Docstoc

PERSONAL PROFILE AND HISTORY OF EMPLOYMENT (DOC)

Document Sample
PERSONAL PROFILE AND HISTORY OF EMPLOYMENT (DOC) Powered By Docstoc
					Carisbrooke Shipping Ltd.

               PERSONAL PROFILE AND HISTORY OF EMPLOYMENT


Rank:                           Surname:                                       Forenames:




Nationality:                          Date of Birth:                           Place of Birth:

Home Address:                         Tel. No:                                 Fax No:


                                      Mobile No:                               E-mail:


                                      Nearest                                  Alternati ve
                                      Airport:                                 Airport:


Marital                               Chil dren (Please include Date of Birth.):
Status:




Next of Kin*                      Address                                             Tel. No:
Name &
                                  (if different to
Relationship
                                  above):                                             Other..




Sea Service
Please comp lete even if all Carisbrooke vessels. If details unknown please insert approximate:
Vessel Name:        Fl ag:      GRT        HP         Vessel       Engine    Rank        From     To   Ship Manager/
                                                       type         type                                   Owner




Experience wi th mixed                       Nationalities:
Nationality crew: Yes/No



Height (Mtr/cm)                                           Frame Size (S, M, L)
Weight (KG)                                               Any Distinguishing Marks


                                                     Page 1 of 3
   Carisbrooke Shipping Ltd.

                PERSONAL PROFILE AND HISTORY OF EMPLOYMENT


           DOCUMENT             NUMBER              ISSUED AT   ISSUED ON   DATE OF
                                                                            EXPIRY
LICENCE / CERTIFICATE         Grade   Number
National


LICENCE / CERTIFICATE

Others (please specify)
STCW ENDORS EMENT

GMDSS (GOC) CERT
MEDICAL CERTIFICATE
SEAMAN’S BOOK
YELLOW FEV ER CERT
PASSPORT
US VISA C-1-D
SSO COURS E
RADAR SIMULATOR CERT
ARPA COURS E
FIRE FIGHTING CERT

FIRST AID CERTIFICATE
PERSONAL S URVIVAL
PERS ONAL S AFETY & S OCIAL
RES PONS IBILITIES

SURVIVAL CRAFT
PILOTAGE EXEMPTIONS

DRIVERS LICENCE

LANGUAGES

CRANE EXPERIENCE :
             YES / NO


REASON FOR LEAVING LAST
COMPANY




LAST SALARY:




                                      Page 2 of 3
     Carisbrooke Shipping Ltd.


          PERSONAL PROFILE AND HISTORY OF EMPLOYMENT



REFERENCES


1. COMPANY NAME &                ……………………………………………….
     TELEPHONE NUMB ER

                                 ……………………………………………….




2.    COMPANY NAME &             ………………………………………………..
     TEL EPHONE NUMB ER

                                 ………………………………………………..



ANY OTHER
RELEV ENT INFORMATION




I hearby declare that all information given is herein correct and all certificates listed are genuine and
re-validated to STCW 95:


 DATE:                                 SIGNED:




                                              Page 3 of 3

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:28
posted:3/12/2011
language:English
pages:3
pptfiles pptfiles
About