Safety Officer Security
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APPLICATION FORM
ДОГ
РЕГ
RANK APPLIED
READINESS
MIN EXPECTED SALARY
1.PERSONAL DETAILS
SURNAME FIRST NAME MIDDLE NAME
NAME
Date of Birth
Place of birth
Nationality
Present Address
Telephone
Marital Status
Name of Spouse
No of Children
Height
Weight
Shoes
Boiler suit
Blood Group
Father
Name
Date of birth
Age
Mother
Next of Kin
Relationship
Addr/Tel
Education (Professional)
Period
(from - to)
English level
2.PASSPORTS
Document Name
Document No.
Date of Issue
Date of Expiry
Place of Issue
TRAVEL PASSPORT
NATIONAL SEAMANS’S BOOK
AMERICAN VISA
3. SEA EXPERIENCE: (Most recent last)
FROM - TO
COMPANY
RANK
VESSEL
TYPE
DWT
FLAG
ENGINE / HP
CREW
REASON
SIGN OFF
4.STCW AND OTHER CERTIFICATES
STCW COURSES
Certificate No.
Date of Issue
Date of Expiry
Place of Issue
CERTIFICATE OF COMPETENCY
ENDORSEMENT OF COMPETENCY
BASIC SAFETY TRAINING
PROFICIENCY IN SURVIVAL CRAFT
ADVANCED FIRE FIGHTING
MEDICAL 1ST AID
MEDICAL CARE
GMDSS GENERAL OPERATOR
RADAR & ARPA
SHIP’S SECURITY OFFICER
SHIP’S SAFETY OFFICER
SSO CERTIFICATE
TANKER FAMILIARISATION
CRUDE OIL WASHING
INERT GAS SYSTEM
OIL TANKER
SPECIALIZED TRAINING
CHEMICAL TANKER SPECIALIZED TRAINING
GAS TANKER
SPECIALIZED TRAINING
CAR. DANGEROUS & HAZARDOUS CARGO
YELLOW FEVER
NOTES:
Hereby affirm that all information provided by me in this application form is the true and correct to the best of my knowledge
Date: Signature:
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