APPLICATION FORM
Position
Position applied for: : ETO/EO
Are you willing to accept any other positions? If YES, which positions would you consider?
YES/NO
YES
SENIOR ETO/EO
Are you responding to a media advertisement? If YES, please state which publication
YES/NO
YES
MARREX,JOBSHIP
From what date will you be available? Immediate
2
Personal details
Name:
(Surname) MANDLE
(First Names) ASHOK
(Middle Name) KUMAR
Date/Place of Birth:
TAKHATGARH, PUNJAB
TAKHATGARH, PUNJAB
Permanent address:
A-402,HEENA GAURAV JEWELS, GEN. A.K.VAIDYA MARG, FILM CITY ROAD, GOREGAON (E),
MUMBAI
E-Mail:
********@**********.***
(Tel No. :022-********
Mobile
Local address:
SAME AS ABOVE
E-Mail:
AS ABOVE
(Tel No. 022-********
Mobile
3a
Educational Background
Qualification
School / College
From
To
Percentage/ Grade
GRADUATE
PUNJAB UNIVERSITY CHANDIGARH
APR,1976
APR,1977
3b
Technical Background
Degree/ Diploma
Institute/ College
From
To
Percentage / Grade
DIPLOMA IN ELECTRICAL ENGINEERING
ELECTRICAL TRAINING INSTITUTE OF THE INDIAN NAVY, INS VALSURA
MASTER CHIEF ELECTRICAL
EX-INDIAN NAVY
07 FEB,1970
31st DEC,1993
4
Identity documents
DOCUMENT
COUNTRY
NUMBER
DATE OF ISSUE
PLACE OF ISSUE
DATE OF EXPIRY
Passport:
INDIAN
Z26 01161
07.05.2013
MUMBAI
06.05.2023
Seaman Book:
National
MUM 98951
07.02.2012
MUMBAI
06.02.2022
Panamanian
1130873
09.10.2015
LONDRES
08.10.2020
Liberian
Others
Do you hold a US Visa ‘C1/D’?
YES/NO
YES
Issue Date:
22.08.2012
Expiry Date: 13.08.2017
Do you hold a US Visa ‘B1/B2’?
YES/NO
NO
Issue Date:
Expiry Date:
Have you been rejected for any visa applied for?
YES/NO
NO
If YES, please state the country and reasons
INDOS No: (only for Indians) 01LL1421
YELLOW FEWER V/T YES UNLIMITED
MUI NO : E023419
DOI: 08.08.2010, DOE: UNLIMITED
5
Family Details: (If Unmarried kindly give details of Father / Mother)
NAME
Relation
DOB
POB
PASSPORT NO.
PLACE OF ISSUE
DATE OF ISSUE
DATE OF EXPIRY
ECNR
MRS.KAMLESH MANDLE
WIFE
20.09.1956
AMARGARH
L1688652
MUMBAI
16.04.2013
15.04.2023
NOT REQUIRED
6
Certificates (Highest certificate of competency held)
Grade/Class Of COC Country
Issuing Country
Date of Passing Exam
Certificate No.
Date Issued
Place Issued
Valid Until
ETO
INDIA
17.10.2016
ETO-862
07.12.2016
MUMBAI
16.10.2021
7
Certificates Of Competency issued by other countries (Issued by countries other than in Section 6)
Issuing Country
Certificate No.
Date Issued
Place Issued
Valid Until
Panama
Others
8
Details of Courses
Courses
Certificate No.
