Crew Resource Management Audits HANZA MARINE MANAGEMENT

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Crew Resource Management Audits HANZA MARINE MANAGEMENT Powered By Docstoc
					                                                 HANZA MARINE MANAGEMENT LTD
                                                             APPLICATION FORM
                                                                                                                               Passport
                                                                                                                              Photograph
RANK APPLIED FOR:                                                             OR
                                                                                                                              (please attach)
Surname/Family Name (as in Passport):
First Name:                                                       Middle Name (if any):
Date and place of birth:
Permanent Address:
Telephone No.:                                                 Mobile Ph.:                                 Fax:
E-mail:                                                                                        Nearest airport:
Citizenship/Nationality:                                                           Identity No./Personal code:
Marital status:                                                   Next of kin name:
Next of kin relationship:                                         Next of kin address:
No of children:                                  Names/Dates of birth:

                                                                MARINE EDUCATION HISTORY:
                             Name of School attended                         Address (City)      Graduated (Date)           Speciality




                                                                         DOCUMENTS:
Documents:                              Type                   Grade               Number          Place of issue   Date of issue   Expire date
                             National
                             British
     Seamans
       book




                             Liberian
                             Panamanian
                             Other:
                             Other:
  Passport                   National
                             National
     Information




                             Endorsement (National)
       Licence




                             British
                             Liberian
                             Panamanian
                             Other:
                             SOLAS (basic)
                             Proficiency in Survival Craft
                             Fire Fighting
                             Advanced Fire Fighting
                             First Aid
                             Medical Care
        Other certificates




                             Radar Observer
                             A.R.P.A.
                             GMDSS
                             Ship Security Officer
                             AMOS
                             Bridge Team Management
                             ER Resource Management
                             Ship's Handling
                             ECDIS (Electronic Charts)
                             Safety Officer



                             Petroleum
   Endorsements




                             Chemical
    Dangerous




                             LPG/LNG
      Cargo




                             HAZMAT
                             Crude Oil Washing
                             Inert Gas


HMM 1101 (Jul 08 Rev 7)
                                                            MEDICAL INFORMATION
Medical Certificate. Place of issue:                Date of issue:                                             Date of Expire:
Height:        cm      Weight:       kg     Colour of eyes:                                              Colour of hair:
  Yellow fever vaccination expire date (10 years):
                                                            UNIFORM INFORMATION:
    Height (cm)           Chest (cm)                 Waist (cm)              Collar (cm)       Shoes size:      Sweater size         Trousers size


           VISAS INFORMATION                                                               LANGUAGE INFORMATION
                      Type           Valid Until                                           Good      Satisf.     Poor                Remarks
U.S.A.                                                     English
Schengen:                                                  Other:
Other:                                                     Other:
MULTINATIONAL CREW EXPERIENCE (tick the appropriate box)
 British    Greek       Indian     Philipinno    Polish    Ex USSR


OTHER PRACTICAL EXPERIENCE (tick the appropriate box)
                                         Yes      No                               Types of Main Engines previously worked with:
Have you sailed on UMS vessels before?                                         Sulzer   MAN/B&W Pielstick Kobe Diesel             Other      Other
Have you had any operational problems
on your last two/three vessels ?
Have you had any ITF exposure?                                                     Types of Auxiliaries previously worked with:
Are you aware of "No Alcohol Policy"                                          Yanmar        B&W       Deutz    Dhaihatsu          Other      Other
ECDIS (Electronic Charts) experience ?

                                                                       HISTORY
Have you previously, or do you now have a      Yes                No
problem with drinking alcohol in large amounts                         :
(alcoholic)? If YES, please give details
Have you ever been dismissed from a company or
                                                                       :
vessel? If YES, please give details
Have you ever been in trouble with the police?
                                                                       :
If YES, please give details
Have you had serious injuries, ailments,
                                                                       :
diseases? If YES please give details
Have you ever claimed on insurance?
                                                                       :
If YES, please give details

                                                REEFER, DRY CARGO CHECK LIST
REEFER CARGOES EXPERIENCE (indicate number of years)
Bananas     Citrus    Pineapples     Kiwi       Grapes      Apples         Mango    Melons        Vegetables     Meat         Fish        Transhipment


REEFER CHARTERERS / OWNERS EXPERIENCE (indicate number of years)
  Dole     Chiquita     Cool       Del Monte Lauritzen Seatrade            Green    Zodiac    Lat.S.C.     Lavinia    Lomar        Blasco


