PT. Rizki Karya Samudera
Manning Crew Agency
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Tanker Application form
TANKER APPLICATION FORM
Applied Date
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Position Applied
Name
*
Date Of Birth (dd-mm-yyyy)
Place Of Birth
Status
Nationality
Contact No
Email Address
Height
weight
Safety Shoes Size
Coverall Size
Shirt Size (Officer only)
Pants Size (Officer only)
Address
Name Of Next Kin
Relationship
Address
Emergency Contact
Travel Document
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International Passport
National Seaman Book
National Seaman ID
Australian MCV
US Visa – Type D
Others visa
Numbers
Issued
Expiry
Issuing Authority
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EDUCATIONAL BACKGROUND
Educational Background
Name Of School
From (Year)
To (Year)
Type Of Certificate Received Upon Graduation
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CERTIFICATE OF COMPETENCE
Field Out Certificate of Competence
Certificate of Competence Type
National COC
COC Endorsement
National GMDSS
GMDSS Endorsement
National COC for Rating
Country
Grade
Number
Date Of Issued
Date Of Expiry
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Yellow Fever Date of expiry
D&A tests on:
Chemical Blood Test on:
Pre-Medical on:
Date of Expiry :
DOCUMENTS
Field Out Other Courses / Certificates
Subjects
Basic Safety Training (VI/1)
Basic Safety Training (VI/1) – Natl
Proficiency Survival Craft (VI/2)
Advanced Fire Fighting (VI/3)
Watchkeeping as rating
Tanker Endorsement – National
Basic Training in Oil and Chemical Tanker Cargo Operations (VI/1-1)
Advanced Training in Oil Tanker (ATOT)
Advanced Training in Chemical Tanker (ATCT)
Advanced / Specialized Training in Liquefied Gas Tanker (ATLGT / STCW)
Medical First Aid (VI/4-1)
Medical Care (VI/4-2)
ECDIS – Generic
ECDIS – Type
Bridge Team Resource Management BRM / Bridge Team Management BTM
Engine Resource Management ERM / Engine Resource Management ETM
Ship Simulator and Bridge Teamwork
Cargo Handling Simulator Training for Product Tanker
Cargo Handling Simulator Training for Crude Oil Tanker
Cargo Handling Simulator Training for Chemical Tanker
Ship Handling Simulator
Ship Security Officer
Ship Security Awareness
Proficiency in Designated Security Duties (PDSD)
Safety Officer Course
Radar Observation and Plotting
ARPA
Risk Assessment
Incident Investigation
Auditor/Lead Auditor Training / ISM Auditor
AMOS FOR WINDOWS
ISM Code for Officers
Food Handling Certificate (For Cook and Mess only)
High Voltage Certificate
Carrying Dangerous and Hazardous Cargoes
Inert Gas System Operations
Crude Oil washing
Welding Certificate – NTC-M UNITOR / Others
Basic Lathe Machine Course
Free Fall Lifeboat Familiarization
Framo Course
Shore-Based Fire Fighting
Country
Number
Issued
Expiry
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PREVIOUS SEA EXPERIENCE
Field Out Previous Sea Experience
Vessel`s Name
Flag
Employer
Engine Type & KW
Type Of Vessel
Year of Build
GRT
Rank
Period
From (dd-mm-yyyy)
To (dd-mm-yyyy)
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LAST SALARY
For New Candidate Only
Your Last Salary
Your Expected Salary
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