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Position

Position(s) applied for:

Second Position:

From what date will you be available?:

Personal Details

Photo:

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Last name:

First names:

Place of birth:

Date of birth:

Nationality:

Permanent address:

Skype:

E-mail:

Telephone numbers:

Identity Documents

Holded visas expiry:

US Visa C1 / D

US Visa B1 / B2

Schengen Visa

Highest Certificates of Competency held

Class / Grade

Issuing Country

Certificate No.

Date Issued

Plase Issued

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Endorsement

Issuing Country

Certificate No.

Date Issued

Place Issued

Valid Until

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Courses attended and certificates obtained

Course

Place

Cert. No.

Issued

Valid Until

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Record of previous service

(Please give a full record starting with the last vessel on which you served)

Vessel

Company

Vessel type / DP class

Flag

DWT

Year built

Main engine make

Main engine type

Power, kW

Rank

Sign on date

Sign off date

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Remarks

Multicrew experience:

Yes No

English level:

Salary expected:

Duration of employment expected:

Size shoes:

Size boiler suit:

Weight:

Height:

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