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EVALUATION FORM FOR NEW APPLICANTS

(To be used in conjunction with the application form)

NAME       DATE OF BIRTH      

RANK APPLIED       VSL TYPE REQUEST      
EDUCATION       NATIONAL ID. NO      
FIRM READINESS       REQUESTED TENURE      
US VISA TYPE       US VISA EXPIRY      
PASSPORT EXPIRY       AUMCV EXPIRY      
NAT. COC HELD NAT COC EXPIRY       NAT. COC
AUTHENTICATION
NAT. SMN BK HELD NAT SM BK EXPIRY       NAT. SMN BK
AUTHENTICATION
NAT. GMDSS NAT. GMDSS ENDORSE.       NAT.GMDSS ENDORSE.
ENDORSE. HELD EXPIRY AUTHENTICATION
NAT. TANK END HELD NAT.TANK END EXPIRY       NAT.TANK END
AUTHENTICATION
NAT. W/K CERT FOR NAT. W/K CERT EXPIRY       NAT. W/K CERT
RATINGS AUTHENTICATION
STCW DOCUMENTS SIGHTED & VERIFIED
PST FPFF EFA PSSR
PSC/RB AFF MFA MEDICARE
OILFAM CO. CHEMFAM GASFAM CO YEL. FEVER
CO
OIL COURSE- CHEM GAS COURSE- SHIP SEC OFF
ADV COURSE-ADV ADV
OIL ENDORS CHEM ENDO GAS ENDORS      
OTHER IMPORTANT COURSE CERTIFICATES SIGHTED & VERIFIED :

BTM BRM SMS/SHS ECDIS

HAZMAT                  

GENERAL IMPRESSIONS
5 4 3 2 1
English Communication skills/Aptitude
Appearance and Behavior (Personality)
Reference Check with previous Employers
Safety and environment conscious
Attitude
Note: 5 – Very Good 4 – Good 3 – Average 2 – Below Average 1 – Poor

SPECIAL EXPERIENCE / SKILLS & FAMILIARITY WITH :

DECK OFFICERS:
1 Cargoes Carried ( In reference to Vessel Type/s applied for)      

2 Areas/Regions Traded      

3 Canals/Inland Waterways/Narrow Channels Navigated      

4 Experience on ECDIS, BOW/STERN Thrusters, VPP etc      

5 Experience in PMS System      

6 Experience in Operation of Cranes( Electric, Hydraulic,      

Gantry etc)
7 Experience on Operations of Cargo Pumps ( Centrifugal,      
Reciprocating, Deep well, Framo etc)

WSM GLOBAL/MA/104 Rev 1 Dated 01/Aug/2012

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ENGINEERS/ ELECTRICAL OFFICERS:

1 Type of Main Engines worked ( Including Medium Speed)      

2 Type of Aux Engines ( Generators) , Shaft Generators,      

Turbo Generators
3 Type of Boilers worked      

4 Whether worked with UMS operations      

5 Main Engine Remote Control system worked      

6 Experience on maintenance of Electronic & Instrument      

Automation
7 Experience on maintenance of Hydraulic & Pneumatic      
Machinery
8 Experience in Welding ( TIG/GAS/ARC/CI) etc      

9 Experience in PMS System      

10 Experience on maintenance of Cargo Pumps ( Centrifugal,      

Reciprocating, Deep well, Framo etc)
11 Experience in maintenance of Cranes ( Electric, Hydraulic,      
Gantry etc)

CATERING OFFICERS/ CHIEF COOKS:

1 Cooking Indian / Continental / Chinese / Filipino cuisine      

2 Keeping Accounts, Provision/Cabin stores inventory      

management/ Victualling budget Control
3 House Keeping, Garbage Management      

4 Assisting Master in Port/ Knowledge on Computer Usage      

PERSONAL IMPRESSION OF INTERVIEWER

SUITABLE FOR EMPLOYMENT NOT SUITABLE FOR EMPLOYMENT
Dry-docking Experience if any. If so name vessels      

Vetting Inspections experience if any. If so please name the oil      

majors
If any of the vessels involved in major accidents. If so provide      
details
New Yard Delivery/ New Take over experience if any      

ADDITIONAL REMARKS IF ANY

     

REFERENCE CHECK WITH PREVIOUS EMPLOYER

     

DATE OF EVALUATION      

SIGNATURE OF INTERVIEWER

NAME OF INTERVIEWER      

WSM GLOBAL/MA/104 Rev 1 Dated 01/Aug/2012