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    Ofper 1 Application For Seagoing Appointment

    Uploaded by

    Narayana Reddy
    This document is an application for a seagoing appointment. It contains the applicant's personal details, contact information, identification documents like passport and medical certificates, qualifications and training certificates, sea time history employed on various vessels, and references. The applicant is providing all relevant information for consideration for a seagoing position.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    Ofper 1 Application For Seagoing Appointment

    Uploaded by

    Narayana Reddy
    168 views4 pages
    This document is an application for a seagoing appointment. It contains the applicant's personal details, contact information, identification documents like passport and medical certificates, qualifications and training certificates, sea time history employed on various vessels, and references. The applicant is providing all relevant information for consideration for a seagoing position.

    Original Description:

    fgchk

    Original Title

    Ofper 1 Application for Seagoing Appointment (5) (1)

    Copyright

    © Attribution Non-Commercial (BY-NC)

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    This document is an application for a seagoing appointment. It contains the applicant's personal details, contact information, identification documents like passport and medical certificates, qualifications and training certificates, sea time history employed on various vessels, and references. The applicant is providing all relevant information for consideration for a seagoing position.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    168 views4 pages

    Ofper 1 Application For Seagoing Appointment

    Uploaded by

    Narayana Reddy
    This document is an application for a seagoing appointment. It contains the applicant's personal details, contact information, identification documents like passport and medical certificates, qualifications and training certificates, sea time history employed on various vessels, and references. The applicant is providing all relevant information for consideration for a seagoing position.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 4

    Application for Seagoing Appointment

    Applicant Details
    Date of
    Rank:

    Application:

    Type of Contract:

    Available From:

    05/12/2013
    Surname:

    First Name:

    Marriage Status:

    Date of Birth:

    Place of Birth:

    Nationality:

    Height (cm):

    Weight:

    Eye Colour:

    Contact Details
    Address:

    Town/ City:

    Country:

    Telephone Number:

    Postcode:

    Mobile Number:

    E-Mail Address:

    Nearest Airport:

    Next of Kin
    Surname:

    First Name:

    Relation:

    Address:
    Town/ City:

    Country:

    Telephone Number:

    Post Code:

    Mobile Number:

    Identification
    Passport Number:

    Date of Issue:

    Date of Expiry:

    Country Issued:

    Seamans Book Number:

    Date of Issue:

    Date of Expiry:

    Country Issued:

    Visa Number:

    Date of Issue:

    Date of Expiry:

    Country
    Issued:

    Type:

    Certificate of Competency
    Certification Rank:

    CoC Number:

    Issuing Authority:

    Date of Issue/ Revalidation:

    Date of Expiry:

    Endorsements:

    Level Operational

    Management

    Chemical

    Level Operational

    Management

    Gas

    Level Operational

    Management

    Oil

    Please use additional sheets to supply details of further documents which you hold where
    there is not enough space provided below

    OFPER 1 (Ver. 6 Mar 12)

    Medical Certificates
    Country:

    Type:

    Date of Issue:

    Date of last Drug and Alcohol Test:

    Date of Expiry:

    Result:

    Expiry Date of Yellow Fever Vaccination:

    Training
    Please check all the qualifications you hold below and detail their issue and expiry dates.

    Personal Safety Techniques:

    Basic Safety:

    GMDSS General Operator:

    Issue:

    Issue:

    Issue:

    Expiry:

    Personal Safety & Social


    Responsibilities:
    Issue:

    Advanced Fire Fighting:


    Issue:

    Expiry:

    Fire Fighting and Prevention:

    Expiry:

    Expiry:

    Proficiency in Survival Craft &


    Rescue Boats:
    Issue:

    Expiry:

    Issue:

    Expiry:

    Safety Officer:

    Security Officer:

    Issue:

    Issue:

    Expiry:

    Expiry:

    Expiry:

    Medical Care:

    Elementary First Aid:

    Medical First Aid:

    Issue:

    Issue:

    Issue:

    Expiry:

    ECDIS:
    Issue:

    Expiry:

    Expiry:

    Bridge Team Management:

    Hull Integrity:

    Issue:

    Issue:

    Expiry:

    Crowd Management:

    Crisis Management:

    FRAMO:

    Issue:

    Issue:

    Issue:

    Expiry:

    Expiry:

    Ice Navigation:

    ISM/ISO Auditor:

    Issue:

    Issue:

    Expiry:

    Tanker Familiarisation Training:


    Chemical
    Gas

    Expiry:

    Expiry:

    Expiry:

    Expiry:

    Oil

    Specialised Tanker Training:


    Gas

    Oil

    DP Induction:

    DP Simulator :

    DP Operator:

    Issue:

    Issue:

    Issue:

    Expiry:

    Expiry:

    Chemical

    Expiry:

    Other specialised training certificates held:

    Marlins English Test :


    Issued at

    Issue:

    Expiry:

    Other languages you are proficient in:


    Spanish:

    French:

    German:

    Result:

    Italian:

    Please use additional sheets to supply details of further documents which you hold where
    there is not enough space provided below

    OFPER 1 (Ver. 6 Mar 12)

    Please fill in full sea time history from beginning of cadetship to current date. Please use additional sheets if necessary.

    Sea Time History


    Rank

    Vessel Type

    Vessel Name

    Employer

    Flag

    From

    To

    DWT

    Gross
    Tonnag
    e

    Main Engine
    Model

    BHP

    References

    Please provide your most recent employer as your first referee. Contact to current employer will only be made upon
    acceptance of a job offer.

    Name:

    Job Title:
    carried:
    Officers with experience on
    Product/Chemical
    tankers please state
    Cargoes
    Telephone Number:

    Email Address:

    Company Name:

    Address:

    Reference:

    Please use additional sheets to supply details of further documents which you hold where there is not enough space provided below
    Name:

    Job Title:

    Telephone Number:

    Email Address:

    Company Name:

    Address:

    OFPER 1 (Ver. 6 Mar 12)

    Reference:

    Please fill in full sea time history from beginning of cadetship to current date. Please use additional sheets if necessary.

    Sea Time History


    Rank

    Vessel Type

    Vessel Name

    Employer

    Flag

    From

    To

    DWT

    Gross
    Tonnag
    e

    Main Engine
    Model

    BHP

    Officers with experience on Product/Chemical tankers please state Cargoes carried:

    Please use additional sheets to supply details of further documents which you hold where there is not enough space provided below

    OFPER 1 (Ver. 6 Mar 12)

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