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    Seafarer'S Application Form: Rev 1/2017-09-015 Page 1 of 4

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    Richard Macunan
    This 3-page document contains a seafarer's application form providing personal details, education history, certifications, medical records, training courses, and previous work experience of an applicant named Richard S. Macunan applying for the position of Cadet Electrician. Contact information, passport details, licenses, medical exams, and more than 20 training courses are documented on the form. No previous sea experience is listed.

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    Seafarer'S Application Form: Rev 1/2017-09-015 Page 1 of 4

    Uploaded by

    Richard Macunan
    216 views4 pages
    This 3-page document contains a seafarer's application form providing personal details, education history, certifications, medical records, training courses, and previous work experience of an applicant named Richard S. Macunan applying for the position of Cadet Electrician. Contact information, passport details, licenses, medical exams, and more than 20 training courses are documented on the form. No previous sea experience is listed.

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    1 BELCHEM CV NEW 2021

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    This 3-page document contains a seafarer's application form providing personal details, education history, certifications, medical records, training courses, and previous work experience of an applicant named Richard S. Macunan applying for the position of Cadet Electrician. Contact information, passport details, licenses, medical exams, and more than 20 training courses are documented on the form. No previous sea experience is listed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    216 views4 pages

    Seafarer'S Application Form: Rev 1/2017-09-015 Page 1 of 4

    Uploaded by

    Richard Macunan
    This 3-page document contains a seafarer's application form providing personal details, education history, certifications, medical records, training courses, and previous work experience of an applicant named Richard S. Macunan applying for the position of Cadet Electrician. Contact information, passport details, licenses, medical exams, and more than 20 training courses are documented on the form. No previous sea experience is listed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    MPM 6.

    13B
    Rev 1/2017-09-015
    Page 1 of 4

    SEAFARER’S APPLICATION FORM


    Date: 07-27-21
    Position Applied : CADET ELEC. Name : RICHARD S.
    MACUNAN
    Date of Birth : 06/17/1990 Place of Birth : TULUNAN, NORTH
    COTABATO
    Status : SINGLE Nationality : FILIPINO
    Contact no : +63686072952
    Email Address : [email protected]
    Height : CM 167.64 Weight : KG 65
    Safety Shoes Size : 43 Coverall size : SMALL
    Shirt Size (Officer only) : N/A Pag-IBIG Number : 290-000-530-703
    Pants Size (Officer only) : N/A SSS Number : 09-3025748-6
    E-Registration Number : PhilHealth Number : PIN-020260817354
    Address : 18 SANTAN II – SANTAN ST, FORTUNE MARIKINA CITY
    Name of next Kin : JARDELIZA S, Relationship : MOTHER
    MACUNAN
    Address : PRK 6, BUAL TULUNAN NORTH COTABTO
    Contact no : +63909847242

    Travel Documents
    Subject Number Issued Date Expiry Date Issuing Authority
    International Passport P3352576A 08-JUN-2017 07-JUN-2022 DFA
    Nat’l Seaman Book MARINA
    National Seaman ID
    Flag SIRB -
    Australian MCV
    US Visa – Type D US EMBASSY
    Other visa

    Educational Background
    Name of School From To Type of certificate received upon
    Graduation / Course
    University of Southern Mindanao, 2009 2013 BACHELOR OF SCIENCE IN
    Kidapawan City

    Certificate of Competence
    Type STCW Flag Certificate Issued Date Expiry Date
    Number
    Nat’l COC in Rank PHILIPPINE
    S
    COC Endorsement
    National GMDSS
    GMDSS Endorsement
    Nat’l COC for Rating ASD / PHILIPPINE

    Page 1 of 4
    MPM 6.13B
    Rev 1/2017-09-015
    Page 2 of 4

    SEAFARER’S APPLICATION FORM


    ASE S
    Flag License
    Flag Tanker Product Oil
    Flag Tanker Chemical
    Flag SQ in Rank
    Flag ECDIS
    Flag BST
    Flag SSO
    Flag PSCRBC

    Rank/Name:
    Yellow Fever Date of expiry: LIFETIME
    D&A tests on: TO FOLLOW
    Chemical Blood Test on: TO FOLLOW
    Pre-Medical on: TO FOLLOW Date of Expiry: TO FOLLOW

    Other Courses / Certificates


    Subject Country Number Issued Expiry
    Basic Training (V1/1) PHILIPPINES
    -Personal Survival Techniques (VI/1-1)
    -Fire Prevention & Fire Fighting (VI/1-2)
    -Elementary First Aid (VI/1-3)
    -Personal Safety & Social Responsibilities
    (VI/1-4)
    Basic Training in Oil and Chemical Tanker
    Cargo Operations (V/1-1)
    Proficiency Survival Craft and Rescue Boats
    (VI/2)
    Advanced Fire Fighting (VI/3)
    Watchkeeping as Rating Deck II/4 or II/5 /
    Engine III/4 or III/5
    Medical First Aid (VI/4-1)
    Medical Care (VI/4-2)
    Advanced Training in Oil Tanker (ATOT)
    Advanced Training in Chemical Tanker
    (ATCT)
    ECDIS - Generic
    ECDIS - Type Specific:
    Bridge Team Management (Renew 5yearly)
    Engine Team Management (Renew 5yearly)
    Ship Simulator and Bridge Teamwork
    Bridge Resource Management
    Engine Resource Management
    Ship Security Officer
    Ship Security Awareness Training
    Designated Security Duties
    Ship Safety Officer Course
    Radar Observation and Plotting

    Page 2 of 4
    MPM 6.13B
    Rev 1/2017-09-015
    Page 3 of 4

    SEAFARER’S APPLICATION FORM


    ARPA
    Risk Assessment
    Incident Investigation
    Cyber Security
    Fuel Management
    SEEMP
    Working Effectively Across Cultures
    Auditor/Lead Auditor Training
    AMOS FOR WINDOWS
    Welding Certificate
    Ship’s Cook Certificate – MLC2006 Reg3.2
    Annex 1&2
    Food Handling Certificate – MLC2006 Reg3.2
    Annex 1&2 (For Cook and Msm only)
    High Voltage Certificate
    Carrying Dangerous and Hazardous Cargoes
    Crude Oil Washing/Inert Gas System
    Operations
    Welding Certificate
    Basic Lathe Machine Course
    Free Fall Lifeboat Familiarization
    Framo Course
    Shore-Based Fire Fighting
    Ship Handling & Maneuvering - Management
    Ship Handling & Maneuvering - Operation
    Cargo Handling Simulator Training for Product
    Tanker
    Cargo Handling Simulator Training for Crude
    Oil Tanker
    Cargo Handling Simulator Training for
    Chemical Tanker
    ISM Awareness Course
    Malaysia EDUCOR – For Officers only

    Rank/Name:
    Previous Sea Experience
    Vessel Flag Employer Engine Type of Year GRT / Rank Period
    Name Type & KW Vessel Built TEU From-To

    Rank/Name:

    Page 3 of 4
    MPM 6.13B
    Rev 1/2017-09-015
    Page 4 of 4

    SEAFARER’S APPLICATION FORM

    For New Candidate Only


    Your Last Salary $
    Your Expected Salary $

    English Proficiency Very Good Good Average Below Average Poor


    9 - 10 8 to 7 6-5 4 3-1
    Oral 8 X
    Listening 7 X

    Interview by:

    Processor:

    Page 4 of 4

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