INTERWORLD SHIPPING AGENCY LLC

FORM FILE

ISM CODE

TITLE : PREJOINING CHECK LIST

FORM NO. :

IW 028

ISSUE DATE :

MAY- 2013

PAGE 1 OF 2

ISSUE STATUS :

1

AUTHORIZED BY :

DPA

FLEET PERSONNEL DEPARTMENT

PREJOINING CHECK LIST

All Officers and Ratings are responsible for updating endorsement of certificates as shown in the table below. All Documents (Passport, Seaman s Book & Certificates) should have at least 6 months validity upon joining the vessel and must carried along at the time of joining.

PERSONAL DETAILS:

Name:

Abasali Nazemi

Rank:

oiler cadet engineering

Date of Birth:

18/09/1985

Place of Birth:

Iran

Marital Status:

single

Nationality:

iranian

Height:

1.80m

Weight:

85kg

Address:

3rdu nit,no,7 7sarab,12/1alley,shahrood,semnan3616759517,Iran

Contact Numbers:

009***********

Nearest Airport:

lmam khomenini

EDUCATIONAL ATTAINMENT:

Year Graduated

degree

school attended

Highest Award Received

2011

bachelor of science engineering technology heating and and cooling

ragheb isfahani

2018

unlimited third engineer(matching period for mechanical engineers)

FAMILY BACKGROUND:

Name

Date Of Birth

Age

Father:

ali alimohamad

1956

62

Mother:

soheila

1344

52

Spouse:

Children:

NEXT TO KIN:

Name:

Relation:

Address:

Contact Nos.:

ENGLISH PROFICIENCY:fair

Excellent

Very Good

Fair

Poor

DOCUMENTS:

Number

Date of Issue

Date of Expiry

Place of Issue

Certificate of Discharge (CDC Book)

0453193

08/10/2017

10/04/2023

10/04/2018

Passport

42276125

21/09/2017

21/09/2022

TRAINING CERTIFICATES: (To be filled-up by Ratings)

95 CERTIFICATION

ISSUE DATE

EXPIRY DATE

TRAINING

ISSUE DATE

EXPIRY DATE

1

The Four Courses (EGA + EFF + PST + PSSR)

13/03/2018

13/03/2023

6

2

Medical Fitness

08/10/2019

08/10/2019

7

3

Vaccination Card

8

4

Certificate of Discharge

9

5

Watch Keeping Certificate

10/04/2018

10/04/2023

10

INTERWORLD SHIPPING AGENCY LLC

FORM FILE

ISM CODE

TITLE : PREJOINING CHECK LIST

FORM NO. :

IW 028

ISSUE DATE :

MAY- 2013

PAGE 2 OF 2

ISSUE STATUS :

1

AUTHORIZED BY :

DPA

TRAINING CERTIFICATES: (To be filled-up by Officers)

95 CERTIFICATION

ISSUE DATE

EXPIRY DATE

TRAINING

ISSUE DATE

EXPIRY DATE

1

Certificate of Competency

16

ISO, ISM Familiarization

2

Certificate of Endorsement

17

PMS System Familiarization

3

Flag Endorsement

18

Engine Simulators Briefing Completion

4

The Four Basic Courses (EFA + EFF + PST + PSSR)

19

Recognition Certificate

5

Advanced Fire Fighting

20

MLC Familiarization

6

Medical First Aid

21

7

Medicare

22

8

Radar and ARPA

23

9

Operating Level - Radar & ARPA

24

10

Management Level – GMDSS (G.O.C.)

25

11

ECDIS

26

12

Medical Fitness

27

13

Vaccination Card

28

14

Bridge Team Management

29

15

SSO Certificate

30

WORK EXPERIENCES:

PERIOD

COMPANY

RANK

VESSEL

TYPE

DWT

FLAG

ENGINE TYPE

VSL HP

CREW NAT.

SIGN-OFF REASON

FROM

TO

CANDIDATE SIGNATURE

RECRUITING AGENT’S SIGNATURE

F.P. MANAGER SIGNATURE

COMPANY’S VERIFICATION & DATE

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