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application form








Position applied for:
Address:
Availibility date:
Tel: Cont. tel:
Surname:
Martial status: No. of Children:
Forenames:
Next of Kin:
Date of Birth:
Address:
Place of Birth:
Residence:
Citizenship:
Graduation:
Nearest airport:
Languages spoken:
 
National licence Grade Number Date Issued Place Issued Valid Until
1. National licence
STCW Endorsm
Licence limited  
2. National licence
SOLAS/STCW95
Radar Observer
APRA
Basic First Aid
Refresher Training
SOC(GMDSS)
 
Grade Number Date Issued Place Issued Valid Until
National Passport
National S/Book
Seaman`s Passport
Norvegian S/Book
German S/Book
Other S/Book
 
Personal Info
Eyes:
Weight:
Hairs:
Height:
Special features:
Saf. Shoes:
Boilersuit:
 
Previous Sea Expirience (for last 10 years):
From - To Vessel`s Name Flag GRT BHP Engine Type of vsl Position Company`s Name
 
List of valid Certificates
Health Cert. valid
Lic.
Radio
Radar Obs.
Med. Care
CH.TCS.
LPG
Yelow Fever valid
Endr.
GMDSS
ARPA
Fire Fighting
TCS
LNG
D&A Test
   
Ship Simul.
Hazmat
   
 
  
Hõbeda 6, 10125, Tallinn, Estonia
Ph. +372 6273 940 Fax. +372 6273 939 E-mail: info@utec.ee