MSC CREWING SERIVCES PRIVATE LIMITED

APPLICATION FORM

1

Position ID/PD No. (For Office Use Only)

Position applied for: Electrical officer

Are you willing to accept any other positions? If YES, which positions would you consider?

YES/NO

NO

Are you responding to a media advertisement? If YES, please state which publication

YES/NO

YES

www.seajobs.net

From what date will you be available?

At one week notice

2

Personal details

Name:

(Surname) VARMA

(First Names) CHANDRA

(Middle Name) PRAKASH

Date/Place of Birth:

05/01/1957 JIYABERA, JODHPUR

Nationality:

INDIAN

Permanent address:

7D3, CHOPASANI HOUSING BOARD, JODHPUR RAJASTHAN

Pin Code: 342008

E-Mail:

ac8k8v@r.postjobfree.com

Tel No. :029*-*******

Mobile

966*******

Local address:

Pin Code:

E-Mail:

ac8k8v@r.postjobfree.com

Tel No. 029********

Mobile

966*******

3a

Educational Background

Qualification

School / College

From

To

Percentage/ Grade

Graduation

INDIAN NAVY

1972

1984

3b

Technical Background

Degree/ Diploma

Institute/ College

From

To

Percentage / Grade

DEGREE IN ELECTRICAL ENGINEERING

INDIAN NAVY

1972

1984

4

Identity documents

DOCUMENT

COUNTRY

NUMBER

DATE OF ISSUE

PLACE OF ISSUE

DATE OF EXPIRY

Passport:

INDIAN

L4359663

11/7/2013

JAIPUR

10/7/2023

Seaman Book:

National

BY 64380

23/11/2011

MUMBAI

22/11/2021

Panamanian

CTB232350 624607 B1

01/10/09

MANILA

01/10/14

Malta

Others

Do you hold a US Visa ‘C1/D’?

YES/NO

YES

Issue Date:

12/06/2014

Expiry Date: 10/06/2019

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) 01LL0978

YELLOW FEWER V/T 17/05/2012

MUI / NUSI NO : E038537 V/T

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

PUSHPA VARMA

WIFE

4-4-59

Jodhpur

VIKRAM SINGH VARMA

SON

11-9-78

JAMNAGAR

AMRIT JEET KAUR VARMA

DAUGHTER

2-8-84

AGRA

ANURAG SAGAR VARMA

SON

3-10-87

JODHPUR

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

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

A07793

MTI/SCI

17-2-1996

HH

AFF- Refresher & Updating

AFF-RF/773/2016

BPMARINE

24-2-2016

EFA / MFA / MEDICARE

154MFA/6704/0211

FOSMA

30-5-214

PSCRB

PSCRB-RF/1518/216

BPMARINE

22-2-2016

PST

PSSR – Personal Safety & Social Responsibilities

PSSR/1074/2016

BPMARINE

27-2-2016

SSO – Ship Security Officers Course

154SSOR/6704/0377

FOSMA

29-5-2014

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 (SMCC)

