(Passport Photo)

Can be scanned / sent

separately

43rd Primaverii street, 900635,

Constanta, Romania
Tel: +40 721 938432
+40 241 584483
Web: www.oilgasrecruitment.ro
Crew Department
Email: crewing@oilgasrecruitment.ro

SEAFARER'S APPLICATION FORM - Page 1 of 3 - PERSONAL DATA

PERSONAL INFORMATION
Family Name
Birth Date
Nationality
Marital Status
Height (cm)
Nearest Airport

First Name (s)

Birth Place
Religion
No. of Children
Weight (kg)

ADDRESS (include telephone country & area codes, advise also secondary or contact addresses if any)
Street & Nr.
Location
City
State, Country
Postal (ZIP) Code

Email Address
Mobile Phone
Residence Phone
Fax
P.O. Box (if any)

NEXT OF KIN INFORMATION (person to contact in case of emergency & insurance beneficiary)
Family Name
Nationality
Street & Nr.
Location
City
State, Country

First Name(s)
Relationship
Email Address
Mobile Phone
Residence Phone
Fax

Postal (ZIP) Code

P.O. Box (if any)

REMARKS
Requested Rank(s)
Availability Date
Prefer Vessel Types
Minimum Salary
Employment Preference
All
English Language Skills
Spoken: average/good/fluent - Written: average/good/fluent
Other Foreign Languages
Professional School / Academy
- Name & Period (From - To)
Foreign Crew Experience
(specify nationalities)
Other Skills
Further Remarks
I hereby affirm that all the information provided by me in this application is true and correct to the best of my knowledge.

SEAFARER'S APPLICATION FORM - Page 2 of 3 - LIST OF DOCUMENTS

Family
First
Name
Name(s)
A. TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES
Document Name (Desciption)
Document Number
Country
Passport
Seaman's Book (national)
Seaman's Book (flag state)
Seaman's Book (flag state)
Visa - United States (type C1/D)
Visa - Others (Work/Resid. Permits)
Medical Examination Report
Offshore Medical (UKOOA, ENG1)
Vaccination against Yellow Fever
Vaccination against Cholera

Rank

Issue Place Issue Date Exp. Date

B. CERTIFICATES OF COMPETENCY & ENDORSEMENTS, COURSE CERTIFICATES

- deck & engine certificates & endor- - radio certificates & endorsements - deck, technical & management
sements (officers / ratings)
- safety training (surv., fire,
courses (radar/ARPA, ISM, Marpol,
- electrical & reefer certificates
medical)
simulators, computer, welding etc.)
- cook & steward certificates
- tanker courses (oil, chem., gas)
- Dynamic Positioning Experience
- passenger vsl, roro, hazmat courses
Document Name (Desciption)
Document Number
Country
Issue Place Issue Date Exp. Date
CERTIFICATE of COMPETENCY
ENDORSEMENT
DYNAMIC POSITIONING BASIC
DYNAMIC POSITIONING ADV.
UK
DYNAMIC POSITIONING LICENCE
LONDON
HUET
BOSIET
RADAR ARPA
GMDSS (GOC)
MARPOL
DANGEROUS CARGO
ADVANCED FIRE-FIGHTING
PERSONAL SURVIVAL TECH.
PROFIENCY SURVIVAL CRAFT
PERSONAL SAFETY
MARITIME ENGLISH
ECDIS
SHIP SECURITY OFFICER
BRIDGE TEAM MANAGEMENT
SHIP HANDLING
MEDICAL FIRST AID
MEDICAL CARE

OIL & GAS RECRUITMENT SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)
Please indicate your sea service in the last 10 years as exactly as possible - required are the actual sign-on and sign-off dates according to the service certificates resp. seaman's book entries. To speed
up processing kindly indicate phone and/or fax numbers of your previous employers. Ship sizes are to be indicated in gross tons, total engine output in kilo Watt (1 kW = 1.34 bhp) to go along with
STCW limitations. Please attach evidence for the listed sea service (copies of seaman's book entries, service certificates etc.). The information provided may be passed on to our clients and to flag
state administrations to allow for verification of rank experience. Please use the European date format (DD.MM.YY).
Family Name:
Vessel's Name

First Name(s):
Flag

GT

Date:
Oil & Gas Recruitment Ltd.
18th Brizei str. FD3, Constanta, Romania
www.oilgasrecruitment.ro, crewing@oilgasrecruitment.ro

kW Ship Type

Signature:

Date of Birth:
Eng.Make

Rank

S/On Date S/Off Date Employer (company to contact for reference)