OTHER CARGOES / VESSELS EXPERIENCE (indicate number of years)
Gen.CargoContainers Ro-Ro           Bulker         Ferry   Offshore


OTHER CHARTERERS / OWNERS EXPERIENCE (indicate number of years)




OTHER PRACTICAL EXPERIENCE (tick the appropriate box)
Have you carried any USDA cargo and      Yes      No                               Reefer plant experience:                          Yes       No
completed the checks prior to carriage?                                                                                 Brine ?
Have you sailed without a Reefer Engineer ?                                                        Direct Freon evaporation ?
Have you sailed on vessels built in Japan?                                         Reefer containers experience ?
Cargo crane experience?                                                            Stevedore damages experience?
Ship's derricks experience?



HMM 1101 (Jul 08 Rev 7)
                                                        TANKER CHECK LIST
CARGO EXPERIENCE (indicate number of years)
                      Kerosene            Ul Sulpher                  Crude
 Mogas      Gas Oil            Condensate                Naphta                 Fuel Oil Chemicals Veg. Oil   Palm Oil
                      Jet Kero             Gas Oil                     Oil


CHARTERERS/OWNERS EXPERIENCE (indicate number of years)
  Irving              Shevron/   Exxon/      Statoil/                  BP/
             Shell                                      Elf / Total             Conoco
    Oil                Texaco    Mobil       Philip                   Amoco


Number of Years experience on tankers:                                    Number of Years experience in rank:

OTHER PRACTICAL EXPERIENCE (tick the appropriate box)
                                              Yes No                                                                            Yes    No
Have you sailed on Tankers equipped with C.O.W.?                               Have you sailed without a pumpman ?
Have you sailed on Tankers equipped with                                       Have you sailed on Tankers equipped with
Hydraulic Deepwell Pumps?                                                      Inert Gas Generators ?
Have you sailed on vessels built in Japan / Korea?                             Have you Vapour Recovery Systems experience?
Have you sailed on vessels in Ice Conditions?                                  Remotely operated cargo systems ?
Oil Major Vetting Inspections experience ?                                     Closed loading / sampling experience ?
USCG TVELL / Letter of Compliance inspections?                                 Closed washing systems experience ?
ISM audits for vessel's SMS ?                                                  Tank cleaning required for grade changes ?
Cargo contamination or outturn shortages ?



                                                  GAS TANKER CHECK LIST
CARGO EXPERIENCE (indicate number of years)
Propane     Butane    Butadiene Propadiene Propylene      VCM         Amonia    Ethane     Methane Ethylene


CHARTERERS/OWNERS EXPERIENCE (indicate number of years)
                      Shevron/   Exxon/      Statoil/                  BP/
Sonatrach    Shell                                      Elf / Total
                       Texaco    Mobil       Philip                   Amoco


Number of Years experience on tankers:                                    Number of Years experience in rank:

OTHER PRACTICAL EXPERIENCE (tick the appropriate box)
                                                 Yes No                        Previous Vessels and Types:
Have you sailed on vessels built in Japan / Korea?                             Full Pressurized    Semi Pressurized      Atmospheric
Have you experience of cargo contamination
or outturn shortages ?
Oil Major Vetting Inspections experience ?                                     Types of Tanker equipment previously worked with:
USCG TVELL / Letter of Compliance inspections?                                 Reliquifaction:
ISM audits for vessel's SMS ?                                                  Booster Pumps:
Pressure control on atmospheric vessels ?                                      Inert Gas:
Inert Gas Generators experience ?                                              Cargo Heater:
Tank cleaning required for grade changes ?                                     Compressor types:
Have you sailed without a Gas Engineer ?
Reliquifaction and cooling Systems experience ?




I hereby certify that all the information provided by me in this form is true and correct to the best of my knowledge.

Signed by Seaman:                                                                         Date:

HMM 1101 (Jul 08 Rev 7)
RECORD OF SEA SERVICE (at least 7 last years, most recent vessel last)
                          Vessels   Year                                                       From          To
    Vessels Name                            Flag      DWT   Engine Type    BHP          Rank                          Months   Company
                           Type     built                                                      (date)      (date)




PREVIOUS COMPANIES DETAILS FOR REFERENCES

        Name of Company                     Address                   Name of Manager          Telephone            Fax         E-mail

				
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Description: Crew Resource Management Audits document sample