Issued By
Date Issued
Date Of Expiry
FPFF / AFF
SCI MARITIME TRAINING INSTITUE, POWAI,
MUMBAI
02.05.2016
01.05.2021
MFA
R-MFA/A-101/2014
MARINE TRAINING ACADEMY
GOREGAON
(E)
28.01.2014
27.01.2019
PSCRB & PST
AIIMT/MUM/REF/PSCRB/B122/2863
ASHA INTERNATIONAL INSTITUTE OF MARINE TECHNOLOGY, CBD BELAPUR, NEW MUMBAI
09.06.2016
08.06.2021
PST
PSTC/0127/021/2003
22.03.2003
PSSR – Personal Safety & Social Responsibilities
PSR/E-10996/2016
MARINE TRAINING ACADEMY
GOREGAON
(E)
07.05.2016
UNLIMITED
HIGH VOLTAGE SAFETY AND SWITCH GEAR COURSE
411
ANGLO EASTERN MARITIME TRAINING CENTRE
19.11.2016
ME ENGINE CONTROL SYSTEM
ANGLO EASTERN MARITIME TRAINING CENTRE
15/07/2011
MARINE HYDRAULIC COURSE
SCMPIP/HYDR/012
SEASPAN COMPETENCE DEVELOPMENT CENTRE
12.07.2013
A/C & REFRIGERATION COURSE
044615
DIMS
14.12.1993
PROFICIENCY IN SECURITY TRAINING WITH DESIGNATED SECURITY DUTIES
STSM/A-1164/2014
MARINE TRAINING ACADEMY
24.01.2014
SSO – Ship Security Officers Course
ISPS Course
ROSC – Radar OBS Simulator
ARPA – Automatic Radar Plotting Aid
RANSCO – Radar, Arpa & Navigation Simulator
BTM
SMS / SHS / ERS
ECDIS
Bridge / Engine Resources Management (BRM / ERM)
Ship Master Command and Control Course
GMDSS + endorsement
RUTC – Refresher & Up gradation Course
Container Operations Familiarization
Electrical Familiarization for Marine Engineers
Electronics for Marine Engineers
Instrumentation & Shipboard Control Systems
Automation and Controls
Container Refrigeration
Hydraulics for Engineers (Basic / Advance)
Hazmat (In compliance with STCW-95 Section-B -V/b & V/c & CFR – 49)
CFR-49
Hydraulics and Pneumatics Workshop
Watch Keeping Certificate Ratings (Deck/Engine)
Applied Electronics (AELC)
Practical Marine Electrical Workshop
Engine Equipment Maintenance Workshop
Basic Electrical and Fluid Technology
Reefer Container and Maintenance Course
MEPC
MEPC/JUN16/5171
MSC TRAINING CENTRE
15.06.2016
Operational competence enhancement course for deck officers
Safety, Environment Compliance & Pollution Prevention Training for Crew
Vessel Resource Management (VRM)
Electro Technical Officer/ Rating Certificate
AMOS
AMOS/SEP15/961
MSC TRAINING CENTRE
22.09.2015
9
9
Record of previous service
(Please give a full record starting with the last vessel on which you served)
COMPANY
VESSEL NAME
VESSEL TYPE
D.W.T/
GRT
CONTS TEU’S
VSL AGE
TYPE OF ENGINES
(Please give full dtls)
B.H.P
RANK
SIGN ON dd/mm/yy
SIGN OFF dd/mm/yy
DURATION yy/mm/dd
REASONS FOR S/OFF
MSC
MSC ANZU
LARGE CONTAINER VESSEL
8800
MAN B&W 10K98ME-C7; 68530
63530
SR. E/O
28.11.2016
18.02.2017
0/2/21
CREW REPLACED BY OTHER NATIONALITY
MSC
MSC RENEE
VERY LARGE CONTAINER
13100
HYUNDAI–MAN B&W 12K98ME7; 72240 kW at 104 RPM
72240
SR. E/O
17.06.2016
02.09.2016
0/2/16
WIFE SERIOUS MEDICAL PROBLEM
MSC
MSC AGRIGENTO
LARGE CONTAINER VESSEL
8800
MAN B&W 10K98ME-C7; 68530
47430
SR. E/O
17.10.2015
22.03.2016
0/5/5
Contract completed
SEASPAN
COSCO PRIDE
VERY LARGE CONTAINER
141823
13100
HYUNDAI–MAN B&W 12K98ME7; 72240 kW at 104 RPM
72240
E/O
08-Dec-2014
13-May-2015
0/5/6
Contract completed
SEASPAN
COSCO GLORY
VERY LARGE CONTAINER
141823
13100
HYUNDAI–MAN B&W 12K98ME7; 72240 kW at 104 RPM
72240
E/O
14-Mar-2014
03-Sep-2014
0/5/19
Contract completed
SEASPAN
COSCO EXCELLENCE
VERY LARGE CONTAINER
141823
13100
HYUNDAI–MAN B&W 12K98ME7; 72240 kW at 104 RPM
