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MCL Application Form

This document is an application form for employment as a seafarer. It requests personal information such as name, contact details, nationality, documents, education and training certificates. It also requests employment history and references. The purpose is to collect all information needed to assess an application for employment as a seafarer.

Uploaded by

Paul B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
210 views5 pages

MCL Application Form

This document is an application form for employment as a seafarer. It requests personal information such as name, contact details, nationality, documents, education and training certificates. It also requests employment history and references. The purpose is to collect all information needed to assess an application for employment as a seafarer.

Uploaded by

Paul B
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 5

MCL INTERNATIONAL Srl

16th Banu Mihalcea Str, 900532 Constanta, Romania


Phone: +40 241 485888, 485889
Email: [email protected] Application Form
GDPR Notice
We need your permission to receive and process your data. Please read and consent with our Privacy policy
☐ Please tick – I Agree to the collection and processing of my personal data for the recruitment activity

Seafarer’s personal information Photo


Rank Available From
Family Name Given Name
Gender Nationality
Date of Birth Place of Birth
Father’s Name Mother’s Name
Phone No Mobile No
Address Postcode Biometrics
Town/City Country Eyes
E-Mail Address Skype ID Hair
Civil Status Nor of Children Height (cm)
English Level Nearest Airport Weight (kg)

Seafarer’s next of kin


Family Name Given Name Relationship
Phone No Address

Documents Number Issue date Expiry date Place of issue


Passport
US Visa C1/D
UK Frontier Work Permit
Other visas
Seaman’s Book
Certificate of Competency STCW Code
National Rank Endorsement STCW Code

EDUCATION
Maritime Education last attended City From To Major diploma
[dd/mm/yyyy] [dd/mm/yyyy]

Certificate of Proficiency / Endorsements issued by Number Issue date Expiry date Place of
Maritime Authority issue
Basic Training for Oil & Chemical Tanker Cargo Operations
Basic Training for Liquified Gas Tanker Cargo Operations
Advanced Training for Oil Tanker Cargo Operations
Advanced Training for Chemical Tanker Cargo Operations
Advanced Training for Gas Tanker Cargo Operations
Ship Security Officer
Proficiency in Fast Rescue Boats
Proficiency in survival crafts and rescue boats other than fast

Page 1 of 5
MCL INTERNATIONAL Srl
16th Banu Mihalcea Str, 900532 Constanta, Romania
Phone: +40 241 485888, 485889
Email: [email protected] Application Form
rescue boats
Other

Page 2 of 5
MCL INTERNATIONAL Srl
16th Banu Mihalcea Str, 900532 Constanta, Romania
Phone: +40 241 485888, 485889
Email: [email protected] Application Form
Training Certificates STCW Number Issue date Expiry date Issued by
Basic Training (Personal Survival Techniques, Personal Safety and
Social Responsibilities, Elementary First Aid, Basic Fire Fighting)
Medical First Aid
Medical Care
Advanced Fire Fighting
Proficiency in survival crafts and rescue boats other than fast rescue boats
Security Awareness & Designated Security Duties
General operator for GMDSS (GOC Training)
GMDSS Certificate
ECDIS Generic
ECDIS SPECIFIC
Human Element, Leadership and Management - Managerial Level
Human Element, Leadership and Management - Operational Level
Maritime English
Bridge Team and Resource Management
Ship Handling and Maneuvering Simulation
Engine Team and Resource Management
Engine Room Simulator
Ship Security Officer
Ship Safety Officer
Proficiency in Fast Rescue Boats
Hygiene Course for Catering Personnel
Prevention of Pollution of the Marine Environment - Marpol 73/78
Transport and handling of dangerous, hazardous and harmful cargoes
High Voltage Safety and Maintenance Course
MAN Electronic Certificate
Ship Steam Propulsion
Liquid Cargo Handling Simulator
Risk Assessment in Ship Operation
Marine Casualty Investigation
Basic Training for Oil & Chemical Tanker Cargo Operations
Basic Training for Liquefied Gas Tanker Cargo Operations
Advanced Training for Oil Tanker Cargo Operations
Advanced Training for Chemical Tanker Cargo Operations
Advanced Training for Liquefied Gas Tanker Cargo Operations
Specialized training for RoRo/Passenger Ships
DP Maintenance
BOSIET - OPITO
HUET
OTHER
OTHER

Please provide your most recent employer Reference 1 Reference 2


Company Name
Address
Name of person to contact

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MCL INTERNATIONAL Srl
16th Banu Mihalcea Str, 900532 Constanta, Romania
Phone: +40 241 485888, 485889
Email: [email protected] Application Form
Job title
Telephone No
E-Mail Address

Page 4 of 5
MCL INTERNATIONAL Srl
16th Banu Mihalcea Str, 900532 Constanta, Romania
Phone: +40 241 485888, 485889
Email: [email protected] Application form
List most recent employer first
Type /
Vessel's name / GRT /
Flag Type DWT Engine Power Rank From To Owner / Manager Crewing Agency
IMO No TEU
(BHP)

Cargo / Engine Experience (for Officers only)


For Deck Officers
Pls list cargo carried
Oil
Products:
Chemicals Liquid cargoes STS Operations
☐
For Engine Officers
Pls list engine experience
ME Engine
☐ LNG Powered
☐ High Voltage
☐

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