0% found this document useful (0 votes)
129 views7 pages

CMA-CGM Crew-001A Application Form

The document is a crew application form for Harish Irudayaraj, applying for the position of wiper on a container vessel. It includes personal details, education background, medical history, employment history, and various certifications. The application confirms the accuracy of the provided information and includes a declaration for reference checks by the employer.

Uploaded by

hc digital
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
129 views7 pages

CMA-CGM Crew-001A Application Form

The document is a crew application form for Harish Irudayaraj, applying for the position of wiper on a container vessel. It includes personal details, education background, medical history, employment history, and various certifications. The application confirms the accuracy of the provided information and includes a declaration for reference checks by the employer.

Uploaded by

hc digital
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
You are on page 1/ 7

CREW MANUAL GENERAL FORM

Card No Crew-001A Version 1 2022-09-06


Subsidiaries Application form

APPLICATION FORM ATTACH


RECENT
PHOTO

Njordships Management India Pvt Ltd,Unit 101,Akshaya Shanta Door No: 27/44

Position applied for: wiper


Type of vessel: container
Availabibity date: 22.04.2025

Are you responding to a media advertisement? YES/NO NO


If YES, please state which one

Are you applying upon personal or professional recommendation? YES/NO No


If YES, please state who

Surname: Irudayaraj First name: Harish

Other names Known as Nationality: Indian

Place of birth: Tiruchendur Date of Birth: 21.021990 Age:21 Male

Passport

Date of
Number Place of issue issue Date of expiry Issuing Authority

N8839126 Madurai ### 27/03/2026 Republic Of India

Visas
Type Number Place of issue Date of issue Date of expiry
C1/D (USA) 2024120477000 Chennai 03/05/2024 28/04/2029
1
C1 (USA)
D (USA)
Australia Entry visa
MCV (Australia)
Schengen

Education Background
School / College From To Highest qualification attained
college 2005 2008 DME

Personal details 2/69,St.James


Street,Mapad(po
Full address: ), Tiruchendur Manapad(po), Tiruchendur (T.k) Tuticorin (Dist) Tamilnadu
(T.k), Tuticorin
(Dist),
Postal code: Tamilnadu. 628209 Country: India

E-mail: imman.harish.90@gmail.com
Home tel number: 9894349264

Mobile phone: 8433867181

1/7
Domestic Airport Tuticorin International Airport Chennai

Marital status: Married

Full name of Next of Kin: Jency Relationship wife


Address of Next of Kin if
different from above
Phone if
different from above

Dependents
Name Date of birth Age Gender Relationship

Person to contact in case of emergency


Name: Jency Relationship Wife
2/69,St.James
Address: street,Manapad( Manapad(po), Tiruchendur (T.k) Tuticorin (dist), Tamilnadu.
po),
Phone number: Mobile number:

National Seaman's Book


Date of
Number Place of issue issue Date of expiry Issuing Authority

MUM232667 Mumbai ### 01/03/2034 DG Shipping

National Certificate of Competency (COC)- Licences


Grade Issuing Authority Number Date of Date of expiry Place of Issue Date revalidated Date expiry
issue

National GMDSS & Endorsement


Issuing Authority Number Date of Date of expiry Place of Issue
issue

Medical Fitness Certificate


Type Date of issue Date of Expiry

Yellow Fever Vaccination


Date of Issue Date of Expiry
A63566 01/04/2016 01/04/2026

Foreign languages other than English


Level: Beginn
Language
er Intermediate Advanced
English

Medical History
Have you ever signed off from
a ship due to medical reasons? No If yes give details
Name of vessel Date of Occurrence

Brief description of Illness or Injury

Other personal details


Height:173 Weight: 83 Colour of Hair:Black

Colour of eyes: Brown Safety shoes size: 10 Boiler suit size:xl

2/7
Uniform Shirt size:L Uniform Trousers size: 34

Details of other Marine courses

Type of Marine Course IMO model Reference- Regulation Number Date of issue Date of expiry
course
1.19 - 1.20 1.13 - STCW Reg.
Basic Training 1.21 A-VI/1-1 to A-VI/1-4

Personal Survival STCW Reg. A-VI/1-1 203010611221201


1.19 29/07/2022 12/08/2026
Techniques 13
STCW Reg A-VI/1-2
BASIC TRAINING
Basic Fire Fighting 1.20 203010612221197 29/07/2022 12/08/2026
10
STCW Reg A-VI/1-3
Elementary First Aid 1.13 BPMA/E/427/2017 29/01/2017 Life

Personal Safety & Social


STCW Reg A-VI/1-4
BPMA/PSSR/
Responsibilities (Human 1.21 363/2017 25/01/2017 Life
Relationship)

