STAFF CENTRE — APPLICATION FORM

Fields marked with an asterisk * are required!

PERSONAL DATA
DATE AVAILABLE
POSITION APPLIED FOR *
POSITION #2 APPLIED FOR
LAST NAME / SURNAME *
NAME *
DATE OF BIRTH
NATIONALITY
COUNTRY OF BIRTH
VALID USA VISA *
PHOTO 4x5cm(optional)
E-MAIL *

FULL MAILING ADDRESS
STREET ADDRESS 1st line
STREET ADDRESS 2nd line(opt)
CITY *
Postal / ZIP Code
REGION (optional)
COUNTRY
PHONE NUMBER *
PHONE NUMBER #2
MOBILE PHONE NUMBER *
MOBILE PHONE NUMBER #2
COUNTRY OF RESIDENCE

YOUR SEA-GOING EXPERIENCE (LAST 5 YEARS DATA):

* At least one record is required
# VESSEL NAME * TYPE DWT ENG. TYPE HP POSITION * FROM * TILL * CREWING AGENCY
1
2
3
4
5

CERTIFICATES / LICENSES:

# DOCUMENT * NUMBER * PLACE of ISSUE [City/Country] * DATE OF ISSUE * VALID UNTIL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

EDUCATION:

# EDUCATION * INSTITUTION/COLLEGE * FROM YEAR* TILL YEAR*
1
2
3
CLEAR