QATAR SHIPPING COMPANY Q.S.

C FORM No:QS:10A
Rev 00
Date of Issue: 02/04
Application For Employment Page 1 of 5

Position Applied For: __DECK CADET______________________________

Availability Date: _____12 MONTH_______________________________

Photograph

Date Of application: __03 SEPTEMBER

2015_______________________________

Please Use Black Ball Point Pen & Capital Letters As Far As Possible
Surname Middle Name First Name
RESSY IBRAHIM MUNTAHA IBRAHIM RESSY

Nationality Date of Birth Place of Birth

INDONESIA 06 SEPTEMBER 1993 SEMARANG, IND

Permanent Address: Present Address:

St. SAWAH BESAR X/8
SEMARANG, CENTRAL OF JAVA,
INDONESIA

Post code: 50164 Post Code:

Phone: +62-8564 0593 763 Phone: +
Email: ressyibrahim26@gmail.com Mobile No:
Date of Place of Date of ECNR Blank Pages
Issue Issue Expiry
Passport No A 9391356 No Yes
INDONESIA Oct,30th 2019
U.S. VISA MUI/Union Membership
No:

Seamans Book Number Date of Issue Place of Expiry Remark

(CDC) Issue Date
Indian

Liberian

Panamanian

Marshal Islands

IOM

Bermuda

INDOS No :
 QATAR SHIPPING COMPANY Q.S.C FORM No:QS:10A
Rev 00
Date of Issue: 02/04
Application For Employment Page 2 of 5

Others

License Grade Number Date of Place of Date of

Issue Issue Expiry
Indian
U.K.
Singapore
Liberian
Panamanian
Marshal Islands
IOM
Bermuda
Others
Dangerous Cargo Grade/ Level Number Date of Place of D.O.E
Endorsements Issue Issue
Oil
Chemical
Liquefied Gas

Civil Status: Single

Full Name of Next of Kin: Relationship:
Address of
Next of Kin:
Phone-

Weight : _______65______ Kg
Height : ___1________mts ______74____ cm
Boiler Suit Size Shoe Size
MEDIUM 41

Family Name D.O.B Passport D.O.I Place of D.O.E ECNR

Data No Issue (Yes/No)
Wife

Child
M/F
Child
M/F
Child
M/F
* Tick Visa USA UK Australia Brazil
Valid
 QATAR SHIPPING COMPANY Q.S.C FORM No:QS:10A
Rev 00
Date of Issue: 02/04
Application For Employment Page 3 of 5

Details of Courses & Number Date of Date of Issued

Certificates Issue Expiry by
Advanced / Basic Fire Fighting 621140029106
0314
Proficiency in Survival Craft /
Rescue Boat / PST
Elementary / Medical First
6211400291082514
Aid /Medicare
Personal Survival & Social
Responsibility (PSSR)
Radar Observer / ARPA

Radar Simulator (RANSCO) /

6211400291032514
ENS
Ship Handling Simulator

LCHS/Gas Cargo Simulator

GMDSS / MCC
Petroleum Tanker Safety
(STPOTO)
Chemical Tanker Safety
(CHEMCO)
Gas Tanker Safety (GASCO)
Oil Tanker Familiarisation
(OTFC)
Chemical Tanker Familiarisation
(CTFC)
Gas Familiarisation (GTFC)
Ship Simulator
Engine Room Simulator
Hazmat Course
Bridge Team Management
Engine Resource Management
Revalidation Course
FRAMO
NOR CONTROL
PMS SYSTEMS
Risk Management/Loss
Prevention
 QATAR SHIPPING COMPANY Q.S.C FORM No:QS:10A
Rev 00
Date of Issue: 02/04
Application For Employment Page 4 of 5

OPA 90
Commercial Knowledge
Courses
Ship Security Officers Course
ISM Course
ISO Course (9000,14000,18000)
Yellow Fever
Educational Qualification
Name of Institute / College From To Type of Degree

Pre Sea Training Apprentice ship

Name of Institute / College From To Type of Degree

Reference Checks( For Office use only)

Name of the company
Address Yes No

Name of Person /Company Title Phone No.

1.
2.
I hereby affirm that all this information provided by me in this application is true and
correct to the best of my knowledge and belief; further, that no Certificate of
competency or Licence issued to me has ever been Revoked or Suspended. I also
certify that any false statement or undisclosed Material information about the past will
disqualify me from any employment benefits and claims.

Date___________ Rank___________ Signature of Applicant ____________

 QATAR SHIPPING COMPANY Q.S.C FORM No:QS:10A
Rev 00
Date of Issue: 02/04
Application For Employment Page 5 of 5

Note: All pages to be sent by agents as Fax or Email attachments

 QATAR SHIPPING COMPANY Q.S.C FORM No:QS:10A
Rev 00
Date of Issue: 02/04
Application For Employment Page 6 of 5

Previous Sea Service (Date Commencing from Last Vessel Until First Vessel)
Sr.No. Name of Owners Name of Type DWT BHP Engine type UMS Rank From To Total Reason
Y/N
/ Manager Vessel MM/DD for
S/OFF
1

10

11

12

Note: Please use Extra Pages As Applicable.