APPLICATION FOR SEA STAFF EMPLOYMENT

							   Attach recent
    color photo         APPLICATION FOR SEA STAFF EMPLOYMENT
  (Passport Size)                                   (RATINGS)


                      POST APPLIED FOR
                     (Form to be filled in by the Applicant in block letters)

THIS FORM HAS BEEN DESIGNED TO PROVIDE US WITH THE BASIC INFORMATION FOR EASY PROCESSING OF YOUR
APPLICATION FOR EMPOLYMENT WITH US. IT ALSO SERVES AS OUR PERSONNEL RECORD SHOULD YOU BE EMPLOYED. IT
IS ESSENTIAL FOR YOU AND HELPFUL TO THE INTERVIEWER THAT THE FORM IS NEATLY AND CAREFULLY FILLED IN. ALL
PARTS TO BE COMPLETED, WHERE NOT APPLICABLE STATE ‘N.A.’
PERSONAL PARTICULARS:
NAME (AS IN PASSPORT):
ADDRESS:



TELEPHONE NO: (1)                                     (2)
DATE & PLACE OF BIRTH:                                MARITAL STATUS:
NATIONALITY:                                         COUNTRY OF DOMICLE:
HEIGHT (CM):                                          WEIGHT (KGS):
NRIC NO (FOR SINGAPOREANS/MALAYSIANS):
NATIONAL SERVICE LIABILITY (FOR SINGAPOREANS ONLY): YES/NO/COMPLETED/EXEMPTED *
LANGUAGE/DIALECT PROFICIENCY:
SEAMAN’S REGISTRATION NO:                            TRADE:                 EXPIRY:
PASSPORT NO:                              PLACE/DATE ISSUE:                 EXPIRY:
VISA HELD: (1)                            PLACE/DATE ISSUE:                 EXPIRY:
           (2)                            PLACE/DATE ISSUE:                 EXPIRY:
DISCHARGE BOOK NO:                        PLACE/DATE ISSUE:                 EXPIRY:
DISCHAGRE Ì OTHERS:                       PLACE/DATE ISSUE:                 EXPIRY:
S.T.C.W ENDORSEMENT (YES/NO)*                                               EXPIRY:
S.T.C.W MODULAR CERTIFICATES (PHOTOCOPIES REQUIRED)
                                                           CERT NO.                 DATE ISSUED:
1) FIRE FIGHTING COURSE (BASIC/ADVANCE)*       :
2) FIRST AID AT SEA (BASIC/ADVANCE)*           :
3) PERSONAL SAFETY TECHNIQUES                  :
4) PERSONAL SAFETY & SOCIAL RESP               :
5) TANKER FAMILIARISATION                      :
6) PERSONAL SURVIVAL CRAFT & RESCUE BOAT :
7) LIFEBOATMAN CERT                            :
8) EFFICIENT DECK HAND CERT                    :
9) ENGINE RATING CERT                          :
10) RE-TRAINING CERT                           :
11) DANGEROUS CGO ENDORSEMENT (OIL)            :
12) OTHERS                                     :
13) OTHERS                                     :
* TO DELETE AS APPROPRIATE
NEXT OF KIN:                                                         RELATIONSHIP:
ADDRESS:

TELEPHONE:

RECORD OF PERVIOUS SEA GOING EXPERIENCE LAST 3 YEARS:
      VESSEL              TYPE        FROM            TO                       RANK                   COMPANY




NAME & ADDRESS OF PRESENT/LAST EMPOLYER


PERSON IN CHARGE:                                                     TELEPHONE

SHORE EMPOLYMENT:

      NAME/ADDRESS                  NATURE OF               PERIOD               REASON FOR                  WAGES
      LAST EMPOLYER                   WORK                  THERE                  LEAVING




PHOTOCOPIES OF TESTIMONIALS/REFERENCES OF PERVIOUS EMPOLYMENT TO BE ATTACHED:

WHEN ARE YOU READY TO JOIN:

IMPORTANT: ALL APPLICANTS MUST READ & CHECK THE APPROPRIATE BOX FOR EACH ITEM:
Have you ever been afflicted with a communicable disease of public health
significance, a dangerous physical or mental disorder?                    YES:                                  NO:
Have you ever been arrested or convicted of any crime?                    YES:                                  NO:
Are you a user of any prohibited drugs?                                   YES:                                  NO:
Have you been ever employed by NSSPL before?                              YES:                                  NO:
Are you under any CNB/POLICE probation or restriction to travel?          YES:                                  NO:

DECLARATION TO BE SIGNED BY THE APPLICANT
I hereby declare that information contained in this form is to the best of my knowledge and belief correct and that I
have withheld nothing that would affect this application. I also understand that if employed, my services may be
terminated if any of the information given above is false. I understand that a strict medical examination is a condition
precedent to selection for appointment and I express my willingness to be examined (if required) and to furnish to
Consulting Physician with full details of my pervious medical history.


        Signature of Applicant                                                                       Date

                                           RESERVED FOR OFFICIAL USE ONLY