Online Application Form

Rank Applied For		Recommended By		Relationship to Applicant
Date of Application

Applicant Permanent Address
NAME		Nationality	Height	Weight
Date of Birth	Place of Birth	Blood Group	Overall Size	Safety Shoe Size
Sex	Religion		Body Mass Index
No. of Dependents	Marital Status

Home Contact Number	Country Code: Area Code: Contact No: +	NO. OF DEPENDENTS
Mobile Contact Number	Country Code: +95 Area Code: 9 Contact No:

Document	Number	Issued by	Date of Issue	Date of Expiry
International Passport
Seafarer's Passport
VISA - USA (Please circle: Type C1/D)
Seaman's Book
ILO Convention No. 185 - Crew SID
Medical Fitness Certificate
STCW & Flag State Documents	STCW Regulation No.
Officer's Certificate of Competency
Singapore Certificate of Endorsement
Liberia / Marshall Islands Licence / Seaman's Book
Panama Licence / Seaman's Book
STCW Endorsement for Officers
STCW Watchkeeping Certificate for Ratings
STCW Special Training (V/1. V/2)
STCW Familiarization Training
STCW Personal Survival Techniques
STCW Fire Prevention and Fire Fighting
STCW Elementary First Aid
STCW Personal Safety & Social Resp.
STCW Prof in Survival Craft & Rescue Boat
STCW Prof in Fast Rescue Boats
STCW Advanced Fire Fighting
STCW Medical First Aid and Medical Care
GMDSS General Operator's Certificate
GMDSS Restricted Operator's Certificate
Other Supplementary Certificates & / Or Qualifications	SSA
	DSD
	SSO
	ARPA
	BRM
	ECDIS
	ECDIS / FURUNO
	ECDIS / JRC

NAME :		RANK :		AGE :

Rank Applied For		Recommended By		Relationship to Applicant
Date of Application

Applicant Permanent Address
NAME		Nationality	Height	Weight
Date of Birth	Place of Birth	Blood Group	Overall Size	Safety Shoe Size
Sex	Religion		Body Mass Index
No. of Dependents	Marital Status

Home Contact Number	Country Code: Area Code: Contact No: +	NO. OF DEPENDENTS
Mobile Contact Number	Country Code: +95 Area Code: 9 Contact No:

Document	Number	Issued by	Date of Issue	Date of Expiry
International Passport
Seafarer's Passport
VISA - USA (Please circle: Type C1/D)
Seaman's Book
ILO Convention No. 185 - Crew SID
Medical Fitness Certificate
STCW & Flag State Documents	STCW Regulation No.
Officer's Certificate of Competency
Singapore Certificate of Endorsement
Liberia / Marshall Islands Licence / Seaman's Book
Panama Licence / Seaman's Book
STCW Endorsement for Officers
STCW Watchkeeping Certificate for Ratings
STCW Special Training (VI/1, VI/2)
STCW Familiarization Training
STCW Personal Survival Techniques
STCW Fire Prevention and Fire Fighting
STCW Elementary First Aid
STCW Personal Safety & Social Resp.
STCW Prof in Survival Craft & Rescue Boat
STCW Prof in Fast Rescue Boats
STCW Advanced Fire Fighting
STCW Medical First Aid and Medical Care
GMDSS General Operator's Certificate
GMDSS Restricted Operator's Certificate
Other Supplementary Certificates & / Or Qualifications	SSA
	DSD
	SSO
	BRM
	HVT

NAME :		RANK :		AGE :

Please answer the following questions	Yes / No	If yes, please provide details.
Have you previous injuries or sickness ?	Yes No
Premature termination of contract ?	Yes No
Have been dismissed or logged for mischief ?	Yes No
Have been involved in industrial dispute ?	Yes No
Any criminal offence ?	Yes No
Have been refused entry by any country ?	Yes No
Any special diet or religious restrictions ?	Yes No
Any medical restrictions / drugs / allergies ?	Yes No
Any alcohol / drinking habits ?	Yes No
Any past history medical / mental condition?	Yes No
Can we make reference check with ex employers ?	Yes No

Have you previous injuries or sickness ?	NO YES
Premature termination of contract ?	NO YES
Have been dismissed or logged for Inaction ?	NO YES
Have been involved in industrial dispute ?	NO YES
Any criminal offence ?	NO YES
Have been refused entry by any country ?	NO YES
Any special diet or religious restrictions ?	NO YES
Any medical restrictions / drugs / allergies ?	NO YES
Any alcohol / drinking habits ?	NO YES
Any past history medical / mental condition?	NO YES
Can we make reference check with ex employers ?	YES NO