Orient Ship Management & Manning Pvt. Ltd.

Licence No. RPSL-MUM-019 Validity: 15.02.2021

Photo

***, ****** ********,

Off-New Link Road, Andheri (W), Mumbai-400 053. India

Tel: 26736459 (6 Lines)

Email: adsgk9@r.postjobfree.com

adsgk9@r.postjobfree.com

Website: www.osmm.com

276, R.P.S. Flats,

Sheikh Sarai, Phase-1,

Near A.P.J. School,

New Delhi – 110017, India

Tel: 26017457 / 26016065

Fax: 26017456

Email: adsgk9@r.postjobfree.com

FOR DECK CADET, JR/ENG AND RATINGS

Date of Availability

Post Applied for

Height

Weight

SUR NAME:

FIRST NAME:

MDDLE NAME:

Nationality:

Date of Birth:

Place of Birth:

Blood Group:

Shoe Size:

Boiler Suit Size:

DETAILS OF CERTIFICATES OF COMPETENCY AS COOK

Certificate Number

Date of Issue

Date of Expiry

Issued by

Indian

Other

Document Number

Date of

Issue

Date of

Expiry

Place of

Issue

EMMIGR CLR

Yes / No

PASSPORT

U.S.A. VISA

CDC (INDIAN)

CDC (PANAMA)

CDC (NORWAY)

CDC (OTHER)

Yellow Fever

Number of blank pages in the passport

RECORD OF EDUCATIONAL QUALIFICATION

Name of Institute

Percentage of Marks

Year Passed

Course Duration

SCHOOL FINAL

COLLEGE

PRE – SEA

INDOS NUMBER

RECORD OF PREVIOUS SERVICES

Shipping Company (Full Name)

Name of Ship

Flag

Type

DWT/

GRT

Rank

Date

From to

DETAILS OF S.T.C.W. & VALUE ADDED COURSES / CERTIFICATES

Place of

Issue

Date of

Issue

Date of Expiry

Issued

By

Certificate

Number

1. Proficiency in Survival Craft and Rescue Boats

Other than Fast Rescue Boats (PSCRB)

2. Personal Survival Techniques (PST)

3. Fire Prevention & Fire Fighting (FPFF)

4. Elementary First Aid (EFA)

5. Personal Safety & Social Responsibilities (PSSR)

6. Tanker Familiarization Course (Oil) (OTFC)

7. Tanker Familiarization Course (Chemical) (CTFC)

8. Tanker Familiarization Course (LPG) (GTFC)

9. DCE (OIL) Operation / Support

10. DCE (CHEM) Operation / Support

11. DCE (LPG) Operation / Support

12. Certificate of Proficiency (COP) – For Bosun, AB & Oiler

13. Watch Keeping Certificate – For OS & Wiper

14. Part A Exemption Certificate for Junior Engineers

15. Crane Operator Licence (only for Offshore Deck Ratings)

16. Security Training with Designated Security Duties

17. Basic offshore Safety Induction & Emergency Training

Course (BOSIET) (only for Offshore Ratings)

18. 6G welding (for Oiler & Wiper joining offshore vessels)

19. Maritime English

20. Vessel Inspection Preparation – Support Level

21. Passenger Ship Familiarisation

Local Address in Mumbai & Contact No.

Permanent Address, Contact No. (with STD Code) & Email

Next of Kin

Relation-ship

DOB

Passport Number

Date of

Issue

Date of

Expiry

Issuing Authority

Place of Issue

EMMIGR. CLR.

Correct and detail information about Next of Kin is very important from legality point of view. Next of Kin includes dependent

parents, spouse and children.

ACKNOWLEDGEMENT: (1) COPY RECEIVED (2) ALL INFORMATIONS FURNISHED BY ME ARE TRUE & MY CERTIFICATES ARE GENUINE .

Date Rank Signature

SEAMAN (REG.No)

M.U.I MEMBERSHIP No

NOTE NO.1 : THE APPLICATION FORM IS FREE OF COST

NOTE NO.2: NO PROCESSING FEES OR RECRUITMENT CHARGES ARE LIABLE.

NOTE NO.3: EMPLOYMENT SUBJECT TO CONFIRMING THE STATUTORY REQUIREMENTS & OWNER’S APPROVAL.

NOTE NO.4: INFORMATIONS IN THIS FORM SHALL BE KEPT PRIVATE & CONFIDENTIAL.

NOTE NO:5: THIS APPLICATION WILL BE ACCEPTED AND PROCESSED WITHOUT ANY BIAS BASED ON APPLICANTS CASTE, CREED, SEX.

RELIGION, POLITICAL OPINION, NATIONALITY OR SOCIAL ORIGIN

OSMM-APLCN (09/17)

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