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    104-B, Mittal Towers, Nariman Point, Mumbai 400 021, Maharashtra, India

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    baba maacho
    The document appears to be a job application for an offshore services company, as it requests personal details, travel documents, certifications, previous sailing experience, medical history, references, and includes a declaration and salary information section. The application collects information on the applicant's identity, qualifications, experience, health, and employment history relevant for the position. It aims to assess the applicant's suitability for a job in offshore services.

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    104-B, Mittal Towers, Nariman Point, Mumbai 400 021, Maharashtra, India

    Uploaded by

    baba maacho
    46 views2 pages
    The document appears to be a job application for an offshore services company, as it requests personal details, travel documents, certifications, previous sailing experience, medical history, references, and includes a declaration and salary information section. The application collects information on the applicant's identity, qualifications, experience, health, and employment history relevant for the position. It aims to assess the applicant's suitability for a job in offshore services.

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    PDF_Application_Form 2258

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    The document appears to be a job application for an offshore services company, as it requests personal details, travel documents, certifications, previous sailing experience, medical history, references, and includes a declaration and salary information section. The application collects information on the applicant's identity, qualifications, experience, health, and employment history relevant for the position. It aims to assess the applicant's suitability for a job in offshore services.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    46 views2 pages

    104-B, Mittal Towers, Nariman Point, Mumbai 400 021, Maharashtra, India

    Uploaded by

    baba maacho
    The document appears to be a job application for an offshore services company, as it requests personal details, travel documents, certifications, previous sailing experience, medical history, references, and includes a declaration and salary information section. The application collects information on the applicant's identity, qualifications, experience, health, and employment history relevant for the position. It aims to assess the applicant's suitability for a job in offshore services.

    Copyright:

    © All Rights Reserved
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    of 2

    BHN Offshore Services Private Ltd.

    (BHNOSPL) ISO 9001:2008 / OHSAS 18001:2007 Certified


    RPSL No.: MUM-307
    104-B, Mittal Towers, Nariman Point, Mumbai 400 021, Maharashtra, India MLC Certificate Number : TBA
    Tel. : +91-22-40781700 ( 10 Lines ) Fax : +91-22-40781766 Email : [email protected]
    Application Number : Date : Post applied for : Indos No :

    PERSONAL DETAILS :
    Nationality : Date and Place of Birth : Marital Status :
    Sur Name : First Name : Last Name : Father’s Name :

    Full Name :
    Permanent Address :
    Permanent Tel. No. Permanent Mobile No. :
    Present Address :
    Present Tel. No. Present Mobile No. :
    Email address : Highest Education Qualification :
    Name Next of Kin : Next of Kin Relation :
    Next of Kin Address :
    NOK Email Address NOK Tel. No. NOK Mobile No. :
    TRAVEL DOCUMENTS :
    Document Number Date of Issue Place of Issue Valid Till Days Remains to Expired
    Passport
    Indian CDC
    Panama CDC
    Liberian CDC
    Belize CDC
    Other CDC
    USA Visa
    CERTFICATES :
    Certificate COS/COC/MOT held COS/ COC / MOT Number Issuing Authority Valid Till Days Remain
    Indian
    United Kingdom
    Panama
    Liberian
    Belize
    Other
    Watch Keeping
    STCW 95 COURSES / OTHER COURSES
    COURSE TITLE CERTIFICATE NUMBER DATE OF ISSUE INSTITUTION
    PRE SEA TRAINING
    P.S.S.R.
    PERSONAL SURVIVAL TECHNIQUES
    FPFF
    A.F.F.
    P.S.C.R.B.
    EFA
    MFA
    MEDICARE
    OIL TANKER FAMILIRISATION
    GAS TANKER FAMILIRISATION
    CHEMICAL TANKER FAMILIRISATION
    D.C.E. OIL
    D.C.E. GAS
    D.C.E. CHEMICAL
    ARPA
    ROC
    TASCO
    G.M.D.S.S.
    G.M.D.S.S. ENDORSEMENT
    SHIP HANDLING SIMULATOR

    QA13 REVISION NO.: 00 REVISION DATE : PAGE 1 OF 2


    VESSEL RESOURCE MANAGEMENT
    SHIP SECURITY OFFICER
    ISPS
    OPA 90
    HUET
    YELLOW FEVER
    DP BASIC
    DP ADVANCE
    DPO UNLIMITED LICENSE
    PREVIOUS SAILING EXPERIENCE : Kindly use additional Sheet if Required
    Engine / Months
    Company’s Name Vessel’s Name Type / Flag Rank DWT GRT From To
    BHP / Days

    Previous Medical History / Disclosure :

    Comments
    How did you know about Us / This Job
    Seaman Club Notice Board Marex News Letter
    Shipping Naukri .Com Company Website

    References from last two employers :


    Name : Name :
    Designation : Designation :
    Address : Address :
    Contact No. : Contact No. :

    Declaration : (If the answer is YES to any of the below, please give full details on separate page)
    Have you ever been the subject of a court of enquiry or involved in a maritime accident? Yes / No
    Have you ever had a professional license suspended or revoked? Yes / No
    I HEREBY CERTIFY AND CONFIRM that the forgoing information is true and correct and that any misrepresentation or distortion of material facts will be
    sufficient round for denial of this application. I'm aware that any falsification of the above shall be a cause of my dismissal in case I am employed.
    I ALSO CERTIFY AND CONFIRM that I have not paid or not promised to pay any monetary consideration.

    Last Salary : Signature of Applicant

    Joining Details :

    Company’s Name Vessel’s Name Rank Joined


    Date Joined Basic Wages Total Wages
    Per Day Wages

    Date of Signed Off :


    Any Comments :

    QA13 REVISION NO.: 00 REVISION DATE : PAGE 2 OF 2

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