72240
E/O
23-Jul-2013
16-Jan-2014
0/5/23
Contract completed
SEASPAN
COSCO HOPE
VERY LARGE CONTAINER
141823
13100
HYUNDAI–MAN B&W 12K98ME7; 72240 kW at 104 RPM
72240
E/O
06-Oct-2012
29-Mar-2013
0/5/23
Contract completed
SEASPAN
COSCO FORTUNE
VERY LARGE CONTAINER
141823
13100
HYUNDAI–MAN B&W 12K98ME7; 72240 kW at 104 RPM
72240
E/O
27-Apr-2012
14-Jul-2012
0/2/20
Compassionate grounds
SEASPAN
COSCO DEVELOPMENT
VERY LARGE CONTAINER
141823
13100
HYUNDAI–MAN B&W 12K98ME7; 72240 kW at 104 RPM
72240
E/O
10-Aug-2011
16-Jan-2012
0/5/6
Contract completed
SEASPAN
COSCO PHILLIPINES
LARGE CONTAINER
91051
8500
MAN B&W 11K98ME-C7; 68530 @97rpm
Man B&W
68530
E/O
23-Jan-2011
26-Apr-2011
0/3/3
contract completed
BERNARD SCHULTE
ANNA SCHULTE
CONTAINER
26582
3500
Man B&W
21573
E/O
03-Oct-2010
16-Nov-2010
0/1/13
Sea span called back
SEASPAN
CSCL AFRICA
LARGE CONTAINER
90645
9000
MAN B&W -93120kW@104rpm/ GT-90645
93120
E/O
01-Mar-2010
25-Jun-2010
0/4/24
Contract completed
SEASPAN
MV JAKARTA EXPRESS
CONTAINER
39941
4200
MAN B&W 8K90MC-C; 37493kW@104rpm
49680
E/O
06-May-2009
25-Oct-2009
0/5/19
Contract completed
SEASPAN
MV LAHORE EXPRESS
CONTAINER
39941
4200
MAN B&W 8K90MC-C; 37493kW@104rpm
49680
E/O
16-Sep-2008
30-Mar-2009
0/6/14
Contract completed
SEASPAN
MV SAIGAON EXPRESS
CONTAINER
39941
4200
MAN B&W 8K90MC-C; 37493kW@104rpm
49680
E/O
10-Feb-2008
30-Jul-2008
0/5/20
Contract completed
SEASPAN
MV LAHORE EXPRESS
CONTAINER
39941
4200
MAN B&W 8K90MC-C; 37493kW@104rpm
49680
E/O
08-Oct-2007
02-Dec-2007
0/1/24
Contract completed
SEASPAN
CSCL HAMBURG
CONTAINER
39941
4200
MAN B&W 8K90MC-C; 37493kW@104rpm
49680
E/O
19-Mar-2007
16-Sep-2007
0/5/27
Contract completed
SEASPAN
CSCL CHIWAN
CONTAINER
39941
4200
MAN B&W 8K90MC-C; 37493kW@104rpm
49680
E/O
17-Oct-2006
23-Dec-2006
0/3/6
COMPASSION-AT GROUND
SEASPAN
CSCL MELBOURN
CONTAINER
39941
4200
MAN B&W 8K90MC-C; 37493kW@104rpm
49680
E/O
10-Jul-2006
25-Aug-2006
0/1/15
COMPASSION-AT GROUND
SEASPAN
CSCL SYDNEY
CONTAINER
39941
4200
MAN B&W 8K90MC-C; 37493kW@104rpm
49680
E/O
09-Apr-2006
01-Jun-2006
0/1/22
Mother Expired
ZODIAC MARITIME AGENCIES
MV GRAFTON
CAP SIZE BULK CARRIER
85421
Hanjung - MAN B&W
5S 70 MC
18200
E/O
20-Jul-2005
24-Feb-2006
0/7/4
Contract completed
ZODIAC MARITIME AGENCIES
MV HEYTHROP
CAP SIZE BULK CARRIER
85421
Hanjung - MAN B&W
5S 70 MC
18200
E/O
08-Nov-2004
06-May-2005
0/5/28
Contract completed
OCEAN BULK CARRIER
MV GOWENDOLEN
BULK CARRIER
27985
8650
E/O
28-Jul-2004
30-Sep-2004
0/2/2
COMPASSION-AT GROUND
Zodiac maritime agencies
MV NEW FOREST
CAP SIZE BULK CARRIER
93629
HYUNDAI MAN B&W
7S 70MC
21650
E/O
07-Dec-2003
22-May-2004
0/5/15
Contract completed
Zodiac maritime agencies
MV FERNIE
CAP SIZE BULK CARRIER
63153
Hanjung - MAN B&W
5S 70 MC
16200
E/O
22-Apr-2003
11-Oct-2003
0/5/19
Contract completed
Zodiac maritime agencies
MV MEYNELL
CAP SIZE BULK CARRIER
93629
HYUNDAI MAN B&W
7S 70MC
21650
E/O
14-JAN-2002
19-JUN-2002
0/5/5
Contract completed
K-LINE
AKASHI BRIDGE
CONTAINER
48272
3600
41600
E/O
19-Jul-2002
24-Nov-2002
0/4/5
Contract completed
Dockendale
MV VOC STERLING
BULK CARRIER
14118
MAN B&W 6S 42 MC
8370
E/O
14-Feb-2001
24-Oct-2001
0/8/10
Contract completed
Fleet Management Ltd
MSC Paraguay
CONTAINER
22667
2200
HYUNDAI B&W
6L 70MC
8040
E/O
05-Sep-2000
31-Oct-2000
0/1/26
COMPASSION-AT GROUND
