APPLICATION FORM
POST APPLIED FOR :
ENGINE CADET
PERSONAL PARTICULARS :
NAME :
SAIFUL ISLAM TIPU
HOME
ADDRESS :
C/O – RAJJAB ALI HAJI BARI, P.O – KADOMTOLA, VILL – CHARPARBOTHI, P.S – COMPANIGONG, DIS – NOAKHALI.
PRESENT
ADDRESS :
CMC, HOUSE – 02, ROAD - 04, SECTOR – 09, UTTARA MODEL TOWN, DHAKA – 1230.
POST CODE :
3850
PHONE (HOME) :
PHONE(PERSONAL):
DATE OF BIRTH :
03-FEB-1992
PLACE OF BIRTH :
COMPANIGONG,NOAKHALI.
NATIONALITY:
BANGLADESHI
RACE :
BANGALI
RELEGION :
ISLAM
AGE :
21
PASSPORT NOM :
AC3274949
PLACE OF ISSUE:
DHAKA,
BANGLADESH
DATE OF ISSUE :
26-FEB-2012
DATE OF EXPIRY :
25-FEB-2017
DISCHARGE BOOK NO :
CTB818129
PLACE OF ISSUE:
MANILA
DATE OF ISSUE :
20-MAY-2013
DATE OF EXPITY :
20-MAY-2018
MARITIAL STATUS :
SINGLE
LANGUAGE :
LANGUAGE CONVERSANT :
ENGLISH
SPOKEN :
ENGLISH
WRITEN :
ENGLISH
CONTACT :
NAME : SAIFUL ISLAM TIPU.
PHONE NO : +880**********
EMAIL : *************@**********.***.
FACEBOOK ID : www.FaceBook.com/saifulislam.tipu
SKYPE : Landking1090
VIBER NO : +880**********
EDUCATION :
NAME OF EDUCATION :
NAME OF INSTITUTE
ISSUED BY :
HND in Marine Engineering
CAMBRIDGE MARITIME COLLEGE (CMC)
EDEXCEL (UK)
HSC (HIGHER SECONDARY CERTIFECATE)
GOVT. MUJIB COLLEGE
BOARD OF INTERMEDIATE AND SECONDARY EDUCATION, COMILLA, BANGLADESH,
SSC (SECONDARY SCHOOL CERTIFECATE)
COMPANIGONG MODEL HIGH SCHOOL
BOARD OF INTERMEDIATE AND SECONDARY EDUCATION, COMILLA, BANGLADESH,
STCW-2010
SHORT COURSE
CAMBRIDGE MARITIME COLLEGE (CMC)
DEPARTMENT OF SHIPPING
(GOVT. OF BANGLADESH)
STCW COURSE CERTIFECATE :
NAME OF
CERTIFECATE :
CERTIFECATE
NO :
EXPITY DATE :
ISSUED AT :
ISSUED BY :
ELEMENTARY FIRST AID COURSE (EFA)
EFA/18/18
02-03-2018
CMC, DHAKA
DEPARTMENT OF SHIPPING, BANGLADESH
FIRE PREVENTION AND FIRE FIGHTING (FPFF)
FPFF/021/543
15-06-2018
CMC, DHAKA
DEPARTMENT OF SHIPPING, BANGLADESH
PERSONAL SURVIVAL TECHNIQUE (PST)
PST/021/393
25-03-2018
CMC, DHAKA
DEPARTMENT OF SHIPPING, BANGLADESH
PERSONAL SAFETY & SOCIAL RESPONSIBILITY (PSSR)
PSSR/021/243
25-03-2018
CMC, DHAKA
DEPARTMENT OF SHIPPING, BANGLADESH
INTERNATIONAL SHIP AND PORT SEQUERTY CORD FAMILIARISATION (ISPS)
ISPS/21/93
11-03-2018
CMC, DHAKA
DEPARTMENT OF SHIPPING, BANGLADESH
TANKER FAMILIARISATION COURSE FOR OIL & CHEMICAL (TFO&C)
TFO&C/021/318
25-03-2018
CMC, DHAKA
DEPARTMENT OF SHIPPING, BANGLADESH
TANKER FAMILIARISATION COURSE FOR GAS(TFG)
TFG/021/168
18-03-2018
CMC, DHAKA
DEPARTMENT OF SHIPPING, BANGLADESH
OTHER CERTIFECATE :
NAME OF
CERTIFECATE :
CERTIFECATE
NO :
EXPITY DATE :
ISSUED AT :
ISSUED BY :
MEDICAL FITNESS CERTIFECATE (MFC)
1399/2013
22-04-2015
CHITTAGONG, BANGLADESH
PORT HEALTH DEPARTMENT, CHITTAGONG,
MARITIME ENGLISH LANGUAGE (MEL) COURSE
MEL/021/468
24-03-2018
CMC, DHAKA
INTERNATIONAL MARITIME LECTURERS ASSOCIATION
WATCH KEEPING CERTIFECATE
PENDING
PENDING
CMC, DHAKA
DEPARTMENT OF SHIPPING, BANGLADESH
PARTICULARS OF FAMILY :
NAME OF NEXT KIN :
ABUL KHAIR AMIN
RELATIONSHIP :
FATHER
OCCUPATION :
DEED WRITER
PHONE NO :
ADDRESS :
ROOM NO-10, 1ST FLOOR, MAOLANA SHOPING COMPLEX(OPOSET OF COMPANIGONG THANA), P.O – COMPANIGONG, DIS – NOAKHALI.
NAME OF PERSON TO CANTACT IN EMERGNCY :
ABUL KHAIR AMIN
PHONE NO :
RECORD OF SEA SERVICE :
NO
SHIP & COMPANI NAME
RANK
TYPE OF VESSEL
GRT
TRADE
SIGN ON DATE
SIGN OFF DATE
1.
N/A
N/A
N/A
N/A
N/A
N/A
N/A
2.
N/A
N/A
N/A
N/A
N/A
N/A
N/A