Admirals Crewing

Agency
SEAFARER'S APPLICATION FORM - PERSONAL
office@admirals-recruitment.com
www.admirals-recruitment.com DATA

No. / date: /

APPLICATION FORM
NAME
SURNAME
POSITION
PERSONAL DETAILS
AGE MARITAL STATUS PHOTO
WEIGHT HEIGHT
DATE OF BIRTH PLACE OF BIRTH
LANGUAGES NATIONALITY
NEAREST AIRPORT US VISA
ADDRESS

CONTACT PHONE

NEXT OF KIN (NAME AND ADDRESS)

CONTACT PHONE
DETAILS OF PERSONAL DOCUMENTS
DOCUMENT NUMBER PLACE OF ISSUE DATE ISSUING AUTHORITY
ISSUED EXPIRES
PASSPORT
SEAMAN BOOK
I.D. CARD
MEDICAL CERTIFICATE
DETAILS OF LICENCES / CERTIFICATES (NATIONAL FIRST)
CERTIFICATE NUMBER GRADE DATE ISSUED BY
ISSUED EXPIRES
ROMANIAN

O T H E R: H O B B I E S, I N T E R E S T S, ETC.

CAREER DETAILS
RECORD OF PREVIOUS SERVICE
COMPANY RANK SHIP PARTICULARS DATES
NAME TYPE DWT MAIN ENGINE FROM TO

Cod doc: F14-01 / 01.01 / 18.02.2016 Operator date personale: 37110 Pag. 1 / 3
Admirals Crewing
Agency
SEAFARER'S APPLICATION FORM - PERSONAL
office@admirals-recruitment.com
www.admirals-recruitment.com DATA

SUMMARY OF SEA SERVICE (IN MONTHS)

RANK OIL TANKER BULK GEN. CARGO RO / RO CONTAINERS OTHERS TOTAL

C O L L E G E S / I N S T I T U T E S, ETC.
NAME OF INSTITUTION COURSE ATTENDED DATES QUALIFICATIONS GAINED
FROM TO

ADDITIONAL COURSES
NAME OF COURSE CERTIFICATE DETAILS
NO. ISSUED AT DATE EXPIRES ISSUED BY
SURVIVAL AT SEA
FIRE FIGHTING
FIRE FIGHTING ADVANCE
SURVIVAL CRAFT
MEDIC. CARE / FIRST AID
MEDIC. CARE ADVENCED
RESCUE BOAT COMMENDER
DANGER. CARGO END. P/G/C
MARINE POLLUTION
RADAR PLOTTING
ARPA
GMDSS
GOC
ENGLISH COMMUNICATIONS
P.S.S.R. (PERS. SAF. SOC.
RESP.)
OIL TANKER FAMILIARISATION
OIL TANKER EXPL.
SAFETY IN OIL TANKERS
CRUDE OIL WASHING (COW)
INERT GAS (IGS)
BRIDGE TEAM MANAGEMENT
GAS TANKER FAMMILIARISATION
SPECIALIZED TRAINNING FOR
LPG
SSD-Sarcini specifice de
securitate
SUMMARY OF PREVIOUS EMPLOYERS ( REFERENCES )
Company Name Phone no. and email address Contact Person

Cod doc: F14-01 / 01.01 / 18.02.2016 Operator date personale: 37110 Pag. 2 / 3
Admirals Crewing
Agency
SEAFARER'S APPLICATION FORM - PERSONAL
office@admirals-recruitment.com
www.admirals-recruitment.com DATA

WAGE EXPECTATION (BETWEEN) SIGNED DATE PLACE

I hereby affirm that all the information provided by me in this application is true and correct to the best
of my knowledge. Also, I agree that the company Admirals Crewing Agency use my personal information
only in order to find me an employer (schipowner, vessel) and to facilitate my engagement.
Prin prezenta confirm ca toate informatiile transmise de mine in aceast formular sunt adevarate si corecte. De
asemenea, conform ca sunt de acord ca firma Admirals Crewing agency s utilizeze informaiile mele personale
pentru a mi gsi un angajator (armator, nav) i a mi nlesni angajarea.
Date / Data Signature / Semnatura

Cod doc: F14-01 / 01.01 / 18.02.2016 Operator date personale: 37110 Pag. 3 / 3