Get documents about "PARAMOUNT SHIPPING MANAGEMENT PVT
Document Sample
PARAMOUNT SHIPPING & MGMT. PVT. LTD.
(Member of Schulte Group)
APPLICATION FORM
PHOTOGRAPH
RANK APPLIED DATE OF APPLICATION
INDOS NUMBER DATE OF AVAILABILITY
1 . PE R S O N A L DE T A I L S SURNAME FIRST NAME MIDDLE NAME
NAME
Date of Birth Place of Birth Nationality
Permanent Address Present Address
City & Pin code: City & Pin code:
Telephone Telephone
Email 1 E-mail 2
Next of Kin (Name) Relationship
Address of next of kin:
Height Weight Blood Group Languages Known
Marital Status Name of Spouse Number of Children
2 . PA S S PO R T D E T A I L S
Number Place of Issue Date of Issue Date of Expiry
PASSPORT
US VISA C1/D
Required Not Required
ECNR YELLOW FEVER
3 . C O N T I N UO U S D I S C H A R G E C E RT I FI C A T E ( S )
CDC Number Place of Issue Date of Issue Date of Expiry
INDIAN
PANAMA
LIBERIAN
4 . A C A D E M I C Q U A L I FI C A T I O N S Grade / Degree From (Year) To (Year)
School
College
Pre-sea Training
Institute
Form no. 05-1 12/2002
5 . L I CE N C E / C E RT I FI C A T E O F C O M PE T E N C Y
Grade Number Date of Issue Date of Expiry Date Revalidation STCW 95
YES NO
INDIAN
UK / AUS
LIBERIAN
PANAMA
HONGKONG
SINGAPORE
6 . S T CW A N D O T H E R C E RT I FI C A T E S
STCW COURSES Certificate No. Date of Issue Date of Expiry Place of Issue Issuing Authority /INSTITUTE
PSSR
EFA / FAS / MFA / MEDICARE
(First Aid)
SAS / PST(C) / PSCRB
(Survival)
FP & FF / BFF / AFF
(Fire Fighting)
ROC
ARPA
GMDSS
REFRESHER & UPDATING
W/K CERT. FOR RATINGS
SIMULATOR TRAINING
RANSCO / RSC
SMS / NAV CONTROL
ENGINE SIMULATOR
BTM / ETM
TANKER COURSES
TASCO / TANK FAM.
LIQUID CARGO SIM.
DCE PETROLEUM
DCE CHEMICAL
DCE LPG
HAZMAT
Form No. 05- 1 12/2002
8 R E FE R E N CE S (Please give two referees/companies whom we can ask about your seagoing experience)
Name Company / Designation Telephone / Contact. No.
1
2
9 H O W D I D Y O U C O M E T O K N O W A B O U T U S ? ( Please tick the appropriate medium)
A Company presentation/seminar B Marine Club notice-board C Marine magazine advertisement
D Newspaper advertisement E Told by seagoing friend(s) F Direct Mail from Company
G Others (Please specify)
1 0 D E C L A R AT I O N
I certify that the details given by me in filling up this form are true, complete, and correct to best of my knowledge and belief. I understand that any misrepresentation or material omission made in
this application form or other documents submitted to Paramount Shipping & Management Private Limited may renders me liable for termination or dismissal.
Date: _____________ SIGNATURE OF APPLICANT ____________________________________
Please hand in, mail or e-mail your application to:
PARAMOUNT SHIPPING AND MANAGEMENT PVT. LTD.
401, Olympia, Hiranandani Gardens, Powai 208, Oriental House, Gulmohar Enclave Commercial Complex
Mumbai - 400 076 New Delhi –110 049
Telephone: (022) 40017300 Fax: 91-22- 40017444 Telephone: (011) 26510222 Fax: 91-11-26960222
E-mail: seacareers@eurasiagroup.com
11. S PA C E FO R O FFI C I A L U S E
Assessment: Grade Application Status: Date:
Personality Forwarded to Mumbai
Attitude Entered in Shipmate
Technical Knowledge Shipmate ID Number
PRINCIPAL’S ACCEPTANCE DETAILS
YES NO
ACCEPTED
REF :
Overall Assessment
Grade: A – Very Good; B – Good; C- Satisfactory; D - Poor
Interviewed by ______________________ Date __________________
Additional Comments:
Form No. 05-1 12/2002
7. S E A E X PE R IE N C E : (Most recent first)
COMPANY / VESSEL PERIOD MAIN ENGINE REASON FOR
AGENTS NAME TYPE DWT GRT TEU RANK FROM TO M/D MAKE MODEL BHP UMS SIGN-OFF
CBM
PARAMOUNT PSM PRIDE TNKR 99,358 45,701 C/O 1.02.2001 2.08.2001 6M3D B&W 6L80GFC 15,814 YES END OF CONTRACT
(Sample ) Crude
Any Major Incidence / Observation / Special experience for reporting:
Form No. 05- 1 12/2002
Related docs
