SEAFARER APPLICATION FORM Personal Information Rank * 2nd Engineer 2nd Officer 3rd Engineer 3rd Officer 4th Engineer AB-Carpenter AB-Cook AB-Electrician AB-Fitter Able Seaman AB-Motorman AB-Welder Anchor Operator Ass. Cook Assistant Bartender Assistant Chief Housekeeper Assistant Maitre Assistant Waiter Bar Waiter Barge Master Bartender Boatswain Broadcast Manager Buffet Attendant Cabin Steward Casino Dealer Casino Manager Chief Cook Chief Engineer Chief Housekeeper Chief Officer Chief Technologist Chief Trawlmaster Cook Crane Operator Crew Cleaner Crew Utility Deck Cadet Deck Fitter Donkerman DPO Electric Cadet Electric Officer Electrical Engineer Electrician Engine Cadet Engine Fitter ETO Excavator Driver Fish Master Fish Meal Plant Operator Fitter Fitter-Welder Gaz Engineer HLO JDPO Junior Engineer Junior Officer Master Mess Boy Motorman 1st class Motorman 2nd class Motorman-Electrician Motorman-Fitter Motorman-Oiler Motorman-Turner Motorman-Welder Oiler Oiler-Fitter Oiler-Turner Oiler-Welder Ordinary Seaman OS-Cook OS-Welder Plumber Pumpman Radio Officer Ref. Cadet Ref. Engineer Ref. Machinist Rig Mechanic Safety Officer Sandblaster SDPO Security Officer Single Engineer Staff Capitan Staff Chief Engineer Steward Superintendant Trawmaster Turner Watch Engineer Welder Wiper Rank alternative 2nd Engineer 2nd Officer 3rd Engineer 3rd Officer 4th Engineer AB-Carpenter AB-Cook AB-Electrician AB-Fitter Able Seaman AB-Motorman AB-Welder Anchor Operator Ass. Cook Assistant Bartender Assistant Chief Housekeeper Assistant Maitre Assistant Waiter Bar Waiter Barge Master Bartender Boatswain Broadcast Manager Buffet Attendant Cabin Steward Casino Dealer Casino Manager Chief Cook Chief Engineer Chief Housekeeper Chief Officer Chief Technologist Chief Trawlmaster Cook Crane Operator Crew Cleaner Crew Utility Deck Cadet Deck Fitter Donkerman DPO Electric Cadet Electric Officer Electrical Engineer Electrician Engine Cadet Engine Fitter ETO Excavator Driver Fish Master Fish Meal Plant Operator Fitter Fitter-Welder Gaz Engineer HLO JDPO Junior Engineer Junior Officer Master Mess Boy Motorman 1st class Motorman 2nd class Motorman-Electrician Motorman-Fitter Motorman-Oiler Motorman-Turner Motorman-Welder Oiler Oiler-Fitter Oiler-Turner Oiler-Welder Ordinary Seaman OS-Cook OS-Welder Plumber Pumpman Radio Officer Ref. Cadet Ref. Engineer Ref. Machinist Rig Mechanic Safety Officer Sandblaster SDPO Security Officer Single Engineer Staff Capitan Staff Chief Engineer Steward Superintendant Trawmaster Turner Watch Engineer Welder Wiper Date of birth * Surname * Place of birth * First name * Citizenship * Father’s name * Passport # Gender MALE FEMALE Eyes color * Black Brown Blue Green Grey Height * cm Overall size * Weight * kg Shoe size * Hair color * Black Brown Red White Marital status * Married Single Divorced Widower Available from * Last salary * Photo Delete Loading... 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 Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Mother Father Brother Sister Wife Husband Son Daughter Grandmother Grandfather Aunt Uncle other Sea service At least 1 contract Vessel name Flag Type Engine Crewing company Rank Sign on Built DWT Power Sign off Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bermuda Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer Cement Carrier ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown 2nd Engineer 2nd Officer 3rd Engineer 3rd Officer 4th Engineer AB-Carpenter AB-Cook AB-Electrician AB-Fitter Able Seaman AB-Motorman AB-Welder Anchor Operator Ass. Cook Assistant Bartender Assistant Chief Housekeeper Assistant Maitre Assistant Waiter Bar Waiter Barge Master Bartender Boatswain Broadcast Manager Buffet Attendant Cabin Steward Casino Dealer Casino Manager Chief Cook Chief Engineer Chief Housekeeper Chief Officer Chief Technologist Chief Trawlmaster Cook Crane Operator Crew Cleaner Crew Utility Deck Cadet Deck Fitter Donkerman DPO Electric Cadet Electric Officer Electrical Engineer Electrician Engine Cadet Engine Fitter ETO Excavator