PERSONAL DETAILS
*  Surname
* Name
*  Date of Birth

* Place of Birth
*  Citizenship
* Marital Status
Children
* Next Kin
* Next Kin Address

* Height(cm) * Weight(kg) * Colour of eyes
* Shoes size * Boiler suit size

ADDRESS
* Street
* House-Flat
* City
* Country
* Phone
Skype
Mobile
E-Mail

IDENTITY DOCUMENTS
No
Issued
(dd.mm.yyyy)
Expiry
(dd.mm.yyyy)
Place
(City only)
* Passport National
* Seaman's book
Seaman's book
Seaman's book
Seaman's book
Seaman's book
Seaman's book
Schengen Visa
U.S. Visa

LICENCES Qualification
No
Issued
(dd.mm.yyyy)
Expiry
(dd.mm.yyyy)
Place
(City only)
* National
Endorsement

CERTIFICATES
No
Issued
dd.mm.yyyy
Expiry
dd.mm.yyyy
Place
(City only)
*  Personal Survival
*  Fire Fighting
Advanced Fire Fighting
*  First Aid
*  Personal Safety and Social resp.
Ship Security Certificate
Crowd management training
HAZMAT
Search and Rescue
Survival Craft
GMDSS Endorsement
ARPA
Radar Observation
ECDIS
Medical Examination
Drug and Alcohol Test
Yellow Fever
Cholera Vaccination
Oil Tanker Certificate
Chemical Certificate

PREVIOUS SEA SERVICE (Last 10 vessels)
Name of Vessel
Flag
Dwt or GRT
Type of Vessel

Engine
(for Engineers specify model, kW)

Ship Owner
Rank
Sign-ON
dd.mm.yyyy
Sign-OFF
dd.mm.yyyy