APPLICATION FORM (Engine Dept)
PLEASE ALL THROUGH USE CAPITAL LETTER TO FILL IT UP.
1
Position REGISTRATION NO.
Position applied for:
4th ENGINEER
Are you willing to accept any other positions?
YES
If YES, which positions would you consider?
3rd ENGINEEE IF ANY CHACE OF PROMOTION
Readiness From
01 march 2023
2
Personal details
Last Name:
ISLAM
First Name:
MD.
Middle Name:
JONYRUL
Date of birth
10 OCT 1995
Place of birth
NARAIL
Nationality
BANGLADESHI
Height
170 CM
Weight
65 KG
ID Mark
NIL
Blood Group
O+
Chest
35
Waist
32
Boiler Suite
170 (L)
Safety Shoe
42
Cap
National ID
SKYPE ID
JONYLORN
Company ID
Address:
VILL +P0ST-TALBARIA, THANA-LOHAGARA, DISTRICT-NARAIL
Post code:
7510
ÈHand Phone No.
(Telephone No.
E-Mail ID:
**********@*****.***
3
Education Background
Name of Institute
From Year
To Year
Highest Qualification Attained
School
LOHAGARA GOVT PILOT HIGH SCHOOL
2008
2010
5.00
College
LOHAGARA GOVT COLLEGE
2010
2012
5.00
Pre Sea Training
BANGLADESH MARINE ACADEMY
2013
2015
3.50
Bachelor s
BANGABANDHU SHEIKH MUJIBUR RAHMAN MARITIME UNIVERSITY
2014
2019
3.40
4
Identity documents
DOCUMENT
COUNTRY
NUMBER
ISSUE DATE
PLACE OF ISSUE
EXPIRY DATE
Passport:
Bangladesh
B00078407
09 MAY 2022
NARAIL
08 MAY 2032
Seaman s book:
National
C/O/9143
24 JAN 2021
CHATTOGRAM
23 JAN 2031
Bahamian
Liberian
Panamanian
Other -Norway
Seaman ID Card
YES
050008817
14 AUG 2016
DHAKA, BANGLADESH
13 AUG 2026
Visa US C1/D
NO
Other Visa
YES
Yellow Fever Vaccination
YES
Holding Australian MCV
NO
5
Family details
Next Of Kin/Nominee
Marital Status :
MARRIED
Relationship :
SISTER
Marriage Date :
Last Name:
PERVIN
First Name
PAPIYA
Address:
VILL +P0ST-LOHAGARA, THANA-LOHAGARA, DISTRICT-NARAIL
Post code:
7510
È Hand Phone No.
(Telephone No.
Relation
Name
P.O.B.
D.O.B.
PPT NO.
D.O.I.
P.O.I.
D.O.E.
Note: Second Next Of Kin / Nominee (In case of voyage with family)
Relation
Name
Address:
Post Code
Mother s Name :
È Hand Phone No.
(Telephone No.
6
National Certificate of Competency (Highest certificate of competency held)
Class/Grade
Issuing Country
Certificate No.
Date Issued
Place Issued
Valid Until
MEO-3
BANGLADESH
2.EC3.000571
24 FEB 2021
DHAKA
23 FEB 2026
6a
National Dangerous Cargo Endorsements
Endorsement Type
Certificate No.
Date Issued
Place Issued
Valid Until
Petroleum
Liquefied Gas
Chemicals
7
Flag State Equivalent Certificates Of Competency issued by other countries (Issued by countries other than in Section 6)
Class
Issuing Country
Certificate No.
Date Issued
Place Issued
Valid Until
Liberia
Panama
Bahamas
7a
Flag State Equivalent Dangerous Cargo Endorsements (Issued by countries other than in Section 6a)
Country
Endorse Type/ Level
Certificate No.
Date Issued
Place Issued
Valid Until
Liberia
Marshall Islands
Panama
8
Certificates ( STCW and Value added)
Course
Institution
Place
Issue Date
Cert. No.