Driver Fish Master Fish Meal Plant Operator Fitter Fitter-Welder Gaz Engineer HLO JDPO Junior Engineer Junior Officer Master Mess Boy Motorman 1st class Motorman 2nd class Motorman-Electrician Motorman-Fitter Motorman-Oiler Motorman-Turner Motorman-Welder Oiler Oiler-Fitter Oiler-Turner Oiler-Welder Ordinary Seaman OS-Cook OS-Welder Plumber Pumpman Radio Officer Ref. Cadet Ref. Engineer Ref. Machinist Rig Mechanic Safety Officer Sandblaster SDPO Security Officer Single Engineer Staff Capitan Staff Chief Engineer Steward Superintendant Trawmaster Turner Watch Engineer Welder Wiper Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bermuda Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer Cement Carrier ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown 2nd Engineer 2nd Officer 3rd Engineer 3rd Officer 4th Engineer AB-Carpenter AB-Cook AB-Electrician AB-Fitter Able Seaman AB-Motorman AB-Welder Anchor Operator Ass. Cook Assistant Bartender Assistant Chief Housekeeper Assistant Maitre Assistant Waiter Bar Waiter Barge Master Bartender Boatswain Broadcast Manager Buffet Attendant Cabin Steward Casino Dealer Casino Manager Chief Cook Chief Engineer Chief Housekeeper Chief Officer Chief Technologist Chief Trawlmaster Cook Crane Operator Crew Cleaner Crew Utility Deck Cadet Deck Fitter Donkerman DPO Electric Cadet Electric Officer Electrical Engineer Electrician Engine Cadet Engine Fitter ETO Excavator Driver Fish Master Fish Meal Plant Operator Fitter Fitter-Welder Gaz Engineer HLO JDPO Junior Engineer Junior Officer Master Mess Boy Motorman 1st class Motorman 2nd class Motorman-Electrician Motorman-Fitter Motorman-Oiler Motorman-Turner Motorman-Welder Oiler Oiler-Fitter Oiler-Turner Oiler-Welder Ordinary Seaman OS-Cook OS-Welder Plumber Pumpman Radio Officer Ref. Cadet Ref. Engineer Ref. Machinist Rig Mechanic Safety Officer Sandblaster SDPO Security Officer Single Engineer Staff Capitan Staff Chief Engineer Steward Superintendant Trawmaster Turner Watch Engineer Welder Wiper Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bermuda Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer Cement Carrier ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown 2nd Engineer 2nd Officer 3rd Engineer 3rd Officer 4th Engineer AB-Carpenter AB-Cook AB-Electrician AB-Fitter Able Seaman AB-Motorman AB-Welder Anchor Operator Ass. Cook Assistant Bartender Assistant Chief Housekeeper Assistant Maitre Assistant Waiter Bar Waiter Barge Master Bartender Boatswain Broadcast Manager Buffet Attendant Cabin Steward Casino Dealer Casino Manager Chief Cook Chief Engineer Chief Housekeeper Chief Officer Chief Technologist Chief Trawlmaster Cook Crane Operator Crew Cleaner Crew Utility Deck Cadet Deck Fitter Donkerman DPO Electric Cadet Electric Officer Electrical Engineer Electrician Engine Cadet Engine Fitter ETO Excavator Driver Fish Master Fish Meal Plant Operator Fitter Fitter-Welder Gaz Engineer HLO JDPO Junior Engineer Junior Officer Master Mess Boy Motorman 1st class Motorman 2nd class Motorman-Electrician Motorman-Fitter Motorman-Oiler Motorman-Turner Motorman-Welder Oiler Oiler-Fitter Oiler-Turner Oiler-Welder Ordinary Seaman OS-Cook OS-Welder Plumber Pumpman Radio Officer Ref. Cadet Ref. Engineer Ref. Machinist Rig Mechanic Safety Officer Sandblaster SDPO Security Officer Single Engineer Staff Capitan Staff Chief Engineer Steward Superintendant Trawmaster Turner Watch Engineer Welder Wiper Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bermuda Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer Cement Carrier ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown 2nd Engineer 2nd Officer 3rd Engineer 3rd Officer 4th Engineer AB-Carpenter AB-Cook AB-Electrician AB-Fitter Able Seaman AB-Motorman AB-Welder Anchor Operator Ass. Cook Assistant Bartender Assistant Chief Housekeeper Assistant Maitre Assistant Waiter Bar Waiter Barge Master Bartender Boatswain Broadcast Manager Buffet Attendant Cabin Steward Casino Dealer Casino Manager Chief Cook Chief Engineer Chief Housekeeper Chief