Application Form for Usa Visa

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Application Form for Usa Visa Powered By Docstoc
					                                                                                                             APPLICATION FORM
                                                                                                              (for deck officers)
                                       Rank                                                 Date of birth
                                       Surname                                              Place of birth
                                       First name                                           Home address
personal details

                                       Patronymic                                           Home phone                             Mobil
                                       Marital status                                       E-mail
                                       Next of kin/relationship/address/phone
                                                                             Test        Marlins    Test       CES 4.1     Height                   Clothes size            Hair color
                                          Language knowledge (english)
                                                                             Result               % Result               % Weight                   Shoes size              Eye color
                                             Education                        University (School, College)                   Year of graduation                         Speciality

                                                     Document                   Grade               Number                  Place of issue                Issued date                   Expire date
                                       Seaman's book

                                       Passport (national)
                                       Passport (foreign)
                                       Visa (USA, others)                   С1/D
                                       Seaman’s passport (Cyp., others)
                                       CERTIFICATE OF COMPETENCY of
                                       RADAR, ARPA
                                       BASIC SAFETY TRAINING EVIDENCE
                                       SURVIVAL CRAFT & RESCUE BOAT

                                       ADVANCED FIRE FIGHTING
                                       MEDICAL FIRST AIDS
                                       MEDICAL CARE
                                       PHYSICAL EXAMINATION REPORT
                                       YELLOW FEVER
                                       D & A TEST
                                       HAZMAT/Carriage of dang.&hazard.subst.
Special training

                                       HAZMAT training program "C", title 49 (USA)
                                       Oil tanker training program
                                       Chemical tanker training program
                                       Other courses:

                                                                                            Type of vessel           Owner's name                                         Date                 Date
                                              Name of vessel                 Flag                                                                        Rank
                                                                                                 DWT           Crew management company                                    from                  to
Previous experience for last 5 years

             Nationality of crewmembers sailed with:                                                                                                               Your comments:

             Recommendations                                                                                                                                            min wage
             Phone of last shipowner (Crew company)                                                                                                                   expected wage
             Others:                                                                                                                                                 expect.duration
        Application form                                                                                                                                            readiness to work
         is accepted by                                                              Date                                  Signature of applicant

Description: Application Form for Usa Visa document sample