PHOTO

APPLICATION FOR POSITION AS

CHIEF ENGINEER

OTHER POSITION (IF ANY)

1. PERSONAL DETAILS

TITLE MR/MRS/MISS

MR

SEX

MALE X

FEMALE

SURNAME

BHAKARE

FIRST NAME

SADASHIV

OTHERS NAMES

DATE OF BIRTH

29/01/1969

PLACE OF BIRTH

MUMBAI

NATIONALITY

INDIAN

MARITAL STATUS

MARRIED

COLOUR OF EYES

BLACK

COLOUR OF HAIR

BLACK

MOTHER’S NAME

VAIJANTA

FATHER’S NAME

MAHADEO

MOTHER’S MAIDEN NAME

HEIGHT (CM)

178

WEIGHT (KG)

76

NEAREST INTERNATIONAL AIRPORT:

MUMBAI

2. ADDRESS

ADDRESS (TEMP.) FROM/TO:

NO & STREET

104,DARSHAN CHS LTD, KOKAN NAGAR,JOGESHWARI EAST

NO & STREET

CITY

MUMBAI

CITY

POST CODE

400060

POST CODE

COUNTRY

INDIA

COUNTRY

TEL. NO.

TEL. NO.

MOBILE

916-***-****

MOBILE

E-MAIL

ac4pnd@r.postjobfree.com

E-MAIL

FAX

FAX

3. NEXT OF KIN

FULL NAME

NANDINI SADASHIV BHAKARE

RELATIONSHIP

WIFE

ADDRESS

SAME AS ABOVE

CITY

MUMBAI

COUNTRY

INDIA

TEL. NO.

MOBILE

FAX NO.

4. CHILDREN

FULL NAME OF CHILD

DATE OF BIRTH

SEX

SAGAR SADASHIV BHAKARE

03/01/2000

M X

F

SAURABH SADASHIV BHAKARE

13/12/2001

M X

F

M

F

M

F

5. TRAVEL DOCUMENTS

TYPE

DOCUMENT NO.

ISS.DATE

EXP. DATE

ISS. BY (AUTHORITY)

PLACE OF ISSUE

PASSPORT

H9757817

27/01/2010

26/01/2020

INDIA

MUMBAI

SEAMAN BOOK

BY68197

26/01/2012

25/03/2022

INDIA

MUMBAI

OTHER SEAMAN BOOK

F0183129

29/08/2017

31/12/2019

US C1/D VISA

J4750634

23/06/2014

19/06/2019

MUMBAI

OTHER VISAS

6. BANK ACCOUNT INFORMATION

BANK NAME

STATE BANK OF INDIA

BRANCH

ANDHERI EAST

BANK ADDRESS

CITY

MUMBAI

COUNTRY

INDIA

SORT CODE

ACCOUNT NO

BANK SWIFT CODE

BANK TEL. NO

ACCOUNT OWNER’S NAME

SADASHIV MAHADEO BHAKARE

ACCOUNT OWNER’S ADDRESS

104,DARSHAN 2 CHS LTD. KOKAN NAGAR, JOGESHWARI EAST MUMBAI 400060

7. EDUCATION

SCHOOL NAME

DIPLOMA IN MECH ENG

FROM

1984

TO

1988

SCHOOL NAME

FROM

TO

8. PROFESSIONAL QUALIFICATION / CERTIFICATE OF COMPETENCY

CERTIFICATE NAME

NUMBER

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

CLASS1 MOTOR

CoC0068196

18/03/2015

31/12/2019

UK

DANGEROUS CARGO ENDORSEMENT

NUMBER

ISSUE DATE

EXPIRY DATE

PETROLEUM

CoC0068196

18/03/2015

31/12/2019

CHEMICAL

GAS

9. LANGUAGES

ENGLISH

FLUENT

X

GOOD

FAIR

POOR

GERMAN

FLUENT

GOOD

FAIR

POOR

FRANCH

FLUENT

GOOD

FAIR

POOR

SPANISH

FLUENT

GOOD

FAIR

POOR

ITALIAN

FLUENT

GOOD

FAIR

POOR

RUSSIAN

FLUENT

GOOD

FAIR

POOR

MARLIN’S TEST / LEVEL

ISSUED DATE

RESULT %

ISSUED BY (AUTHORITY)

ISSUED AT

10. HEALTH CERTIFICATES & VACCINATIONS

FLAGE STATE

NUMBER

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

INTERNATIONAL

LIBERIAN

NORWEGIAN

PANAMANIAN

NAME

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

YELLOW FEVER

07/12/2010

06/12/2020

INDIA

MUMBAI

11. SAFETY CLOTHING

BOILERSUIT SIZE

XL

BOOTS SIZE

44

12. MARINE COURSES

COURSE NAME

NUMBER

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

PERSONAL SURVIVAL

BASIC FIRE FIGHTING

ADV. FIRE FIGHTING

BPMA/AFF/RF222/2016

18/01/2016

17/01/2021

BP MARINE

MUMBAI

ELEMENTARY FIRST AID

MEDICAL FIRST AID

RMFA D228/2014

21/04/2014

20/04/2019

MTI

MUMBAI

MEDICAL CARE

PERS. SAFETY & SOC. RESP.

MMTI/PSSR/16761/2018

06/01/2018

MMTI

MUMBAI

PROF. IN SURVIVAL CRAFT & RESCUE BOATS

BPMA/PSCRB/RF/1538/2016

20/01/2016

19/01/2021

BP MARINE

MUMBAI

FAST RESCUE CRAFT

G.M.D.S.S.