Officer Chief Technologist Chief Trawlmaster Cook Crane Operator Crew Cleaner Crew Utility Deck Cadet Deck Fitter Donkerman DPO Electric Cadet Electric Officer Electrical Engineer Electrician Engine Cadet Engine Fitter ETO Excavator Driver Fish Master Fish Meal Plant Operator Fitter Fitter-Welder Gaz Engineer HLO JDPO Junior Engineer Junior Officer Master Mess Boy Motorman 1st class Motorman 2nd class Motorman-Electrician Motorman-Fitter Motorman-Oiler Motorman-Turner Motorman-Welder Oiler Oiler-Fitter Oiler-Turner Oiler-Welder Ordinary Seaman OS-Cook OS-Welder Plumber Pumpman Radio Officer Ref. Cadet Ref. Engineer Ref. Machinist Rig Mechanic Safety Officer Sandblaster SDPO Security Officer Single Engineer Staff Capitan Staff Chief Engineer Steward Superintendant Trawmaster Turner Watch Engineer Welder Wiper Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bermuda Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer Cement Carrier ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown 2nd Engineer 2nd Officer 3rd Engineer 3rd Officer 4th Engineer AB-Carpenter AB-Cook AB-Electrician AB-Fitter Able Seaman AB-Motorman AB-Welder Anchor Operator Ass. Cook Assistant Bartender Assistant Chief Housekeeper Assistant Maitre Assistant Waiter Bar Waiter Barge Master Bartender Boatswain Broadcast Manager Buffet Attendant Cabin Steward Casino Dealer Casino Manager Chief Cook Chief Engineer Chief Housekeeper Chief Officer Chief Technologist Chief Trawlmaster Cook Crane Operator Crew Cleaner Crew Utility Deck Cadet Deck Fitter Donkerman DPO Electric Cadet Electric Officer Electrical Engineer Electrician Engine Cadet Engine Fitter ETO Excavator Driver Fish Master Fish Meal Plant Operator Fitter Fitter-Welder Gaz Engineer HLO JDPO Junior Engineer Junior Officer Master Mess Boy Motorman 1st class Motorman 2nd class Motorman-Electrician Motorman-Fitter Motorman-Oiler Motorman-Turner Motorman-Welder Oiler Oiler-Fitter Oiler-Turner Oiler-Welder Ordinary Seaman OS-Cook OS-Welder Plumber Pumpman Radio Officer Ref. Cadet Ref. Engineer Ref. Machinist Rig Mechanic Safety Officer Sandblaster SDPO Security Officer Single Engineer Staff Capitan Staff Chief Engineer Steward Superintendant Trawmaster Turner Watch Engineer Welder Wiper Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Austrian Empire Azerbaijan Baden* Bahrain Bangladesh Barbados Bavaria* Belarus Belgium Belize Benin (Dahomey) Bermuda Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Brunswick and Lüneburg Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Central American Federation* Chad Chile China Colombia Comoros Cook Islands Costa Rica Cote d’Ivoire (Ivory Coast) Croatia Cuba Cyprus Czechia Czechoslovakia Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Germany (German Democratic Republic) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Federal Government of Germany (1848-49)* Fiji Finland France Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Hanover* Hanseatic Republics* Hawaii* Hesse* Holy See Hong Kong Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Serbia/Yugoslavia* Kiribati Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lew Chew (Loochoo)* Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mecklenburg-Schwerin* Mecklenburg-Strelitz* Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nassau* Nauru Nepal New Zealand Nicaragua Niger Nigeria North German Confederation* North German Union* Norway Oldenburg* Oman Orange Free State* Pakistan Palau Panama Papal States* Papua New Guinea Paraguay Peru Philippines Piedmont-Sardinia* Poland Portugal Qatar Republic of Genoa* Republic of Korea (South Korea) Republic of the Congo Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Schaumburg-Lippe* Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Texas* Thailand The Bahamas The Cayman Islands The Congo Free State The Duchy of Parma* The Gambia The Grand Duchy of Tuscany* The Netherlands The Solomon Islands The United Arab Emirates The United Kingdom Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Two Sicilies* Uganda