NEMTAS

TÜRKÇE / ENGLISH

	Career

SEAMAN APPLICATION FORM

APPLICATION DATE

:

11.03.2010

PERSONAL INFORMATIONS
Name	:	*	Surname	:	*
Place of Birth	:		Date of Birth	:	*
Nationality	:	*		:
Home Phone No	:	*	Mobile No	:	*
Home Address	:
e-Mail Address	:		Marital Status	:	Single Married
Education Status	:		Comp. Military Status	:
Knowledge of Foreign Lang.	:
Reading		Writing	Listening		Speaking
Mid Good Very Good		Mid Good Very Good	Mid Good Very Good		Mid Good Very Good

SEAMAN DOCUMENTS INFORMATIONS
Passport Number	:		Exp. Date of Passport	:	*
Seaman Book Number	:		Exp. Date of Seaman Book	:	*
Competency	:	*	Exp. Date of Competency	:	*
Yellow Fever Vac.	:	*	Exp. Date of Health Rep.	:	*

APPLICATION INFORMATIONS
Rank	:	*	Date to Begin Job	:	*
Sea Experience	:

WORK EXPERIENCE
Company's Name	Vessel's Name, Tonnage etc.	Rank	Duration

REFERENCES
Name Surname	Company's Name	Job Title	Contact Details

CERTIFICATES
Name of Certificate	Expiry Date	Name of Certificate	Name of Certificate
Fire Prevention and Fire Fighting Training Cert.		Navigational WatchKeeping Cert.	Engine-Room WatchKeeping Cert.
Personal Survival Tecniques Training Cert.		Medical Care Training Cert.	Ship Security Officer Cert.
Elementary First aid Training Cert.		Oil Tanker Familiarization Cert.	Radar Obse. and Plotting Tra. Cert.
Proficiency in Survival Craft and Rescue Boats Cert.		Oil Tanker Opr. Cert.	ARPA Training Cert.
Personal Safety and Social Pesponsibility Training Cert.		Medical First Aid Training Cert.	VHF Radio Comunications Cert.
Advanced Fire Fighting Cert.		Other
GMDSS (GOC)

PYHISICAL INFORMATIONS
Shirt Size	:		Height	:	cm *
Overal Size	:		Weight	:	kg *
Trousers Size	:		Blood Type	:
Shoe Size	:			:

Other