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:

ac4ymk@r.postjobfree.com

(Tel No. :022-********

Mobile

098********

Local address:

SAME AS ABOVE

E-Mail:

AS ABOVE

(Tel No. 022-********

Mobile

098********

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

161***********

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

Contact this candidate