APPLICATION FORM
Post Applied
ORDINARY SEAMAN TRAINEE
Name as per Passport
First Name
Middle Name
Last (or) Surname
ISURANGA
KASUN
SIRIWARDHANA
Date Of Birth
Place Of Birth
Nationality
Contact Number
22.11.1992
KANDY
SRI LANKAN
#1
********************@*****.***
#2
NEXT OF KIN
Full Name
H.K.L.I.GUNAWARATHNE
Relationship
BROTHER
Contact Number
PASSPORT DETAILS
Passport No
Issue Date
Expired Date
Issue Place
OFFICE USE ONLY
N 5498508
21.08.2015
21.08.2025
COLOMBO
ACADEMIC QUALIFICATION: (ENTER DEGREE/ DIPLOMA/ SCHOOL)
Degree
University
Yr. Passed
Grade
G.C.E O/L EXAMINATION
ST’SYLVESTERS COLLEGE KANDY
2010
PASS
PRE SEA TRAINING FPR DECK RATING
OCEAN UNIVERSITY OF SRI LANKA
2015
SUCCESSFULLY COMPLETED
CDC DETAILS
Document
CDC Number
Date Of Issue
Valid Till
Place Of Issue
OFFICE USE ONLY
CDC (Sri Lanka)
C 045938
23.08.2016
22.08.2021
COLOMBO
STCW COURSES ATTENDED AND CERTIFICATES HELD
Course/ Certificate
Certificate No.
Date Of Issue
Valid Till
Place Of Issue
OFFICE USE ONLY
PROFICIENCY IN PERSONAL SURVIVAL TECHNIQUES
RTST503088082
28.10.2015
28.10.2020
MERCANTILE SEAMAN TRAINING INSTITUTED
PROFICIENCY IN ELEMENTARI FIRST AID
RTST505109688
24.10.2015
24.10.2020
MERCANTILE SEAMAN TRAINING INSTITUTED
PROFICIENCY IN FIRE PREVENTION AND FIRE FIGHTING
RTST504094229
05.12.2015
05.12.2020
MERCANTILE SEAMAN TRAINING INSTITUTED
PROFICIENCY IN PERSONAL SAFETY AND SOCIAL RESPONSIBILITIES
RTST506084004
21.10.2015
21.10.2020
MERCANTILE SEAMAN TRAINING INSTITUTED
PROFICIENCY IN SECURITY TRAINING FOR SEAFARERS WITH DESIGNATED SECURITY DUTIES
RTST514114475
16.10.2015
16.10.2020
MERCANTILE SEAMAN TRAINING INSTITUTED
MARITIME ENGLISH LANGUAGE COURSE – SUPPORT LEVEL
RTCM601048999
07.12.2015
07.12.2020
MERCANTILE SEAMAN TRAINING INSTITUTED
BASIC TRAINING FOR OIL AND CHEMICAL TANKER CARGO OPERATIONS
SD1320/16 - 025/0405
01-12-2016
-
CINEC MARITIME CAMPUS
I do hereby declare that all information furnished above is correct to the best of my knowledge and belief.
Date Signature