Oceanic International Shipping (Pvt) Ltd Quality Manual

Tel:0094113637252 /3 ISO 9001:2015 Quality Management System

Email : info@oceanicshippings.com Application Form of Seafarers (CV)
Recruitment & Placement Services Manual
Doc no: RPS/FM/02 Page: 1 of 5 Issue no: 03.01.2017 Revision no : 01
Prepared by: Crew/Ops Manager Issue Date: 03-01-2017 Revision Date: 31.07.2019
Title: Application Form of Seafarers (CV)
FORM no: 02
Personal Data (Name Should be as appearing in the passport)
Surname

Other Names

Nationality Date of Birth (DD/MM/YYYY) Place/ City of Birth

Marital Status Gender: M = Male, F = Female Religion

Rank Applied Willing to Accept Lower Rank: Yes Available From (Date)
(DD/MM/YYYY)
No

Primary/Permanent
Address:

City Country

Home Tel: Mobile No:

Fax: E-mail:

Overall Size: Safety Shoe Size: Height: (cm) Weight : (Kg) BMI: weight (kg) / [height
(m)]2

2. Personal ID/Documents/Visa
Type of Document/ID Country of Issue Number Date of Issue Issued at (Place) Valid Until
(DD/MM/YY) (DD/MM/YY)
Seaman’s Book (National)

Passport

US Visa C1/D

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 Yellow Fever

National ID

3. Nominee/Next of Kin and Family Details

Gender Male Nationality
Full Name of Next of Kin Relationship*
Female

Address

City Country
E-mail Tel: Mobile:
* Select from: *Spouse *Child *Grand Parent *Other Relative (please Specify)
3.1 Family Details
Relationship First Name Last Name Date of Birth
Father

Mother

Spouse

Child M F

Child M F

Child M F

* Strike out inapplicable item

4 STCW – Compliant Certificates/Courses and Other Qualifications:

4.1 Certificate of Competency & Ratings Watch-Keeping Certificate

Qualifications Date Of Issue Date Of Expiry Issuing
Number
dd/mm/yy dd/mm/yy Authority
* Certificate of Competency - COC

Navigational watch keeping A-II/4

Navigational watch keeping A-II/5

Engine Room watch keeping A-III/4

Engine Room watch keeping A-III/5

Electro-Technical Officer A-III/6

Electro-Technical Rating A-III/7

Basic Training For Oil And Chemical Tanker Cargo
Operation - Endorsement A - V/1-1
Basic Training For Oil And Chemical Tanker Cargo
Operation -Certificate
Advance Training for Oil Tanker Cargo Operation
A -V/1-1-2
Advance Training for Oil Tanker Cargo Operation
Endorsement A -V/1-1-2
6G/ 4G Welding Certificate

LLOYDS- Welding Certificate

Ship Cook Updating Certificate –MLC 2006

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 Ship Steward updating certificate – MLC 2006
Liberia endorsement
Panama endorsement
Other
*Enter actual description given in the Certificate of Competency / Watch keeping Certificate held by you
4.2 Other STCW Certificates

Date of Issuing
Country of Date of Issue
Description of Certificate/Course Number Expiry Authority /
Issue dd/mm/yy
dd/mm/yy Institute
Refresher & Updating training A-VI/1-1 to1-4

Basic Training Endorsement A-VI/1-1 to 1-4

Personal Survival Techniques

Elementary First Aid

Fire Prevention & Fire Fighting

Personal Safety & Social Resp.

Proficiency in Maritime English
Seafarers with Designated Security
Duties
Proficiency in Survival Craft & Rescue
Boats

Fast Rescue Boats

Advance Fire Fighting

Medical First Aid

Medical Care (Master/CO)

4.3 Other Mandatory / Recommended Certificates / Courses – (as applicable)

Date of Issuing
Country of Date of Issue
Description of Cert/Course Number Expiry Authority /
Issue dd/mm/yy
dd/mm/yy Institute

GMDSS (GOC/ROC)

ECDIS

ARPA (Reg 11/1 + Solas)

HAZMAT
Radar Simulator

Bridge Team Management

Bridge Resource Management

Bridge E-Room Resource Management

Shipboard Security Officer

Ship Security Awareness
Tanker Familiarization
Navigation Watch Keeping Simulator-
Operational Level
Radar Observation & Plotting
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 Electronic Navigation Systems
Radar Observation and Plotting
International Ship and Port Security Code
(ISPS)
Risk Assessment
Ship Handling And Maneuvering
Other (Add below if any other courses

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5. Sea Experience: All Fields Are Mandatory

Engine
KW / Signed on Signed off Reason of
Vessel Name FLAG Vessel Type GRT DWT Make/ RANK Company Name
BHP dd/mm/yy dd/mm/yy Sign Off
Model

***Nomenclature –
CC – Completed Contract, VS – Vessel Sold, MG – Medical Grounds (Please specify the type of illness), OR – Other Reason (Please Specify)
* Use only the following Abbreviations for vessel types
B/C Bulk Carrier FPSO Floating Production Storage Offloading MLP Multi-Purpose PAS Passenger Ship YAT Yacht
CON Cellular Container GCD General Cargo MSV Multi Service Vessel RFG Reefer Vessel TNB Tanker (Bitumen)
CHM Chem. Carrier IMO 1-11 HLV Heavy Left Vessel NVL Naval Ship R/R Ro/Ro Carrier TNC Tanker (Crude)
CH3 Chem. Carrier IMO 111 LSH Lash RIG Offshore Oil Rig PRR RoRo-Pax TNP Tanker (Product)
DRG Dredgers LIV Live Stock Carrier OSV Offshore Supply Vessel SAL Sailing Vessel TNS Tanker(Storage)
DP Dynamic Positioning LNG LNG Carrier OBO Ore/Bulk/Oil Carrier SRV Survey Vessel TNV Tanker
FSH Fishing Vessel LOG Log/Timber O/O Ore/Oil Carrier SUL Self – Unloader (VLCC/ULCC)
FSO Floating Storage Offloading LPG LPG Carrier OTH Other TUG Tug
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6. Medical History
Blood Type
All previous illnesses other that minor afflictions should be stated below or updated.
If not previously disclosed, the Company is entitled to decline payment of medical
costs for treatment or for any other insured benefits.

(A) Have you ever signed off a ship due to medical reasons? Yes No

If yes, please provide details:

(B) Have you undergone any surgical operations in the past? Yes No

If yes, please provide details:

(C) For what illnesses or accidents have you consulted a doctor during the last 12 months?

(D) Please give details of any health or disability problem from which you presently suffer

Declaration to be signed by the applicant

I hereby certify that the information contained in this form is correct and I understand that the Company may terminate my
services at any time if any of the above information is found to be false.
I understand that a medical examination at my own cost is a condition precedent to selection for employment and I express my
willingness to be so examined (if required) and to furnish the company Doctor with full details of my previous medical history.

Date Signature of the Applicant

Reference
Name of the Company
Name of the person to contact
Address
Contact Number

Office Use Only

Authenticity of COC and Documents checked? Yes No Authority

Knowledge of
English : Fluent Good Average Poor
NAME SIGNATURE DATE

Received By :

Interviewed By:
Interview Notes:

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