Expiry Date
Personal Survival Techniques
BMA
CHATTOGRAM
08DEC2020
039.010583
01SEP2025
Advance Fire Fighting
BMA
CHATTOGRAM
23DEC2021
045.127446
16AUG2025
Medical First Aid
BMA
CHATTOGRAM
08SEP2021
046.127449
11JULY2025
Proficiency In Survival Craft PSCRB
BMA
CHATTOGRAM
08DEC2020
043.123613
25JULY2025
Human Relations PSSR
BMA
CHATTOGRAM
08DEC2020
042.010587
09AUG2025
Ship Security Officer
Tanker Familiarization (Oil,Chem,Gas)
Adv. Oil Tanker Course
Adv. Chemical Tanker Course
Adv. LPG Tanker Course
Liq. Cargo Handling Simulator
Eng. Room Resource Mgmt & LSM
BMA
CHATTOGRAM
23FEB2021
065.127447
24DEC2024
High Voltage System
BMA
CHATTOGRAM
23FEB2021
090.127448
19DEC2024
Shipboard Safety Officer
Elementary First Aid
BMA
CHATTOGRAM
08DEC2020
041.010590
16AUG2025
Fire Prevention & Fire Fighting
BMA
CHATTOGRAM
08DEC2020
040. 010586
25AUG2025
Security Awareness Training
BMA
CHATTOGRAM
08DEC2020
049.010581
21JULY2025
Designated Security Duties
BMA
CHATTOGRAM
08DEC2020
050.010589
11AUG2025
9
9
Record of previous service
(Please give a full record starting with the last vessel on which you served)
VESSEL NAME
COMPANY
VESSEL
TYPE
FLAG
G.R.T.
MT
D.W.T.
MT
YEAR OF BUILT
MAIN ENGINE
B.H.P.
RANK
SIGN ON DATE
DD/MM/YYYY
SIGN OFF DATE
DD/MM/YYYY
DURATION
YY-MM-DD
Maker
Type
MV YANGTZE AMBITION
SINOTRANCE AND CSC
BULK
HONG KONG
20969
32573
2013
MAN B&W
6S50MC-C
6480 KW
ENG. CADET
12-05-2017
21-02-2018
00-09-09
MV CSC XIN HAI
SINOTRANCE AND CSC
BULK
HONGKONG
10817
12479
2012
MAN B&W
6S46MC-C
4440KW
ENGINE CADET
08-09-2018
11-06-2019
00-09-03
MV BANGLAR JOYJATRA
BANGLADESH SHIPPING CORPORATION
BULK
BANGLADESH
25818
38800
2018
MAN B&W
6S50MC-C 8.2
5660 KW
JUNIOR ENGINEER
10-06-2021
15-04-2022
00-10-05
MV TAO MARINER
WISDOM MARINE LINES
GENERAL CARGO
PANAMA
15243
25065
2010
MITSHUI-MAN B&W
7S35MC-C
5180KW
4TH ENGINEER
28-05-2022
26-12-2022
00-7-00
10
For Engineers (Please provide Makers, Model & Capacity details)
Auxiliary Engines
DAHITSU DIESEL ENGINE,TYPE-6 DE-18,FOUR STROKE,750 KW EACH,3 SET
Generators
Cranes / Grabs
MACGREGOR ELECTRO HYD DECK CRANE,4 SET.SWL 30 TON
Purifiers and Boilers
PURIFIER:
ALFA LAVAL, TYPE:P 605 FLEX
BOILER:
ALFA LAVA COMPOSITE VERTICAL BOILER,TYPE-AALBORG OC-TCi
MAX PRESS:0.9 MPA
11
Sailing Experience: (Please advise PRESENT RANK EXPERIENCE on each type of vessel)
CONT/RFG (MM-DD)
G. CARGO (MM-DD)
BC/OBO/RR (MM-DD)
PCC/PCTC (MM-DD)
OIL/VLCC (MM-DD)
CHEMICAL (MM-DD)
PRODUCT (MM-DD)
LPG/LNG (MM-DD)
OTHERS (MM-DD)
TOTAL RANK EXPERIENCE
07-00
07-00
LAST SALARY DRAWN
2300
EXPECTED SALARY
STANDARD
12
References (Please give the name and address of your current or immediate past employer)
Name of company
WISDOM MARINE LINES S.A
Name of person to contact
MR.HAN-YU-LEE
Address
ROOM 711,7 TH FLOOR,FU HSING ROAD,SECTION 2,TAIPEI,TAIWAN
( No. / Facsimile
E-Mail / Web
13
Miscellaneous ( Please give the details of your FC account )
Bank Name
FIRST SECURITY ISLAMI BANK BANGLADES LIMITED
Branch :
LOHAGARA,NARAIL
Account Name
MD JONYRUL ISLAM
Bank Address
Account No.
Swift / BIC Code
14
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
(If the answer is YES to any of the above, please give full details and attach a separate page if necessary)
15
Declaration
I hereby declare that the above particulars are true and authorise you to contact the referees listed above.
JONY
26-02-2023
Name/Signature
Date