APPLICATION FORM

Position

Position applied for JUNIOR ENGINE WATCH KEEPING OFFICER

Lowest rank

acceptable

ENGINE CADET

Preferred vessel type Bulk Carrier

Readiness date

Personal Details

Last name Sugumaran First name Jagan Prakash

Middle name Gender M

Date of birth 19/May/1995 Nationality Indian

Country of

Residence

India City of Residence Chengalpattu, Chennai

Phone Mobile 994*******

Zip code 603211 E-mail adez93@r.postjobfree.com

Address No.28 perumal koil 3rd cross street, Kilambakkam West, Urapakkam,Chengalpattu District,Tamil nadu, INDIA. Identity Documents

Passport number N2142578

Seaman book

number

CHN 102509

Passport issue date 05/Aug/2015

Seaman book issue

date

30/Jun/2016

Passport expiry date 04/Aug/2025

Seaman book expiry

date

29/Jun/2026

Seaman book issue

country

India

OR ASSISTANT 4TH ENGINEER

ANY TYPE PROVIDED THE OPPURTUNITY

IMMEDIATE READINESS

Education

Type Name From year To year Qualification attained High school Sita Devi Garodia Hindu Vidhyalaya Higher secondary School 2010 2012 12th class High school NEELAN MATRICULATION SCHOOL 1998 2010 10th CLASS University AMET UNIVERSITY 2012 2016 B.E(Marine Engineering) Certificates

Category Certificate Number Issuing

Authority Issued Expiry

Place of

issue

STCW MEDICAL FIRST AID A-VI/4 1-3 MFA/B1060/10 India 12/Apr/2018 HIMT CHENNAI

STCW PERSONAL SAFETY & SOCIAL RESPONSIBILITY A-

VI/1-4 PSSR/B636/09 India 16/Sep/2015

AMET

CHENNAI

STCW PROFICIENCY SURVIVAL CRAFT AND RESCUE BOATS

A-VI/2 1-4 PSCRB/B634/12 India 20/Apr/2018

HIMT

CHENNAI

STCW PERSONAL SURVIVAL TECHNIQUES (STCW A-VI/1-1) PST/B696/07 India 23/Sep/2015 AMET CHENNAI

STCW ADVANCED FIREFIGHTING A-VI/3 AFF/B622/10 India 28/Apr/2018 HIMT CHENNAI

STCW FIRE PREVENTION FIRE FIGHTING A-VI/1-2 FPFF/B581/09 India 15/Jul/2015 AMET CHENNAI

SIMULATOR ENGINE SIMULATOR COURSE ERS/B661/11 India 02/May/2018 HIMT CHENNAI

STCW

ADVANCED HIGH VOLTAGE COURSE HV-O/B107/05 India 07/May/2018 HIMT

CHENNAI

VESSEL TYPE OIL TANKER FAMILIARIZATION TFC-

COM/B44/17 India 27/May/2017

HIMT

CHENNAI

VESSEL TYPE CHEMICAL TANKER FAMILIARIZATION TFC-

COM/B44/17 India 27/May/2017

HIMT

CHENNAI

Licences

Licence Capacity Rank Limitation Issuing

Authority Issued Expiry Number

Place of

issue

CERT OF

COMPETENCY

Officer In Charge Of

Engineering Watch

World wide 3000 kw

or more India 28/May/2019

95Z-

29814 KOLKATA

Visas

Country Number Type Issued Expiry Place of issue

United States of America L6400416 US VISA C1/D 12/Aug/2016 10/Aug/2021 CHENNAI Vaccinations

Class

4

Number Type Issued Expires Place of issue

029/020 YELLOW FEVER 08/Aug/2016 07/Aug/2026 CHENNAI Sea Services

Rank Joined Signed off Period Vessel Type Engine GRT KW Owner / Manager TME 28/Jul/2017 28/Mar/2018 0Y 8M

0D

SAFESEA

NEHA 2

Bulk

Carrier

MAN B&W

6S50MC-C 31,144 9,480

NOAH SHIP

MANAGEMENT

JOFF 12/Nov/2019 26/Feb/2020 0Y 3M

15D

SAFESEA

NEHA 2

Bulk

Carrier

MAN B&W

6S50MC-C 31,144 9,480

NOAH SHIP

MANAGEMENT

Experience

Vessel Type Period Voyages

EXPERIENCE BY VESSEL

Bulk Dry 0Y 11M 17D 2

Subtotal: 0Y 11M 17D 2

Total: 0Y 11M 17D 2

Rank Period Voyages

EXPERIENCE BY RANK

0Y 3M 15D 1

TME 0Y 8M 0D 1

Subtotal: 0Y 11M 17D 2

Total: 0Y 11M 17D 2

Declaration

Signature: Date:

JUNIOR ENGINE WATCH KEEPING OFFICER Sugumaran, Jagan Prakash ASST

4th

ASSISTANT 4TH ENGINEER

Contact this candidate