Scribd
Upload
40 views3 pages

Employment Application Form

This document is an employment application and joining checklist for seafarers, detailing personal particulars, required documents, training certifications, and a sea service record. It includes a declaration section where applicants must answer questions regarding their employment history and health. The form requires signatures from both the applicant and a crewing executive to confirm the information provided.

Uploaded by

razifshidiq381
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
40 views3 pages

Employment Application Form

This document is an employment application and joining checklist for seafarers, detailing personal particulars, required documents, training certifications, and a sea service record. It includes a declaration section where applicants must answer questions regarding their employment history and health. The form requires signatures from both the applicant and a crewing executive to confirm the information provided.

Uploaded by

razifshidiq381
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

CONTROLLED COPY

FORM NO: 13010 Revision No : 2


Date Issued : February 20, 2017
Prepared By : DPA
EMPLOYMENT APPLICATION / Approved By : GM
JOINING CHECK LIST Page : 1 of 3

PERSONAL PARTICULAR
Full Name RANK
Place & DOB Next of Kin (NOK)
Nationality Relation of NOK
Marital Status Contact Number NOK
Religion Wife Name
Contact Number (SG) Wife I/C No
Contact Number (IDR) Wife’s Occupation
No of Children
Current Address Employee Code
Date of Join
Document and Certificate
Details
Document No Place Issued Date Issued Expiry Date
Passport

Seaman Book

COC

COE

Panama COR / Dominica COR

Malaysia COR / MPA COE


Bosiet (applicable for
crewboat)
H2S (applicable for crewboat)

Dynamic Position (DP____)

Medical Report (Petronas)

Medical Report (_________)

Course Title
Document No Place Issued Date Issued Expiry Date
Basic Safety Training

Advance Fire Fighting

Prof. Survival Craft & Rescue


Boat
Medical First Aid / Elementary

Medical Care On Board

Ship Security Officer

Crowd Management

Crisis Management and


Human Behavior
Ship Security Awareness
CONTROLLED COPY

FORM NO: 13010 Revision No : 2


Date Issued : February 20, 2017
Prepared By : DPA
EMPLOYMENT APPLICATION / Approved By : GM
JOINING CHECK LIST Page : 2 of 3

Training
Security Training For Seafarer
With Designated Security
Duties
Bridge Resource Management

Engine Room Resource


Management
Arpa Simulator

Radar Simulator

General Operator Certificate


(ORU)
Prof. GOC for GMDSS

ISM Code

Electronic Chart Display and


Information System (ECDIS)

Food Handling

Rigging & Slinging

Sea Service Record


Main Period
Company Vessel Type G.T. Engine From To Rank Reason
Detail

Notes: *Please delete or changed if there is an additional certificate.


CONTROLLED COPY

FORM NO: 13010 Revision No : 2


Date Issued : February 20, 2017
Prepared By : DPA
EMPLOYMENT APPLICATION / Approved By : GM
JOINING CHECK LIST Page : 3 of 3

Declaration By Applicant
Answer “YES” or “No” to the following questions. If “YES”, give details below.
1 Has any previous employer dismissed you for misconduct? Yes / No *
2 Have you had any serious illness, injury or operation affecting your work? Yes / No *
3 Have you physical handicap including eyesight or hearing? Yes / No *
4 Have you ever been convicted in a court of law in any country? Yes / No *
If any answer to the foregoing questions is “Yes”, give brief detail here (indicate question No.):

I hereby certify that the above information provided by me is true, complete and to best of my knowledge. I
further understand that any willful act on my part in withholding information or making any false statement
in the application is in itself sufficient for dismissal from the company.

_____________________ _____________________
Signature of applicant Date

Crewing Executive to confirm all the above are in order by signing below.

_____________________ _____________________
Crew Manning Executive Date

You might also like