Application Form

Application for Sea-Going Employment

Date of Availability:
Position:
1.		ref #: (if applicable)
2.		ref #: (if applicable)

Surname:		Place of Birth:
Forename:		Citizenship:
Telephone:		Mobile:
Email:
Address:



Upload Passport Photo (under 350kb):

Document		Number	Place of Issue	Issue Date	Expiry Date
Passport No.:
Seamans Book No.:
Discharge Book No.:
US Visa C1/D:
CoC:	Grade:
Endorsement:	Grade:
Endorsement is valid for:		Oil Tanker: Chemical Tanker: Gas Tanker:

Certificates		Cert. No.	Place of Issue	Issue Date	Expiry Date
Elementary First Aid
PSSR
PST
CPSC
Fire Prevention and Fire Fighting
Advanced Fire Fighting
Proficienct in Medical First Aid
Proficienct in Medical Care
ARPA
GMDSS
ISPS
Ships Simulator
IDMG, dangerous goods
FLT
VCI
Dr. Diesel
Safety Officer
FRB
Enclose space Entry (ESE)
AMOS
Cherry Picker
MN Disciplinary Course
BOSIET/FOET
DP Maint
DP Operator
OPITO HLO
EHTM
CAA Radio
Crane Operator Stage II / III
Welding Certificate
Tanker Familiarisation
LPG LICOS
Crisis Management and Human behavior
Crowd Management
Ships Cook Cert of competancy
Health and Hygiene
Other Cert. 1:	Name:
Other Cert. 2:	Name:
Other Cert. 3:	Name:
Yellow Fever Vaccination:
Seamans books and Flag State/administration endorsements issued
Type of Document		Issuing Country	Cert. No.	Issue Date	Expiry date





Pre-Sea Training / Nautical school / Institute / University			Qualification		Passed

Name of Vessel	Year Built	Flag	Type of Vessel	DWT	Engine	KW	Position / Rank	Period of Service - From (ddmmyy)	Period of Service - To (ddmmyy)	Owner / Operator	Salary

Minimum Salary (GBP/USD):

Marriage Status:	Married: Single: Divorced: Widower:
Height (cm):		Weight (kg):
Hair Color:		Eyes:
Shoe Size:		Overall Size:
Family Details:
	Surname, Name	Address & Telephone:
Spouse
Children




Next of Kin
Previous Employer / Referees:
Company Name	Telephone	Contact Name	Email

Details of current home country medical
Certificate Number
Issue Date
Expiry Date
Any Limitations on the above
Have you ever had a restricted medical?	No Yes
Have you ever failed a medical and been declares temporary unfit for sea service?	No Yes
Have you had any serious illness of surgery in the last 5 years?	No Yes

Nationalities worked with:
Types of cargo you have worked with:
Registry certificate (for welders only):	Yes No	Issued by:
Knowledge of English:	Fluent Good Poor	Marlins %:
Where did you hear about Bibby Ship Management?