Career

Document No. SSSN/APPL/
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POSITION / RANK APPLIEDFOR:
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AVAILABILITY DATE
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1.1 PERSONAL DETAILS:
Name as in passport
Date & Place of birth
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Home address
Mumbai address if any
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1.2 EDUCATION BACKGORUND:
Qualification
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School/College
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Form
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To
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Percentage/Grade
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1.3 TECHNICAL BACKGROUND:
Degree/Diploma
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School/College
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Form
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To
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Percentage/Grade
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1.4 IDENTITY DOCUMENT:
Document
Seaman book
Passport
Country
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Number
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Issue date
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Expiry date
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Place of issue
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1.5 FAMILY DETAILS (details of wife, children and parents) (if unmarried kindly give details of Father and Mother only) (additional sheet may be attached if required)
Name
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Relation
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D.O.B
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PPT No. / PAN / Aadhaar
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Place of issue
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Issue date
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Expiry date
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ECNR
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1.6 NEXT OF KIN DETAILS: (includes person to be contacted in case of emergency also)
Full name of kin :
Address of next of kin:
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1.7 CERTIFICATES (HIGHEST CERTIFICATE OF COMPETENCY HELD):
Grade/Class of COC
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Issuing country
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Date of passing exam
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Certificate No:
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Issue date
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Place of issue
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Expiry date
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1.8 DETAILS OF COURSES & CERTIFICATES FOR RATINGS:
Courses
1. Elementary First Aid (EFA)
2. Personal Survival Technique (PST)
3. Personal Survival & Social Responsibility (PSSR)
4. Fire Prevention & Fire Fighting (FPFF)
5. Certificate of Proficiency in Security Training for Seafarers with Designated Security Duties ( STSDSD)
6. Oil Tanker Familiarization (OTFC)
7. Chemical Tanker Familiarization (CTFC)
8. Gas Tanker Familiarization (GTFC)
9. ISPS Course
10. ISM Course
11. DCE Oil-Support
12. DCE Chemical – Support
13. DCE Gas – Support
14. AB / MM Course
15. Watch Keeping Certificate Ratings (Deck / Engine)
16. Pump Man Course
17. Cookery Course
18. MMD Cookery Certificate
19. Fitter Course / Class Certificate
20. General Purpose Rating
21. Carry our Fire-Fighting Operations in Basic Trainingfor Oil, Chemical & Liquefied Gas Tanker Cargo Operations
22. Basic Training for Oil Tanker Cargo Operations
Certificate No.
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Expiry date
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1.9DETAILS OF COURSES & CERTIFICATES FOR OFFICERS:
Courses
1. Proficiency in Survival Craft & Rescue Boat (PSCRB)
2 Medical First Aid (MFA) / Medicare
3. Advanced Fire Fighting (AFF)
4. Oil Tanker Familiarization (OTFC) / TASCO
5. Chemical Tanker Familiarization (CTFC) / CHEMCO
6. Gas Tanker Familiarization (GTFC) GSCO
7 DCE Oil-Support / Operation / Management
8. DCE Chemical Support / Operation / Management
9. DCE Gas Support / Operation / Management
10 Ship Security Officers Course (SSO)
11. ECDIS
12. BTM (Renewed every 5 years)
13. Automatic Radar Plotting Aid (ARPA)
14. Radar Observer / RANSCO Simulator
15. GMDSS
16. GMDSS Endorsement
17. Revalidation Course for Deck / Engine Officer
18. Refresher & Up gradation course for Deck /Engine Officer
19. Ship Safety Officer Course / Risk Assessment
20. Ship Maneuvering Simulator
21. Any Other (Please Specify)
22. Basic Training for Oil Tanker Cargo Operations
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Expiry date
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Certificate No.
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Issued by
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1.10TOTAL SAILING EXPERIENCE:
Crude tankers
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Product tanker
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Chemical tankers
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Oil / Chemical
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CARGO
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Others
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1.11MEDICAL HISTORY (IF THE ANSWER IS YES TO ANY OF THE BELOW, PLEASE GIVE FULL DETAILS AND ATTACH A SPARATE PAGE IF NECESSARY):
Have you ever signed off a ship due to medical reasons?
Have you undergone any Surgery/Accident?
Do you have any health disability problems now?
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1.12 BANK ACCOUNT DETAILS:
Account Holder’s name:
Account Holder’s name:
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Name of the Bank :
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Account No.:
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ISM CODE:
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IFSC CODE:
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Branch &Address:
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MICR No. :
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BOILER SUIT SIZE:
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SAFETY SHOE SIZE:
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Blood Group
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Height:
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Birth Mark (if any
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I hereby affirm that all the information provided by me in this application is true and correct. MIRA ROAD
Applicant’s signature
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