Omikron Crew

Date : *

Citizen ID : *

Department:*

A. SEAMAN’S
APPLICATION FORM

Rank (License held)

Position Applying for

Surname *

First name *

Middle name

Date of Birth *

Place of Birth *

Nationality

Address

CellPhone No *

E-mail Address *

Father's Name

Mother's Name

School

Marital Status

Skype

Name of Beneficiary

Relation

Contacts

Address

Emergency Contact Person (Other than family member)

Relation

Contacts

Address

Seaman's Book No *

Placed Issued

Date Issued

Date Valid

Passport No *

Placed Issued

Date Issued

Date Valid

USA VISA Type

Placed Issued

Date Issued

Date Valid

Schengen VISA Type

Placed Issued

Date Issued

Date Valid

Other Countries VISA Type

English Ability

Overalls size

Size of safety shoes

Military Service Status

B. DOCUMENTATION

Documents

Date Issued

Date Expire

Course Attended
TYPE OF SPECIFIC ECDIS ( FURUNO,JRC,TRANSAS ETC.) :

C. ENDORSEMENTS

Flag

Rank

Number

Date of Issue

Date of Expire

D. PREVIOUS SEA SERVICE FOR TANKERS

Rank

Master

C/O

2/O

3/O

C/E

2/E

3/E

4/E

PARAGRAPH D WILL BE COMPLETED BY THE CREW OPERATOR BEFORE SENDING FOR APPROVAL TO SPECIFIC TANKER PRINCIPALS, THE YEARS WILL BE THE AGGREGATE OF BOTH PAIRS OF OFFICERS INDICATED (MASTER & C/O, C/E & 2/E, ETC)

E. PREVIOUS SEA SERVICE (Start with the latest)

Ex-Crew

New-Crew

Company *

Vessel Name
& Flag *

Engine Type & Brand & BHP *

DWT *

Vessel Type
& Year Built *

Rank *

Date Embarked *

Cause of
Discharge *

Remarks: LATEST SERVICE SHOULD BE AT THE TOP. PLEASE SPECIFY ALL YOUR SEA SERVICES IN ORDER..

F. PREVIOUS EMPLOYER

REFERENCE FROM PREVIOUS COMPANY:

Two persons other that relatives to whom we can refer regarding yourself.

Information Sheet

Declaration Form

KVKK formunu kabul ediyorm.