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Record of Personal Information and Past Experience: Address

This document contains a record of personal information and past experience for an individual, including their rank, citizenship, date and place of birth, marital status, present and next of kin contact information, educational history, languages spoken, passport and license details, previous sea experience over the last five to ten years, and certificates held. The record spans four pages and collects contact details, employment history, qualifications and training to provide a comprehensive profile of the individual.

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Leana Jurica
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316 views4 pages

Record of Personal Information and Past Experience: Address

This document contains a record of personal information and past experience for an individual, including their rank, citizenship, date and place of birth, marital status, present and next of kin contact information, educational history, languages spoken, passport and license details, previous sea experience over the last five to ten years, and certificates held. The record spans four pages and collects contact details, employment history, qualifications and training to provide a comprehensive profile of the individual.

Uploaded by

Leana Jurica
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as RTF, PDF, TXT or read online on Scribd
You are on page 1/ 4

RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE

Rank: First Name: Last Name:

Citizenship:

Date & Place of Birth: Marital Status:


Present Address: Next of Kin:
Tel:
Name /
Fax: Relationship:

Email: Address /Tel:

Educational History: Present/Last Employer:

Languages: Address:
Closest airport: Last salary: Tel:
Medical certificate Issued: Expired: Yellow Fever Issued: Expired:
American Visa Issued: Expired: cm/kg Hair: Eyes:
Position Applied: Service Availability:

Licence
Grade of Licence Number Place & Date Issued Date Expired

Passport
Place & Date Issued Date Expired

Seamans Book
Place & Date Issued Number Date Expired

Previous Sea Experience ( For Last Five Years or Last 10 Ships Served )

Vessels Name Flag Deck: DWT Vessel Type Company Name Rank Period: From-To
Engine: Type , KW

Page: 1 of 2

O S M Croatia, Uvala baluni 9 , 21000 Split, Croatia Tel: +385 21 483 693/317 386 Fax: +385 21 483 694 E-mail:
osm.croatia@osm.no
RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE

Page: 2 of 2

O S M Croatia, Uvala baluni 9 , 21000 Split, Croatia Tel: +385 21 483 693/317 386 Fax: +385 21 483 694 E-mail:
osm.croatia@osm.no
RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE

Certificates

Certificates STCW Licence No. Date Date Place Issued


Issued Expired Course Date Date

BASIC TRAINING

MEDICAL FIRST AID

ADVANCED MEDICAL CARE

ADVANCED FIRE FIGHTING

PROFICIENCY IN SURVIVAL
CRAFT & RESCUE BOATS
OPERATIONS
PROFICIENCY IN FAST
RESCUE BOATS OPERATIONS

DANGEROUS CARGO
HANDLING

TANKER FAMILIARIZATION
CERTIFICATE

ADVANCED OIL TANKER


OPERATIONS

ADVANCED CHEMICAL
TANKER OPERATIONS

ADVANCED LIQUEFIED GAS


TANKER OPERATIONS

GENERAL RADIO OPERATORS


CERTIFICATE

ARPA

CERTIFICATE ON RO-RO
PASSENGER SHIP SAFETY

PASSENGER SHIP SAFETY

Page: 3 of 2

O S M Croatia, Uvala baluni 9 , 21000 Split, Croatia Tel: +385 21 483 693/317 386 Fax: +385 21 483 694 E-mail:
osm.croatia@osm.no
RECORD OF PERSONAL INFORMATION AND PAST EXPERIENCE

Place,Date: ______________ Signature:

Page: 4 of 2

O S M Croatia, Uvala baluni 9 , 21000 Split, Croatia Tel: +385 21 483 693/317 386 Fax: +385 21 483 694 E-mail:
osm.croatia@osm.no

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