Fleet Management Ltd
MV WALGAN LIGHT
BULK CARRIER
12909
23000
E/O
01-Sep-1999
27-May-2000
0/8/27
COMPASSION-AT GROUND
Fleet Management Ltd
MV MIN NOBLE
BULK CARRIER
35671
10800
E/O
29-Aug-1998
25-Feb-1999
0/5/25
Contract completed
Fleet Management
MV Spar two
BULK CARRIER
22258
1740
E/O
24-Feb-1998
13-Jul-1998
0/4/18
Contract completed
Fleet Management
MV NOBLE FORTUNE
BULK CARRIER
36053
10500
E/O
20-Jun-1997
11-Dec-1997
0/5/21
Contract completed
Fleet Management
MV NOBLE EMPRESS
BULK CARRIER
14330
7050
E/O
30-Jun-1996
26-Mar-1997
0/8/26
Contract completed
Fleet Management
TA PATHFINDER
BULK CARRIER
12963
Man B&W
7050
E/O
02-Sep-1995
03-May-1996
0/8/1
Contract completed
ARNAV SHIPPING
MV AL BASHIR
GENERAL CARGO
12963
7050
E/O
06-NOV-1994
20-MAY-1995
0/6/19
Contract completed
ESSAR SISCO
MV NANDNEETI
BULK CARRIER
25538
8500
E/O
15-APR-1994
04-AUG-1994
0/3/19
Contract completed
I have experience of working on 13100 TUE & 8500TUE container vessels fitted with ME Engine and High voltage switch boards. I have also taken over two in Nos .New 13100 TUE container vessel (Cosco development & Cosco Fortune) from Hyundai ship yard.
10
For Engineers (Please provide details)
Generators
HHI-Himsen 3470KW,6600V, 720RPM,
YANMAR, M-220 L-EX, 640KW,720RPM
TAIYO ELECTRIC CO. JAPAN,750KVA,450V,900RPM
DIAHATSU, 6PS HTC-26HX3, 500KW,720RPM
CATTERPILLAR 3306KW-165
HYUNDAI 450V,3 PHASE,60HZ, 837.5KVA
Purifiers and Boilers
Alfa Laval SA-881,SA-841,PA-625
SUN ROD BOILER CPDB-15 WP:7 Bar,
COMPOSITE BOILER OSAKA TYPE OVS2-100/80-22 WP:6KG,
SAACKE BOILER SKVJ-15 WP:6 Bar,
HYUNDAI VERTICAL COMPOSIT BOILER WP:7BAR
KANGRIM BOILER-PA0403P38
Type of Cranes / No of Reefer Containers
HHI, TSUZI, MITSUBISHI / 720 reefer containers- Carrier, Daikin, Thermo king, Mitsubishi, star cool
11
Sailing Experience: (Please advise PRESENT RANK EXPERIENCE on each type of vessel)
Container
PCC
Reefer
Multi Purpose
Others
6 years 4 months
1 year 4 months
7 years
LAST SALARY DRAWN (PLEASE MENTION CURRENCY) USD 5500+Rejoining bonus
12
Medical history
Have you ever signed off a ship due to medical reasons?
YES/NO
Yes
Have you undergone any operation in the past?
YES/NO
Have you consulted a doctor during the last 12 months for an illness/accident?
YES/NO
Do you have any health or disability problems now?
YES/NO
(If the answer is YES to any of the above, please give full details and attach a separate page if necessary)
Due to fever
13
General
Have you ever been the subject of a court of enquiry or involved in a maritime accident?
YES/NO
NO
Have you ever had a professional license suspended or revoked?
YES/NO
NO
(If YES, please give full details and attach a separate page if necessary)
14
References (Please give the name and address of your current or immediate past employer)
Name of company
MSC
Name of person to contact
SUBASH CHANDER SHARMA
Address
MSC HOUSE,ANDHERI KURLA ROAD.
MUMBAI. INDIA
( No.
0091-022-67522512, 090********
15
Review
If immediate employment is not available do you wish to be considered for future vacancies?
YES/ NO
YES
If YES, please give any alternative contact details not shown in Section 2
16
Declaration
I hereby declare that the above particulars are true and authorise you to contact the referees listed above.
Date:
04-09-2017
Signature
17
BOILER SUIT SIZE: XL SAFETY SHOE SIZE: 10