BE SUCCESSFUL WITH
GLOBAL OCEAN AGENCY!

SEAFARER APPLICATION FORM

Personal Information

Rank *

Rank alternative

Date of birth *

Surname *

Place of birth *

First name *

Citizenship *

Father’s name *

Passport #

Gender

Eyes color *

Height *      

cm

Overall size *

Weight *

kg

Shoe size *

Hair color *

Marital status *

Available from *

Last salary *

 

Contact Information

Address *

City *

Country *

Email *

Home telephone

Mobile telephone *

Mobile telephone 2

Relatives

Full name Relation Date of birth Actual address Email Mobile telephone Is next of kin

Sea service

At least 1 contract

Vessel name

Flag

Type

Engine

Crewing company

Rank

Sign on

Built

DWT

Power

Sign off

Education

At least 1 information

Institution

Faculty

Speciality

Start

Graduate

Work experience

Organisation

Name of job

Reason of dissmissal

Start

Graduate

Certificates

Document title

Number

Issue date

Expiry date

Is lifetime

Travel Passport *

Seaman's Book *

Certificate of Competency *

Certificate of Competency (II)

Basic STCW (A-VI/1) *

GMDSS

Proficiency in Survival Crafts

Fast Rescue Boats

Advanced Fire Fighting Course

Medical First Aid

RADAR/ARPA

Hazardous materials

Security Officer

Safety Officer

Risk assessment

ECDIS

Yellow Fever Vaccine

Security awareness training

Designated Security Duties

Certificate of Competency (Alternative Rank)

Other documents

Document type

Number

Issue date

Expiry date

Is lifetime

Foreign languages Information

Language

Level

Certificate

I, undersigned, confirm all above information to be true and correct to my best knowledge

16.06.2021
Date