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    BSC Application Form

    Uploaded by

    BatkeLand
    Data

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    BSC Application Form

    Uploaded by

    BatkeLand
    4 views2 pages
    Data

    Original Title

    BSC_Application_form

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

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    Data

    Copyright:

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

    BSC Application Form

    Uploaded by

    BatkeLand
    Data

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Position applied for/

    Alternative
    Expected Salary
    Personal Details
    Surname First name(s)
    Date of Birth Place of Birth
    Nationality Marital Status
    Sex Children
    Shoe Size Weight
    Height Overall size
    Address
    City / Country Phone
    Nearest Airport Mobile phone
    Next of kin Relationships

    E-mail

    National Documents
    Name of Maritime Training Institute
    No. Date / Place of issue Expiry Date
    Passport
    Seaman`s Book
    US Visa
    Shengen VISA
    COC:
    Endorsement:
    GOC (GMDSS) (IV/2)
    Basic Safety Training (VI/1)
    Survival Craft (VI/2)
    Advanced Fire Fighting (VI/3)
    Medical Care (VI/4)
    Tanker Familiarization (V/1)
    Advanced Oil (V/1)
    Advanced Chemical (V/1)
    Advanced Gas (V/1)
    Ship Security Officer
    Inert Gas System Operations
    Crude Oil Washing
    Bridge Team Management
    Safety Management System
    Operation of Electrical and
    Electronic Control Equipment
    Carrying Dangerous and
    Hazardous Cargoes
    Radar & ARPA
    Yellow Fever Vaccination
    Personal Skills
    Excellent Very Good. Good Poor Fair Remarks
    Command of English language
    Computer literacy
    Other
    Super-statutory training
    Flag State Documents / Endorsements
    Enter No. and Exp. Date Dutch Other

    Seaman’s Book

    Dutch endorsement
    Medical
    DP COURSES LEVEL
    BOSIET(OPITO)
    HUET
    Sea Service (from latest to previous for last 5 years due to Seaman’s Book)
    !!! ONLY PRINT LETTERS !!!
    Vessel Eng. Manager / Crew
    Name of Vessel Position DWT kW Flag from to
    Type Type Agent

    Etc.

    Above information is to the best of my knowledge correct. (to be signed by the person, who completed the form) I hereby confirm that above information is true and correct to the best of my
    knowledge. I understand that this information will be held in the computer database due to my real or possible employment. Signing it, I willfully give my permission to collect and process my
    personal information and to use it in all and any legal way. I give my permission for my personal information to be provided to the possible employers and any other persons, if such need arises
    from my employment. Besides, I permit the Black Sea Contractors employees to request personal information (data) about me from my former employers.

    Availability
    Name in Print Signature
    Date

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