Cheif Engineer
Resume:
Employment Application Form
*. Position
Post applied for CHIEF ENGINEER
Willing to accept lower rank? Yes/No
Available From: Any Time
2. Personal Details
First Name Middle Name Last Name/Surname
Subbiah
Karuppiah
Indos No. 08EL0820
Date of Birth : 10.05.1970
Place of Birth : Ramanathapuram
Permanent Address:
2/10, Valluvar Street,
Present/Temporary Address:
Krishnamoorthy Nagar
SAME
Kodungayur
City: Chennai - India
City:
Post Code: 600118 MOBIL : 951-***-****
Post Code: Tel.:
Nearest Airport: CHENNAI International
Nearest Airport:
3. Next of Kin Details
Name of Nominee
in case of fatality: Ms.Lakshmi Karuppiah
Relationship: WIFE
Address: SAME AS ABOVE
City: Post Code: Tel.:
4. Identity Details
Document
No.
Issued on
Place
Valid Until
ECNR
Blank Pages
Passport :
Z3576350
18/03/2016
Chennai
17/03/2026
YES
Seaman’s Book (CDC): National
MUM-211390
29/01/2013
Mumbai
28/01/2023
Seaman’s Book ( CDC) : PANAMA
P0285974
13/12/2017
Mumbai
29/11/2022
Seaman’s Book (CDC):Honduras
041169
14-11-2017
Mumbai
14-11-2021
Seaman’s Book (CDC): Other
5. 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
6.Certificates / Courses:
a) Highest Competency Certificate Held:
Issuing Authority:
Grade
Certificate Number
Date Issued
Place Issued
Valid Until
Panama
Chief Engineer
CT - 127288/17 - HOU
13/12/20177
Panama
29/11/2022
Honduras
CHIEF ENGINEER
KS-5140-M
14-11-2017
Mumbai
14-11-2021
Others(Pls Specify)
6.b) STCW And Other Certificates held & courses attended :
Country
Certificate No.
Date of Issue / Exp
Place of Issue
INDOS No.
08EL0820
12/05/08
Mumbai – LBS
DP Course
SDB/E/03-155/2014
06/01/2014
Mumbai - BIBBY
BOISET
2014-01
11/01/2014
Mumbai
H2S
2014-01
11/01/2014
Mumbai
LGTF
16/11/2019
Chennai – HIMT
PSSR
04/208/2984
09/11/19
Chennai – HIMT
MFA
2088
05/10/19 – 04/10/24
Chennai – HIMT
TFC
B552/11
17/02/2012
Chennai – HIMT
R-AFF
B412/13
25/04/2018
Chennai-HIMT
PSCRB
B460/12
24/04/2018
Chennai-HIMT
BPST
03324-2017
14/11/2022
ITI
PANAMA
ERM
1760
24/11/2022
ITI
PANAMA
SSO
2241
24/11/2022
ITI
PANAMA
SEA EXPERIENCE
OWNER/ AGENT
NAME OF VESSEL
TYPES
BHP
RANK
FLAG/ AREA
FROM
TO
ATLANTIC SHIP MANAGEMENT
AFRICAN PRINCESS -4
UTILITY VESSEL
1600*2
CHIEF ENGINEER
DOGO
10/12/2018
15/04/2019
KNK SHIP MANAGMENT
M.V.VOYAGE SYMPHONY
RORO PAX VESSEL
6000
CHIEF ENGINE
ER
CHINA
12/06/2018
11/09/2018
HEDEOFFS HORE
M.V.SEASAFE
AHTS / OSV VESSEL
6000
CHIEF ENGINE
ER
DUBAI
04/04/2016
23/05/2017
HEDEOFFS HORE
M.V.SEASAFE
AHTS/ OSV VESSEL
6000
CHIEF
ENGINEER
DUBAI
18/06/2014
23/06/2015
C.S.OFFSHO RE
MANIVIKI DEXTER / ACCOMODATION BARGE
AHTS
9753
CHIEF
ENGINE ER
NIGER IA
10/10/2013
11/12/2013
MFH
DELTA TANGO 2
DUCK & BARGE
1600
CHIEF ENGINE
ER
QATA R
19/08/2012
19/03/2013
NAKILAT
M.T.AL DHAKHIRA
DUCK
3460
SECOND
ENGINE ER
QATA R
17/02/2010
17/06/2010
NAKILAT
M.T.MELAIH
DUCK
4412
SECOND ENGINE
ER
QATA R
05/08/2009
05/01/2010
NAKILAT
M.T.AL DHAKHIRA
DUCK
3460
SECOND ENGINE
ER
QATA R
04/03/2009
05/06/2009
ARC MARAINE
M.V.MAHI
CREW BOAT
510*3
JUNIOR
ENGINE ER
MUMB AI
15/09/2006
14/06/2007
ARC MARAINE
M.V.MAHI
CREW BOAT
510*3
JUNIOR ENGINE
ER
MUMB AI
15/11/2005
12/06/2006
ARC MARAINE
M.V.RAAVI
CREW BOAT
525*3
JUNIOR ENGINE
ER
MUMB AI
14/09/2005
10/11/2005
ARC MARAINE
M.V.RAAVI
CREW BOAT
525*3
JUNIOR
ENGINE ER
MUMB AI
15/09/2004
09/06/2005
ARC MARAINE
M.V.RAAVI
CREW BOAT
525*3
JUNIOR
ENGINE ER
MUMB AI
26/11/2003
30/04/2004
8. Knowledge Of Language*
Spoken Written Read
English F F F
Hindi M P P
Telngu M P P
Tamil F F F
*Use abbreviations for the following: F – Fluent; M – Moderate; P – Poor
9. General:
(A) Have you ever been denied a foreign visa ? Yes/No*
If yes, state which country and reason (if known) :
(B) Have you been the subject of a court of enquiry or involved in a maritime accident ? Yes/No*
(If yes, please attach details.)
(C)References
(Please give references from 2 recent employers who we may contact for references.)
Name of Company
HEDE OFF SHORE SERVICES
Name of Person to contact
ALI AKBAR
Address
Country
India & Dubai
Telephone
Declaration:
I hereby certify that I have furnished all above information in good faith with the purpose of employment with your company and that all the data,Including Medical History,is true and can be proven against my original documents (Passport, seaman’s book, professional certificates and certificates of discharge), which I will produce at any time upon request by employing office, Master, Shipping Company and/or authorized authority. Should any discrepancy from above stated data arise, I will be fully responsible for the resulting consequences, including, but not limited to, full charges and costs caused by such fact to involved parties for my employment and for immediate repatriation from the ship.
Place: Subbiah Karuppiah
Date:
(* Strike out whichever is not applicable) Signature
For office use :
App No.
Recent
Passport Size
Photograph
Please affix
Recent Passport
Size Photograph
Contact this candidate