Date of availability

СУДОХОДНАЯ
КОМПАНИЯ Application Form for Seafarers
"ПАВИНО"

POSITION APPLIED FOR:

Surname: photo
First name:
Date of birth:
Place of birth:
Marital Status:
Home Address:
e-mail: Nationality:
Mobile telephone: Height:
Next Relations And Kin’s/Name/Phone: Weight:
Home Airport: Clothes size
Language / Knowledge Marlins Test Other test: Shoes size
Result: Result: Hair color
Speaking: Writing: Eye color
Academic Qualification Name of Institution: Qualification: Year of graduation:

Details of License and Seafarers PLACE OF ISSUE NUMBER ISSUED EXPIRY

Identity-/Travel Documents
Documents
Seafarer's Identity Document
Seaman's Book
Travel Passport
Visa
Medical Certificates
Physical Examination
Yellow Fever Vaccination
Certificates - courses
Certificate of Competency (COC)
GMDSSB General Operator Certificate
Automatic Radar Plotting Aids-ARPA
Radar Observation & Plotting Simulator
ECDIS (Electronic Charts)
Basic Safety Training & Instruction
Proficiency in survival craft and rescue boats
Medical First Aid
Medical Care
Advanced Fire-fighting
ISPS Training
Bridge Team Management
Bridge and Engine Resource Management
Maneuvering & Ship Handling
Safety Officer Training
Военно-морская подготовка
Tanker Certificates
Oil Tanker Endorsement STCW 95
Chemical Tanker Endorsement
Oil-Tanker Familiarization Course
Specialized Oil Tanker Training
Chemical Tanker Familiarization Course
Specialized Chemical Tanker Training
Other Certificates/Special Experience (If any)

Other
References (Company name,person, tel.)
References (Company name,person, tel.)

Performance Report (YES/NO)

SEA SERVICE :

From To Rank Name of the Type of Name of the Flag Type of Vetting Number/Type
vessel vessel* Owner /Manager engine Inspect. of Cargo Tanks Cargo pump
(coating)
dd mm yyyy dd mm yyyy DWT Year built KWT

* Please use following abbreviations for vessel type:

GC – General Cargo OBO – Oil/Bulk/Ore Carrier HVL – Heavy Lift Vessel
MLP – Multi-Purpose TN – Tanker REEF – Reefer
CONT – Container FSH – Fishing ship PAS – Passenger ship
RO-RO – Ro-Ro CHTN – Chemical tanker SS – Sail Ship
BULK – Bulk Carrier GAS – LPG/LNG carrier TUG – Tug

** Engineers to give
maker/model of M/E i.e.
“SULZER 5RTA58”

For my personal data specified in the application be under automated processing, transferring and storing with the purpose of employment, I herewith give my concent.
С автоматизированной обработкой моих персональных данных, указанных в анкете, с их передачей и хранением в целях трудоустройства согласен.