APPLICATION / INTERVIEW FORM
I confirm that the personal data provided to Swire Shipping Pte Ltd.(SSPL) as set out herein is true, complete and accurate and undertake to keep SSPL
✘ informed if any of the personal data provided therein has changed.
I have also read and understood the “Data Protection and privacy policy”, a copy of which is published on SSPL’s website at
https://info.swireshipping.com/policies/data-protection-and-privacy-policy/
✘
I have also read and understood the “Recruitment data and privacy policy”, a copy of which is published on SSPL’s website at
✘
https://info.swireshipping.com/policies/recruitment-data-privacy-policy/
I am aware that the said notice sets out, amongst others, the personal data that SSPL collects, their legal bases and purposes of processing such data as well
✘ as the other third parties to whom SSPL discloses such data.”
Position Applied for Date:
Please indicate if willing to accept a lower position if not offered job applied YES NO
Personal Details
Surname :
Photo
Name :
Date of birth : Place of birth : Height :
Nationality : Marital Status : Weight :
Passport : Date of Issue : Date of expiry :
US Visa : Date of Issue : Date of expiry :
House Phone : E-Mail :
Mobile Phone : Skype :
Home Address :
Next of Kin Details
NOK Name :
House Phone : Relationship :
Mobile Phone : E-Mail :
Home Address :
Please attach Sanctions Checklist with this form
Employment History
Sea Time Manager/ Engine
Rank From Till Vessel name Vessel Type Flag DWT GRT Type / HP
(Mths) Owner
Page no 1 Revision 05 Oct 2020
Total Time For Each Rank
Rank Total Time (Yrs) Rank Total Time (Yrs) Rank Total Time (Yrs)
Master C/E ETO
C/O 2/E 2ETO
2/O 3/E T/O
3/O 4/E EL/ CDT
4/O 5/E
D/CDT E/CDT
Page no 2 Revision 05 Oct 2020
Education
Qualification Name of Maritime College / University From Till
Licences
Seaman Book : Date of Issue : Date of expiry : Place of Issue :
COC : Date of Issue : Date of expiry : Place of Issue :
Certificates
Certificates of Competency / Proficiency Place of Issue Date of Issue
Date of Expiry
STCW 2010 COMPLIANCE YES NO
Certificates Number Date of Issue
Date of Expiry
Advanced Fire Fighting (A-VI/3)
Basic Safety Training (A-VI/1-4)
Designated Security Duties (A-VI/6-2)
Generic ECDIS (A-II/1 & II/2)
Electronic Navigation Systems (Radar or ARPA, if fitted)
Elementary First Aid (A-VI/1-3)
Fast Rescue Boat (A-VI/2-2)
Fire Prevention & Fire Fighting (A-VI/1-2)
GMDSS (A-VI/2)
Medical Care (A-VI/4-2)
Medical First Aid (A-VI/4-1)
Personal Safety & Social Responsibility (A-VI/1-4)
Personal Survival Techniques (A-VI/1-1)
Proficiency in Survival Craft & Rescue Boats (other than FRB) A-VI/2
Security AwarenessTraining (A-VI/6)
Designated Security Duties(A-VI/6-2)
Ship Security Officer (SSO) (A-VI/5)
Bridge Team Management (BTM)
Bridge Resource Management (BRM)
Engine Room Resource Management (ERM)
ECDIS Type : SPERRY FURUNO JRC Transas
Cargo Type : MPP Bulk Logs Cement Cars Heavy Lift Ro-Ro
Please
Passengers Reefer Steel Others Specify :
All Engineers :Dry Docking New Building Other Engineering Projects Please
Specify :
English Level : Good / Satisfactory / Poor
Page no 3 Revision 05 Oct 2020
Question :-
1. Do you have a valid medical certificate / Date of last medicals?
2. Are there any other illness, disabilities or defects present, that may require treatment and have not already been disclosed.
If so, please provide full details.
3. Reason for leaving your previous employment
4. If you have not sailed in the last six month prior application, please advise reason
I hereby affirm that all the information provided by me in this form is TRUE and CORRECT to the best
of my knowledge.
Seafarer's signature: Date :
Page no 4 Revision 05 Oct 2020
