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SEAFARER APPLICATION FORM
PERSONAL DETAILS
EDUCATIONAL BACKGROUND
TECHNICAL BACKGROUND
IDENTITY DOCUMENTS
Passport
Yes/Indian
No
Seaman book
Indian
Others
Do you hold a US Visa ‘C1/D’ ?
Yes
NO
Do you hold schengen Visa
Yes
NO
FAMILY DETAILS (IF UNMARRIED KINDLY GIVE DETAILS OF FATHER / MOTHER)
CERTIFICATES (HIGHEST CERTIFICATE OF COMPETENCY HELD)
DETAILS OF COURSES & CERTIFICATES FOR OFFICERS
Select Courses
Advanced Fire Fighting(AFF)
Medical First Aid (MFA) / Medicare
Proficiency in Survival Craft & Rescue Boat
Personal Survival & Social Responsibility
SSO (Ship Security Officers Course)
ECDIS
BTM (Renewed every 5 years)
ARPA (Automatic Radar Plotting Aid)
GMDSS
Radar Observer / RANSCO Simulator
GMDSS Endorsement
Oil Tanker Familiarization (OTFC) / TASCO
DCE Oil - Support / Operation/Management
Chemical Tanker Familiarization (CTFC) /CHEMCO
DCE Chemical - Support/Operation/Management
Specialized Training Programme On Oil Tanker Operations (STPOTO)
Framo Course
Revalidation Course for Deck / Engine Officers
Refresher & Up Gradation Course for Deck /Engine Officers
DETAILS OF COURSES & CERTIFICATES FOR RATINGS
Select Courses
FIRE PREVENTION & FIRE FIGHTING (FPFF)
ELEMENTARY FIRST AID (EFA)
Personal Survival Technique (PST)
Personal Survival & Social Responsibility(PSSR)
STSDSDS Course
Oil Tanker Familiarization (OTFC)
DCE Oil - Support
Chemical Tanker Familiarization (CTFC)
DCE Chemical - Support
AB / MM Course
Watch Keeping Certificate Ratings (Deck/Engine)
Pump Man Course
Cookery Course
MMD Cookery Certificate
Fitter Course / Class Cert
ISPS Course
Ship Safety Oflicers Course / Risk
Assessment
Ship Maneuvring Simulator
BRM / MRM / BERM (Renewed every 5 years)
Electrical/Electronics for Marine Engineers - Basic / Advance
FOR ENGINEERS(PLEASE PROVIDE DETAILS)
TOTAL SAILING EXPERIENCE
MEDICAL HISTORY (IF THE ANSWER IS YES TO ANY OF THE BELOW, PLEASE GIVE FULL DETAILS AND ATTACH A SEPARATE PAGE IF NECESSARY)
Have you ever signed off a ship due to medical reasons ?
Yes
No
Have you undergone any Surgery / Accident
Yes
No
Do you have any health disability problems now ?
Yes
No
SEA SAILING EXPERIENCES
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DECLARATION
I hereby affirm that all the information provided by me in this application is true and correct
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