Ukraine Union of Soviet Socialist Republics* Uruguay Uzbekistan Vanuatu Venezuela Vietnam Württemberg* Yemen Zambia Zimbabwe Bulk Carrier Container Oil Tanker Ch. Tanker LPG LNG Ro-Ro Lo-Ro Heavy Lift Tug Reefer Passenger Fish Supply Ferry Dry Cargo Dredger PSV Multi-Purpose General Cargo Ro-Flow Research Bunker barge Sailing Universal Pilot boat Hopper Float. Crane Oil Platform AHT OGT Hotel Fireboat Car Carrier AHTS Salvage Diving boat DSV Seismic War ship Submarine Jackup Barge Yacht Floating rig OBO Cable-laying Barge ROV Coaster Drilling research FPSO VLCC AHTS / ROV OSV MSV Trawler Floating Fish Factory Product Tanker Cable/Pipe Layer Cement Carrier ABB Electric Motors Alasaka B&W Barreras BOLNES British Polar BRONS-MAN Catepillar Cummins Daihatsu Deuts EMD Fiat GMT GTS Hanshin Hedemora Hitachi Hyundai Hyundai HIMSEN Kawasaki Kobe Mak MAN MAN-B&W Mercedes Mierleess Mitsubishi Mitsui Mohab MWM NIAGATA Niigata NOHAB Normo NVD Pielstick RD Rolls-Royce Bergen Russian diesel SKL Skoda Steam turbine STEWARD & STEVENSON Stork Sulzer Sulzer RTA Turbine Vichman Volvo WARTSILA Wasa Werkspoor Wichmann Wuxi Yanmar Unknown 2nd Engineer 2nd Officer 3rd Engineer 3rd Officer 4th Engineer AB-Carpenter AB-Cook AB-Electrician AB-Fitter Able Seaman AB-Motorman AB-Welder Anchor Operator Ass. Cook Assistant Bartender Assistant Chief Housekeeper Assistant Maitre Assistant Waiter Bar Waiter Barge Master Bartender Boatswain Broadcast Manager Buffet Attendant Cabin Steward Casino Dealer Casino Manager Chief Cook Chief Engineer Chief Housekeeper Chief Officer Chief Technologist Chief Trawlmaster Cook Crane Operator Crew Cleaner Crew Utility Deck Cadet Deck Fitter Donkerman DPO Electric Cadet Electric Officer Electrical Engineer Electrician Engine Cadet Engine Fitter ETO Excavator Driver Fish Master Fish Meal Plant Operator Fitter Fitter-Welder Gaz Engineer HLO JDPO Junior Engineer Junior Officer Master Mess Boy Motorman 1st class Motorman 2nd class Motorman-Electrician Motorman-Fitter Motorman-Oiler Motorman-Turner Motorman-Welder Oiler Oiler-Fitter Oiler-Turner Oiler-Welder Ordinary Seaman OS-Cook OS-Welder Plumber Pumpman Radio Officer Ref. Cadet Ref. Engineer Ref. Machinist Rig Mechanic Safety Officer Sandblaster SDPO Security Officer Single Engineer Staff Capitan Staff Chief Engineer Steward Superintendant Trawmaster Turner Watch Engineer Welder Wiper 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 Nothing selected Additional Travel Passport Civil Passport Seaman's Book Temp ID for non-UA citizens Travel Passport Certificate of Competency Certificate of Competency (Alternative Rank) Certificate of Competency (II) Certificate of Competency (III) GMDSS C.I.S.R Irish C.E.C. Liberian License Liberian S.I.D. Maltese Endorsment Panamanian ID St.Vincent (SV6) Australian MCV Canadian Visa Schengen Visa U.S. Visa (B1) U.S. Visa (C1/D) Advanced Fire Fighting Course ARPA Basic SCTV (A-VI/1) BOSIET Breathing Apparatus Bridge team and resource management Designated Security Duties ECDIS Engine room resource management Fast Rescue Boats Food sanitation system Furuno ECDIS H2S Orientation Hazardous materials HUET JRC ECDIS JRC ECDIS (II) Medical Care Medical First Aid Messman New Hire Orientation Training Personal Basket Transfer Training Probation Proficiency in Survival Crafts RADAR/ARPA Risk Assessment Safety Officer Security awareness training Security Officer Ship's cran operator Simrad ECDIS Diphteria Vaccination Medical Examination Yellow Fever Vaccination CES English Test Marlins Test Other Nothing selected Additional Travel Passport Civil Passport Seaman's Book Temp ID for non-UA citizens Travel Passport Certificate of Competency Certificate of Competency (Alternative Rank) Certificate of Competency (II) Certificate of Competency (III) GMDSS C.I.S.R Irish C.E.C. Liberian License Liberian S.I.D. Maltese Endorsment Panamanian ID St.Vincent (SV6) Australian MCV Canadian Visa Schengen Visa U.S. Visa (B1) U.S. Visa (C1/D) Advanced Fire Fighting Course ARPA Basic SCTV (A-VI/1) BOSIET Breathing Apparatus Bridge