, змінення, знищення, кодування та будь-які інші
    дії, необхідні для надавання посередницьких послуг з найму за кордоном і/або інших супровідних послуг) моїх особистих даних, що вказано в цій заявці з найму, а також будь-яких інших моїх особистих даних, що
    надаються до ТОВ «ЕМ ЕС СІ КРЮЇНГ СЕРВІСЕС»

    Signature____________________ Date ________________ I understand, that my working contract will be canceled without notifying if any of submitted information and documents are voted as false.

    Nationalities of crew sailed with:

    Version 00/01 Feb 19 Page 3 of 2


    Form CD-P03-1

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