GMDSS + endorsement

National License Revalidation/Refresher Course

Container Operations Familiarization

Electrical Familiarization for Marine Engineers

Electronics for Marine Engineers

Instrumentation & Shipboard Control Systems

Automation and Controls

AUTO/09-06/522

IMTC

20-5-2006

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 / REFRESHER

MEP06145

ARI

23-5-2006

MEPC / REFRESHER

MEP (R)08036

ARI

26-02-2008

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

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

UNIVAN

M/V CRIMSON VENUS

B C

49673

20

MITSUBISHI- 6UELC50

11220

E/O

1-6-12

5-2-2013

00/08/05

CC

UNIVAN

M/V HONGKONG SUN

B C

25425

20

MITSUBISHI- SOLZER

6184 K.W.

E/O

6-6-10

22-12-2010

00/06/16

CC

UNIVAN

M/V TJ ANDROMEDA

BC

38931

20

MAN / B&W

11400

E/O

22-9-09

19-12-09

00/02/27

SHIP HANDED OVER TO OWNER

MSC

M/V MEDITERRANEAN

CONT

/29181

2500

14

MAN / B&W

22930

E/O

2-4-08

17-12-08

00/8/15

CC

MSC

M/V MSC REBECCA

CONT

45561

3400

10

SAMSUNG SOLZER

38539

E/O

23-4-07

23-8-07

00/04/00

CC

MSC

M/V MSC REBECCA

CONT

45561

3400

9

SAMSUNG SOLZER

38539

E/O

12-6-06

26-12-06

00/06/14

CC

MSC

M/V MSC REBECCA

CONT

45561

3400

8

SAMSUNG SOLZER

38539

E/O

22-6-05

30-12-05

00/06/08

CC

UNIVAN

M/V MSC REBECCA

CONT

45561

3400

7

SAMSUNG SOLZER

38539

E/O

22-5-04

25-12-04

00/07/05

CC

UNIVAN

M/V EASTERN EXP.

REF.

9662

15

AKASAKA DIESEL

13090

E/O

07-1-03

07-11-03

00/10/00

CC

ASM

M/V AMER FUJI

REF.

11540

11

KOBEY DIESEL

9200

E/O

23-7-01

28-09-01

00/02/05

ARGENT WORK AT HOME

ASM

M/V IVORY TIRUPATI

REF.

10000

12

B&W

15300

E/O

28-07-2000

06-3-01

00/7/09

CC

ASM

M/V AMER FUJI

REF.

11540

10

KOBEY DIESEL

9200

E/O

08-07-99

02-04-00

00/08/24

CC

ASM

M/V AMER EVREST

REF.

/9072

10

KOBEY DIESEL

9200

E/O

23-01-98

31-07-98

00/06/08

CC

ASM

M/V AMER ASHA

CARGO

/10979

25

DOXFORD

10800

E/O

03-7-96

02-12-96

00/05/00

CC

ASM

M/V SPINOZA

CARGO

/9902

24

MAN

8690

E/O

15-02-95

05-01-96

00/10/20

CC

ASM

M/V AMER FUJI

REF.

11540

2

KOBEY DIESEL

9200

E/O

05-08-92

01-02-93

00/05/28

CC

ASM

M/V AMER FUJI

REF.

11540

2

KOBEY DIESEL

9200

E/O

10-02-92

18-05-92

00/03/08

MOTHER EXPIRED

ASM

M/V AMER JYOTI

CARGO

/9534

17

MAN

8690

E/O

28-11-90

27-08-91

00/09/00

CC

TROODOS

ST. SAPPHIRE

TANKER

392799

17

MAN STEAM TURBINE

45000

E/O

13-4-89

01-06-90

01/01/20

CC

MSSC HOSPITAL

300 BED

SSO

01-9-84

31-3-89

04/07/00

INDIAN NAVY

various ships/submarines

poelp

15-09-72

31-03-84

11/06/16

10

For Engineers (Please provide details)

Generators

Purifiers and Boilers

Type of Cranes / No of Reefer Containers

11

Sailing Experience: (Please advise PRESENT RANK EXPERIENCE on each type of vessel)

Container

tanker

Reefer

Multi Purpose

Others

02 Y, 08 M, 12 D

01Y,01M,20D.

03 Y, 07 M, 22 D

03 Y, 10 M, 23 D

LAST SALARY DRAWN (PLEASE MENTION CURRENCY)

5000 US DOLLAR.

12

Medical history

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

YES/NO

NO

Have you undergone any operation in the past?

YES/NO

NO

Have you consulted a doctor during the last 12 months for an illness/accident?

YES/NO

NO

Do you have any health or disability problems now?

YES/NO

NO

(If the answer is YES to any of the above, please give full details and attach a separate page if necessary)

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

1. UNIVAN

2. MSC

3. ASM

Name of person to contact

Address

No.

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:

14/02/2019

Signature

17

BOILER SUIT SIZE: XL SAFETY SHOE SIZE: 10

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