team and resource management Designated Security Duties ECDIS Engine room resource management Fast Rescue Boats Food sanitation system Furuno ECDIS H2S Orientation Hazardous materials HUET JRC ECDIS JRC ECDIS (II) Medical Care Medical First Aid Messman New Hire Orientation Training Personal Basket Transfer Training Probation Proficiency in Survival Crafts RADAR/ARPA Risk Assessment Safety Officer Security awareness training Security Officer Ship's cran operator Simrad ECDIS Diphteria Vaccination Medical Examination Yellow Fever Vaccination CES English Test Marlins Test Other Nothing selected Additional Travel Passport Civil Passport Seaman's Book Temp ID for non-UA citizens Travel Passport Certificate of Competency Certificate of Competency (Alternative Rank) Certificate of Competency (II) Certificate of Competency (III) GMDSS C.I.S.R Irish C.E.C. Liberian License Liberian S.I.D. Maltese Endorsment Panamanian ID St.Vincent (SV6) Australian MCV Canadian Visa Schengen Visa U.S. Visa (B1) U.S. Visa (C1/D) Advanced Fire Fighting Course ARPA Basic SCTV (A-VI/1) BOSIET Breathing Apparatus Bridge team and resource management Designated Security Duties ECDIS Engine room resource management Fast Rescue Boats Food sanitation system Furuno ECDIS H2S Orientation Hazardous materials HUET JRC ECDIS JRC ECDIS (II) Medical Care Medical First Aid Messman New Hire Orientation Training Personal Basket Transfer Training Probation Proficiency in Survival Crafts RADAR/ARPA Risk Assessment Safety Officer Security awareness training Security Officer Ship's cran operator Simrad ECDIS Diphteria Vaccination Medical Examination Yellow Fever Vaccination CES English Test Marlins Test Other Nothing selected Additional Travel Passport Civil Passport Seaman's Book Temp ID for non-UA citizens Travel Passport Certificate of Competency Certificate of Competency (Alternative Rank) Certificate of Competency (II) Certificate of Competency (III) GMDSS C.I.S.R Irish C.E.C. Liberian License Liberian S.I.D. Maltese Endorsment Panamanian ID St.Vincent (SV6) Australian MCV Canadian Visa Schengen Visa U.S. Visa (B1) U.S. Visa (C1/D) Advanced Fire Fighting Course ARPA Basic SCTV (A-VI/1) BOSIET Breathing Apparatus Bridge team and resource management Designated Security Duties ECDIS Engine room resource management Fast Rescue Boats Food sanitation system Furuno ECDIS H2S Orientation Hazardous materials HUET JRC ECDIS JRC ECDIS (II) Medical Care Medical First Aid Messman New Hire Orientation Training Personal Basket Transfer Training Probation Proficiency in Survival Crafts RADAR/ARPA Risk Assessment Safety Officer Security awareness training Security Officer Ship's cran operator Simrad ECDIS Diphteria Vaccination Medical Examination Yellow Fever Vaccination CES English Test Marlins Test Other Nothing selected Additional Travel Passport Civil Passport Seaman's Book Temp ID for non-UA citizens Travel Passport Certificate of Competency Certificate of Competency (Alternative Rank) Certificate of Competency (II) Certificate of Competency (III) GMDSS C.I.S.R Irish C.E.C. Liberian License Liberian S.I.D. Maltese Endorsment Panamanian ID St.Vincent (SV6) Australian MCV Canadian Visa Schengen Visa U.S. Visa (B1) U.S. Visa (C1/D) Advanced Fire Fighting Course ARPA Basic SCTV (A-VI/1) BOSIET Breathing Apparatus Bridge team and resource management Designated Security Duties ECDIS Engine room resource management Fast Rescue Boats Food sanitation system Furuno ECDIS H2S Orientation Hazardous materials HUET JRC ECDIS JRC ECDIS (II) Medical Care Medical First Aid Messman New Hire Orientation Training Personal Basket Transfer Training Probation Proficiency in Survival Crafts RADAR/ARPA Risk Assessment Safety Officer Security awareness training Security Officer Ship's cran operator Simrad ECDIS Diphteria Vaccination Medical Examination Yellow Fever Vaccination CES English Test Marlins Test Other Foreign languages Information Language Level Certificate I, undersigned, confirm all above information to be true and correct to my best knowledge 27.03.2023 Date