RETURN
NSM CREW MANAGEMENT
APPLICATION FORM
all fields marked with * are required
Full name*
date of birth*
rank*
Choose your rank
master
chief officer
second officer
deck cadet
chief engineer
second engineer
third engineer
electrical engineer
gas engineer
bosun
able seaman
ordninary seaman
wiper
oiler
assistant cook
cook
assistant steward / messman
city*
street*
flat*
contact number*
email*
nationality*
marital status*
Choose your marital status
Single
Married
Divorced
Next of Kin
full name*
relation*
contact number*
Passports
Seaman's book*
date of issue
date of expiry
Travel passport*
date of issue
date of expiry
usa visa
yes
no
certificate of competency (coc)*
number
date of issue
date of expiry
certificates
safety familiarization, basic training and instruction for all seafarers
number
date of issue
date of expiry
security AWARENESS
number
date of issue
date of expiry
designated securiry duties for all seafarers
number
date of issue
date of expiry
Proficiency in survival craft and rescue boats
number
date of issue
date of expiry
advanced fire fighting
number
date of issue
date of expiry
medical first aid
number
date of issue
date of expiry
medical care
number
date of issue
date of expiry
hazardous cargoes handling
number
date of issue
date of expiry
bridge team and resourse management
number
date of issue
date of expiry
radar navigation / arpa
number
date of issue
date of expiry
ecdis
number
date of issue
date of expiry
high voltage
number
date of issue
date of expiry
engine team and resourse management
number
date of issue
date of expiry
ship's handling
number
date of issue
date of expiry
ship security officer
number
date of issue
date of expiry
ship safety officer
number
date of issue
date of expiry
incident investigation and risk analysis
number
date of issue
date of expiry
tanker and lpg documents
do you have basic training for oil & chemical tankers certificate?
yes
no
do you have basic training for oil & chemical tankers endorsement?
yes
no
do you have advanced oil tanker certificate?
yes
no
do you have advanced oil tanker endorsement?
yes
no
do you have advanced chemical tanker certificate?
yes
no
do you have advanced chemical tanker endorsement?
yes
no
do you have basic lpg certificate?
yes
no
do you have basic lpg endorsement?
yes
no
do you have advanced lpg certificate?
yes
no
do you have advanced lpg endorsement?
yes
no
sea service
please include contracts for the last 5 years
please mark relevant checkbox if you have no sea experience
rank
vessel name
vessel type
vessel flag
company
from
to
rank
vessel name
vessel type
vessel flag
company
from
to
rank
vessel name
vessel type
vessel flag
company
from
to
rank
vessel name
vessel type
vessel flag
company
from
to
rank
vessel name
vessel type
vessel flag
company
from
to
I have given information on my last contracts
I have no experience at any vessel
I hereby consent to the processing of the personal data that I have provided
apply