STCW Reg A-VI/2 par 1.3


Proficiency in survival craft & Rescue Boats 1.23
STCW Reg A-VI/3
Advanced Fire Fighting 2.03
STCW Reg A-VI/4-1
Medical First Aid 1.14
STCW Reg A-VI/4-2 par 2
Medical Care 1.15
STCW Reg II/2
ROP 1.08
STCW Reg II/1
ARPA / NCC 1.07

Radar Simulator
STCW Reg II/1 par.2.5
ECDIS 1.27
US 49 CFR 172.700-
HAZ MAT 172.204
STCW
Ship simulator bridge teamwork 1.22 Reg II/1

BTM / ETM
STCW Reg VI/5 / ISPS
Ship Security Officer (SSO) Code

BASSnet
STCW Reg II/1 & II/2
Ship handling & manoeuvring
STCW Reg VIII/2
Bridge resource management US33CFR 157.415

Loading software (name it)

Large Vessel Handling Simulator / Engine CMA CGM


Room Simulator

Indos Number

Upgradation Course

Revalidation Course for renewal of CoC

High Voltage Training

Reefer Training

Engine Maker’s Training

Crane Manufactures training


ISPS
Vessel security training course code
IMO Assembly Res
Ship Safety Officer A741(18)
UK MCA
ISF Marlins English test

Flag State Documents


3/7
Document Grade Number Place of Issue Date of Issue Date Expiry

Malta:

4/7
Employment history (at least the last 5 years)

Vessel * Company Manning Agent Trading area Vessel Flag DWT / Year Main Engine Position Sign on Sign off Total Reason
type TEU built date date mm/dd for
** leaving
Make Type KW
***
man & BW
Green Park Xt ship Management china to USA containemonrovia 34000 2024 Dalian marin 14880 WIPER 18/06/202431/12/2024 contract Finish
Kawasaki Heavy Industries
man & BW
Cape med Xt ship Management china to USA bulk carrmonrovia 185827 2006 16860 WIPER 23/06/202328/01/2024 contract Finish
Hyundai Heavy Industries
man & BW
MV UTE Xt ship Management china to USA containemonrovia 65965 2007 45760 WIPER 8/9/2022 11/4/2023 contract Finish

cap capricorn Xt ship Management china to USA containemonrovia 51931 2013 doosan Enginman & BW 22890 wiper 25-09-2021 3/7/2022 contract Finish
WOLRD TANKER SHIP
MV AGROS MANAGEMENT SINGAPORE CRUDEBAHAMAS 34995 1996 Dalian marin man & BW 10685 WIPER 30/01/202128/03/2021 contract Finish
TEAM SHIPPING
LIMA-1 MANAGENT DUBAI SUPPLYST KITTIS & 1768 1996 WARSILA DIWARTSILA 3980 WIPER 4/4/2016 24/11/2016 contract Finish

* or industry sector if ashore


** Use abbreviation: PC = Pure container, GC = General Cargo, BC = Bulk Carrier, LNG = Tanker, LPG = Tanker, Chem = Chemical, RoRo = Roll on Roll off
*** Use abbreviation: MR = Medical Reason, VS = Vessel Sold, EOC = End of Contract
5/7
Summary of Experiences (in number of years)
Years as/ Bulk
Container Tanker Roro others (Please state)
on carrier
Master -
C/E
C/O - 2/E

2/O - 3/E

3/O - 4/E

E/O

Total

Years as/ Sulzer Sulzer SEMT Steam


B&W MAN others
on RTA RND Pielstick Turbine
C/E

2/E

3/E

4/E

E/O

Total

References
Do you have any objection if we will contact your last employers for
Yes/No NO
reference?
If YES please specify why:
If NO please specify below:

Please give the name and address of your current or immediate past employer
Name of company
Name of person to
contact
Address

Tel number

Please list two contactable referees or past employers


Name of company
Name of person to
contact
Address

Tel number

Name of company
Name of person to
contact
Address

6/7
Tel number

Bank details
INDIAN
Bank
OVERSEA Sort code:
name:
S BANK
Branch UDANGU Swift name
IOBAINBB092
name DI IBAN number:
56A 2 BY
Address: 2, Sri Ram Bus Stand Road, Udangudi 628203
Account Building,
Account
name/ HARISH I ###
number:
Title

I hereby affirm that all the information provided by me in this application is true and correct to the best
of my knowledge and belief; further, that no Certificate of Competency or License issued to me has
ever been revoked or suspended. I also certify that my medical history contained abocve is true and
any false statement or undisclosed material information about past illness or injury will disqualify me
from any employment benefits and claims.

Date__03/04/2025___
___________ Signature_______________________

* The company may contact my previous employer for references.

7/7

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy