COMPANY WORK FORM Form No. F.6.

2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised By MD

DATE AVAILABLE: NOW READY

POSITION APPLIED FOR: DECK CADET / TRAINEE OR THIRD OFFICER
FULL NAME: HEYDAR HEYDAROV ATTACH
SURNAME:HEYDAROV PHOTO
FIRST NAME: HEYDAR HERE
MIDDLE NAME(S) NIL
PERSONAL DETAILS
DATE OF BIRTH 14.01.1996 PLACE OF BIRTH NATIONALITY HEIGHT 172

WEIGHT 74 HAIR COLOUR BLACK EYE BROWN

COLOUR
MARITAL STATUS SINGLE SPOUSE’S NAME       No. of      
Children
FATHER’S NAME ALISHAN MOTHER’S NAME CAMILA NEXT OF FATHER
KIN
HOME ADDRESS AZERBAIJAN / BAKU city / KHATAI dist, PIVZAVOD str, HOME 28/3 TEL. No. +994555349478
(PERMANENT)
OTHER ADDRESS       TEL. No. +994123726874

E-MAIL: [email protected] SKYPE: HEYDER HOMEPORT:       Mob No. +994555349478

HEYDEROV
LICENCES / DOCUMENTS HELD
ITEM No. I S S U E D EXPIRING GRADE
DATE PLACE BY DATE
NATIONAL LICENCE                                    
STCW ENDORSEMENT                                    
MARSHALLS ISL. ENDORSEMENT                                    
LIBERIAN ENDORSEMENT                                    
OTHER LICENCE                                    
PASSPORT C021535 14.08.2018 AZERBAIJAN MINISTRY 13.08.2028      
02 OF
INTERNAL
AFFAIRS
NATIONAL SEAMAN’S BOOK/CDC 014762 02.08.2019 AZERBAIJAN AZERBAIJAN 02.08.2024      
STATE
MARITIME
ADMINISTRA
TION
OTHER SEAMAN’S BOOK / CDC                                    
U.S.VISA                                    
YELLOW FEVER VACCINATION                                    
P.R.C. No. (Filipino Crew only)                                    
National data base of seafarers INDOS                                    
Certificate No. (Indian personnel only)
CERTIFICATES HELD
ITEM No. ISSUED EXPIRING ISSUED BY
BASIC SAFETY TRAINING (*IF ONE CERTIFICATE) SO-1324-15 01.06.2015 01.06.2020 STCW
PERSONAL SAFETY & SOCIAL RESPONSIBILITIES*                        
PERSONAL SURVIVAL*                        
SURVIVAL CRAFT HANDLING*                        
FIRST AID AT SEA (ELEMENTARY LEVEL)*                        
PROFICIENCY IN SURV.CRAFT/ RESCUE BOAT (PSCRB) SL-0790-16 23.05.2016 20.05.2021 STCW
ADVANCED / SHORE-BASED FIREFIGHTING SJ-0359-16 20.05.2016 20.05.2021 STCW
PETROLEUM TKR SAFETY – BASIC/ GEN OIL TKR FAM.                        
MEDICAL FIRST AID SN-0387-19 04.06.2019 03.06.2024 STCW
SHIP MASTERS MEDICARE/ADVANCED MEFA                        
PETROLEUM TKR SAFETY – ADVANCED/SPECIALISED                        
COW / IGS                        
DANGEROUS CARGO ENDORSEMENT - OIL                        
CHEMICAL TANKER SAFETY                        
LIQUIFIED GAS FAMILIARISATION                        
LIQUIFIED GAS SPECIALISED/ADVANCED COURSE                        
DANGEROUS CARGO ENDORSEMENT - LIQUIFIED GAS                        
LICOS (FOR LIQUIFIED GAS – PLS SPECIFY)                        
LIQUIFIED GAS-SPECIFIC FIRE FIGHTING – PLS                        
Rev. 3 dated 30/09/15 1 of 3
 COMPANY WORK FORM Form No. F.6.2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised By MD
SPECIFY
SIGTTO                        
STCW ENDORSEMENT                        
ARPA SR-0056-17 09.06.2017 09.06.2022 STCW
R.O.C. / RANSCO / RADAR SIMULATOR                        
SATCOM                        
\\\

APPLICANTS NAME:      _________________________________________________________

CERTIFICATES HELD (CONTINUED)

ITEM No. ISSUED EXPIRING ISSUED BY
GOC / GMDSS DQ-0214- 07.06.2017 07.06.2022 STCW
17
ECDIS SZ-0174-17 08.06.207 08.06.2022 STCW
SHIP MANOEUVERING/SHIP HANDLING SIMULATOR                        
SHIP SECURITY OFFICER SH-0773-19 14.05.2019 14.05.2024      
ISPS FAMILIARISATION SI-0736-17 29.04.2017 29.04.2022 STCW
SHIPBOARD SAFETY OFFICER                        
ENGINE ROOM SIMULATOR                        
ENGINE ROOM RESOURCES MANAGEMENT                        
HUMAN RELATIONS                        
QUALITY AND SAFETY MANAGEMENT SP-0517-16 20.05.2016 20.05.2021 STCW
RISK ASSESSMENT / RISK MANAGEMENT                        
MARINE ACCIDENT/INCIDENT INVESTIGATION                        
MANAGEMENT OF CHANGE                        
ENVIRONMENTAL COURSE / ISO 14001                        
MLC/LSC MARITIME LEADERSHIP COURSE DL-0177-19 12.06.2019 12.06.2024 STCW
MARPOL I                        
MARPOL II                        
MARPOL VI                        
MARITIME ENGLISH                        
MLC 2006                        
BRIDGE TEAM MANAGEMENT                        
BRIDGE RESOURCES MANAGEMENT SW-0182- 28.06.2019 28.06.2024 STCW
19

RECORD OF PREVIOUS SERVICE (VERIFIED AGAINST SEAMAN’S BOOK ENTRIES)

COMPANY VESSEL’S TYPE/ DWT M/ENG’S BHP/ UMS RANK FROM TO MONTH
S
NAME BUILT TYPE ( Y-
                                                          
 
                                                          
 
                                                          
 
                                                           
      
                                                          
 
                                                          
 
                                                          
 
                                                          
 
                                                          
 
                                                          
 
                                                          
 
                                                                    
 
Rev. 3 dated 30/09/15 2 of 3
COMPANY WORK FORM Form No. F.6.2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised By MD
                                                          
 
                                                          
 
                                                          
 

Rev. 3 dated 30/09/15 3 of 3

 COMPANY WORK FORM Form No. F.6.2
Issue A Date 01/11/06
SEAFARERS’ APPLICATION FORM Authorised By MD
APPLICANT’S NAME: ___________________________________________________________________
ACTUAL TIME SERVED IN MONTHS
OBO / CHEM. / BULK
RANK LNG LPG CRUDE OIL PRODUCT CARRIER/
TANKER TANKER OTHER
MASTER OR CH. ENG.                              
C/OFF OR 1A/E                              
2/OFF OR 2A/E                              
3/OFF OR 3A/E                              
GAS/CARGO ENGINEER                              
CADET/JR.ENG                              
ETO / ELEC (PLS STATE)                              
PMN / FITTER                              
OTHER RANK                              

ALLOTMENT DETAILS
SURNAME      
NAME      
MIDDLE NAME      
DATE OF BIRTH      
RELATIONSHIP      
ADDRESS      
NAME OF BANK      
ACCOUNT No.      
SSS No. (Filipino crew only)      
TIN No. (Filipino crew only)      

WIFE & CHILDREN’S NAME S DOB POB PASSPORT NO. DATE OF ISSUED AT
      ISSUE EXPIRY
                                         
                                         
                                         
                                         
                                         
How long did you stay at your previous company?      
Wages on last vessel?      
Trade route of vessels?      
Who referred you to the company?      
Any relatives with the company?      
If yes, who?      
ANY OTHER INFORMATION ABOUT YOURSELF:      

UNION MEMBERSHIP NO.:       DATE :      

DOE:      
ALL APPLICANTS
DATE APPLICATION FILLED OUT      

SIGNATURE OF APPLICANT      

FULL NAME IN BLOCK CAPITALS      

Rev. 3 dated 30/09/15 4 of 3