Application for Employment

Please complete this form then press the submit button.
* Mandatory fields
** Automatically completed

Availability date for service*: (Please use the following format for dates: dd/mm/yyyy)
Given name*:
Date & Place of Birth: /
Birth country:
Marital Status:
Father name:
Mother name:
Home Address Street*:
Home Address Zip*:
Home Address City*:
Home Address Country*:
Name of maritime academy:
Foreign Languages: / /
Next of Kin Name/relationship/Phone: / /
Nearest international airport:
Military obligations:
Height(in meter):
Weight(in kilos)*:
Boiler Suit size*:
Safety Shoes size*:
Distinguished marks

Documents Rank/Number: Country issued: Date issued: Expiry date:
National Licence*
Foreign licence if any
(Flag Endorsement)
US Visa
National Seaman's Book
Other Seaman's Book
Yellow Fever  
Last Medical aptitude certificate  

Other visas:

Other diplomas:

Other qualifications:

Other competence:

Other endorsements:

Additional certificates & STCW95 (tick as appropriate)
BTRM Bridge Team and/or Resource Management (less than 5 years) A-II/1,2 ARPA VI/1 Basic Safety
ETRM Engine team and/or Resource Management (less than 5 years) V/1-1 Tanker Familiarization VI/2.1 Proficiency in Survival Craft & Rescue boat
V/1-2 Oil tanker Ship Security Officer
IV/2 GMDSS General Operator VI/3 Advanced Fire Fighting
Ship Handling Course Simul (less than 5 years) or Manned model VI/4-1 Medical First Aid V1/4-2 Medical Care
Ballast Water Management
Ship Safety Officer  
Oil record book
Risk Management incident investigation
Refresh Advanced Fire Fighting


Total Sea service expressed in Months
In Actual rank:
In Tanker irrespective of the rank:
In Euronav:
Total sea service:
For engineers only
Name Type Company DWT Maker Model Electronic Power (KW) Rank Sign On Sign off Reason

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