Seafarer'S Application Form - Scotland Crew Department (Page 3 of 4) in pdf

Seafarer'S Application Form - Scotland Crew Department Page 3

Crew Department (Recruitment Group) - Tel: +442032863705 - Email:

SEAFARER'S APPLICATION FORM - Page 3 of 3 - SEA SERVICE (LAST 10 YEARS)

Please indicate your sea service in the last 10 years as exactly as possible - required are the actual sign-on and sign-off dates according to the service certificates resp. seaman's book entries. To speed

up processing kindly indicate phone and/or fax numbers of your previous employers. Ship sizes are to be indicated in gross tons, total engine output in kilo Watt (1 kW = 1.34 bhp) to go along with

STCW limitations. Please attach evidence for the listed sea service (copies of seaman's book entries, service certificates etc.). The information provided may be passed on to our clients and to flag

state administrations to allow for verification of rank experience. Please use the European date format (DD.MM.YY).

Family Name:

First Name(s):

Date of Birth:

Vessel's Name

IMO No.

Flag

kW Ship Type Eng.Make

Rank

S/On Date S/Off Date Employer (company to contact for reference)

Date:

Signature: