crewing
application form
Position applied for:
Address:
Availibility date:
Tel:
Cont. tel:
Surname:
Martial status:
Single
Married
Separated
Divorced
Widowed
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:
Brown
Blue
Green
Gray
Weight:
Hairs:
Blonde
Black
Dark Brown
Light Brown
White/Grey
Red
None
Multicolored
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