Application form – GOOD WINDS Marine Services

Position applied for

Second choice

Date of availability

Name

First

Last

Date of birth (minimum employment age 18 years)

Place of birth

Nationality

Marital status

Sex

Contact information

Next of kin Details

Home address

Relationship

Home Phone

Name/ Surname

Mobile phone

NOK address

Email

NOK contact

Nearest airport

No of children

PERSONAL DETAILS & UNIFORM

Hair color

Weight (kilograms)

Eye color

Working clothes size

Height (centimeters)

Shoe size

EDUCATION

Name of school or academy

Department

From

To

PASSPORTS, SEAMAN’s books , VISAS

National Passport

Number

Place of issue

Date of issue

Date of expiry

National Seaman’s Book

Number

Place of issue

Date of issue

Date of expiry

Seaman’s Passport (if applicable)

Number

Place of issue

Date of issue

Date of expiry

Number

Place of issue

Date of issue

Date of expiry

MEDICAL AND VACCINATIONS

Seafarer’s Medical

Number

Place of issue

Date of issue

Date of expiry

Yellow Fever vaccination

Number

Place of issue

Date of issue

Date of expiry

CERTIFICATES (STCW A II/1-4 & A III/1-4)

Certificate of competency

Capacity

Number

Place of issue

Issued / Expire

Endorsement

Capacity

Number

Place of issue

Issued / Expire

GMDSS

Capacity

Number

Place of issue

Issued / Expire

BASIC TRAINING (STCW A VI/1 & A VI/2-4

Basic Training Certificate

Number

Place of issue

Date of issue

Date of expiry

Advanced Fire Fighting

Number

Place of issue

Date of issue

Date of expiry

Medical First Aid

Number

Place of issue

Date of issue

Date of expiry

Medical Care Person in Charge

Number

Place of issue

Date of issue

Date of expiry

Proficiency in Survival Craft

Number

Place of issue

Date of issue

Date of expiry

HELM

Number

Place of issue

Date of issue

Date of expiry

Ship’s Security Officer (ISPS-A 13.2)

Number

Place of issue

Date of issue

Date of expiry

SSO Endorsement

Number

Place of issue

Date of issue

Date of expiry

SSD

Number

Place of issue

Date of issue

Date of expiry

Place of expiry

ECDIS Certificate

Number

Place of issue

Date of issue

Date of expiry

BRM IMO Model Course 1.22

Number

Place of issue

Date of issue

Date of expiry

Maritime English

Number

Place of issue

Date of issue

Date of expiry

MARPOL

Number

Place of issue

Date of issue

Date of expiry

HAZMAT (Acc US CFR)

Number

Place of issue

Date of issue

Date of expiry

High Voltage Course

Number

Place of issue

Date of issue

Date of expiry

Crowd & Crisis Certificate

Number

Place of issue

Date of issue

Date of expiry

Basic Training-oil & chemical / Endorsement

Number

Place of issue

Date of issue

Date of expiry

Advanced Training-CHEMICAL/Endorsement

Number

Place of issue

Date of issue

Date of expiry

Advanced Training-OIL / Endorsement

Number

Place of issue

Date of issue

Date of expiry

Other certificates

Name of document

Number

Place of issue

Date of issue and expiry

SEA SERVICE DURING THE LAST FIVE YEARS

Rank

Company, Name of vessel, Year Built

Flag, Type, GRT, Engine type KW

From – To

REFERENCES

Company

Contact

Name of vessel

Tel, Fax, Email

OTHER QUALIFICATIONS AND SHORE BASED EMPLOYMENT

ENGLISH LANGUAGE

COMPUTER KNOWLEDGE

Marlins Test in % If other test state details

Uncomfortable / Comfortable / Good / Expert

Captcha

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Section Divider

Date / Time

Date

Time