A.R.P.A. (Management level)

RADAR OBSERVATION

HAZMAT

OIL TANKER

ADVANCE OIL TANKER

CHEMICAL TANKER

ADVANCE OIL TANKER

BPMA/ATOTCO/330/2017

04/08/2017

03/08/2022

BP MARINE

MUMBAI

GAS TANKER

ADVANCE GAS TANKER

CRUDE OIL WASHING

INERT GAS PLANT

ISM CODE

SHIP SECURITY OFFICER

MMTI 350(RT)543

23/04/2014

22/04/2019

MMTI

MUMBAI

BRIDGE TEAM MANAGEMENT

DP INDUCTION

DP SIMULATOR

BRIDGE / ENGIINE ROOM RESOURCE MANAGEMENT.

SHIP HANDLING

INTERNAL AUDITORS COURSE

12. MARINE COURSES (CONTD……)

COURSE NAME

NUMBER

ISSUE DATE

EXPIRY DATE

ISSUED BY (AUTHORITY)

ISSUED AT

13. SPECIALISED EXPERIENCE

TYPE

FROM

TO

COMMENTS

NEW BUILDING

SPECIALISED PROJECTS

SPECIAL TRADES

SHORE EXPERIENCE

COMPLETE SEA – SERVICE DETAILS

( LAST VESSELS FIRST )

NAME:

SADASHIV BHAKARE

RANK:

AVALIABILITY DATE:10/3/2018

COMPANY NAME

RANK

VESSEL NAME

SIGNED

ON

SIGNED OFF

PERIOD IN MONTHS

(eg 4.2)

TYPE OF VESSEL

G.R.T.

ENGINE TYPE

( ENGINEERS ONLY)

BHP

KW

OSM

2/E

MT SOL

18/04/2017

26/12/2017

4.9

TANKER

81479

MAN B&W

16846

SELANDIA

2/E

MT GENER8 DEFIANCE

21/04/2016

17/08/2016

3.26

TANKER

56225

SULZER6 RTA 58T

16300

OSM

2/E

MT DIAMEND

09/09/2015

09/01/2016

4.0

VLCC

165784

SULZER RT-FLEX

31640

OSM

2/E

MT GENMAR MANIATE

09/07/2014

26/10/2014

3.16

TANKER

MAN B&W 6S 70MC-C7

OSM

2/E

MT GENMAR ULYSSES

11/06/2012

27/10/2012

4.17

VLCC

160889

MAN B&W 6S90 MC-C

35910

OSM

2/E

MT SIMA

10/09/2011

16/02/2012

5.6

TANKER

85462

MAN B&W 6S 70MC-C7

18660

OSM

2/E

MT MARBAT

22/06/2010

24/11/2010

5.2

VLCC

163257

MAN B&W 6S 90MC-C7

39900

OSM

2/E

MT NESA

30/06/2009

01/12/2009

5.1

VLCC

156809

SULZER RTA 84T

36960

OSM

2/E

MT NAJM

03/01/2009

06/03/2009

2.2

VLCC

156809

SULZER RTA 84T

OSM

2/E

MT NABI

12/07/2008

17/11/2008

4.5

VLCC

156809

SULZER RTA84T

OSM

2/E

MT GULF SCANDIC

13/07/2007

08/01/2008

5.25

TANKER

80187

MANB&W 6S70 MC

OSM

2/E

MT GULF SCANDIC

14/07/2006

13/01/2007

6.0

TANKER

80187

MAN B&W 6S 70 MC

REFERENCE CONTACT DETAILS

COMPANY NAME

ADDRESS

PHONE NO.

FAX/E-MAIL

CONTACT PERSON

I declare that the information I have given is, to the best of my knowledge, true and complete. I also declare that the documents submitted are genuine, given and sign by persons whose names appear on them.

DATE

SIGNATURE

Officer Application Form

Ref .No

(For Official Use)

Medical History

Have you ever signed off from a ship due to medical reasons?

(If yes give details)

*yes/no

Name of Vessel

Date of occurrence (dd-mmm-yyyy)

Brief Description Of illness/Injury/Accident

Details

Have you ever suffered from any ailment or disease in the past that is likely to render you unfit for sea service or likely to endanger the health /well being of others onboard?

(If Yes give details)

*Yes/No

Details

Do you have any bodily defects or deficiencies?

(If Yes give details)

*Yes/No

Details

Are you currently suffering from any ailment or disease that is likely to render you unfit for sea service or likely to endanger the healthy /well being of others onboard?

(If Yes give details)

*Yes/No

Details

Are you addicted to alcohol or drug of any kind?

(If Yes give details)

*Yes/No

Details

Are you suffering from an ailment that requires you to be on a long -term treatment/medication?

(If Yes give details)

*Yes/No

Details

Have you ever deported or banned from entering any country?

(If Yes give details)

*Yes/No

Details

Have you ever been convicted of a criminal or drug offence or have any pending offences?

(If Yes give details)

*Yes/No

Details

Do you have any obligations towards your current/previous employers?

(If Yes give details)

*Yes/No

I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge and belief; further, that no certificate of competency or License issued to me has ever been Revoked or Suspended. I also certify that my medical history contained above is true and any false statement or undisclosed Material information about past illness or injury will disqualify me from any employment benefits and claims.

dd-mmm-yyyy (Format) Signature

Contact this candidate