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Contacts data

Position: First Name: Last Name:

Father's Name: Email: Phone:

About myself

Citizenship: Date of birth: Place of birth:

Adress: Marital staus: Num of children: Relation:

Next kin: Next kin adress: Next kin name:

Maritime education received Name of school/Academy: From: Till: Type of degree received:

Documents

Seaman's password: Num. doc: Place of issue: Date of issue/validity:

Travel password: Num. doc: Place of issue: Date of issue/validity:

Other S/B: Num. doc: Place of issue: Date of issue/validity:

Shengen visa: Num. doc: Place of issue: Date of issue/validity:

STCW

Cert. of Competency: Grade: Num: Place of issue: Date of issue/validity:

Endorsement: Grade: Num: Place of issue: Date of issue/validity:

Cert. of Competency (2): Grade: Num: Place of issue: Date of issue/validity:

Endorsement (2): Grade: Num: Place of issue: Date of issue/validity:

Basic safety training: Num: Place of issue: Date of issue/validity:

Medical first aid on board ship/ medical care: Num: Place of issue: Date of issue/validity:

Proficiency in survival craft: Num: Place of issue: Date of issue/validity:

Advanced fire fighting: Num: Place of issue: Date of issue/validity:

Dangerous and hazardous cargoes: Num: Place of issue: Date of issue/validity:

Radar observer &plotting/a.r.p.a.: Num: Place of issue: Date of issue/validity:

Maintenance of electrical and
electronic engineering: Num: Place of issue: Date of issue/validity:

Bridge team management: Num: Place of issue: Date of issue/validity:

Ship handling arrangements: Num: Place of issue: Date of issue/validity:

Ship security officer (isps): Num: Place of issue: Date of issue/validity:

Ships safety officer (ism): Num: Place of issue: Date of issue/validity:

Trainig of seafares with
designated security dues: Num: Place of issue: Date of issue/validity:

Tanker familiarization: Num: Place of issue: Date of issue/validity:

Oil tankers specialized training: Num: Place of issue: Date of issue/validity:

Gas tankers specialized training: Num: Place of issue: Date of issue/validity:

Chem. Tankers specialized training: Num: Place of issue: Date of issue/validity:

Crude oil washing of oil tank: Num: Place of issue: Date of issue/validity:

Inert gas system: Num: Place of issue: Date of issue/validity:

Ecdis: Num: Place of issue: Date of issue/validity:

Physical fitness

Medical examination certificate: Num: Place of issue: Date of issue/validity:

Yellow fever vaccination: Num: Place of issue: Date of issue/validity:

Drug & alcohol test: Num: Place of issue: Date of issue/validity:

Previous sea service (last 5 years):

Vessel name: Company: Flag:

Vessel type: Engine type: KWT:

Rank: From: To:

Sizen

Clothes: Shoes: Height: Weight:

Notes

Анкета моряка