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    MEO - Application Form

    Uploaded by

    Abdul Rahim
    This document is a crew application form for Nimbus Maritime Service Pvt Ltd. It requests personal details such as name, date of birth, nationality, qualifications, medical certificates, sea time experience, and next of kin information. The form collects information on certificates of competency, flag state documents, medical certificates, safety and security training certificates, spouse and dependent details, and a record of sea time experience including vessel name, rank, company, period of employment and area of operation. The document was last revised on November 1st, 2018 and released as version 2 of the company's crew application manual.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    MEO - Application Form

    Uploaded by

    Abdul Rahim
    84 views7 pages
    This document is a crew application form for Nimbus Maritime Service Pvt Ltd. It requests personal details such as name, date of birth, nationality, qualifications, medical certificates, sea time experience, and next of kin information. The form collects information on certificates of competency, flag state documents, medical certificates, safety and security training certificates, spouse and dependent details, and a record of sea time experience including vessel name, rank, company, period of employment and area of operation. The document was last revised on November 1st, 2018 and released as version 2 of the company's crew application manual.

    Original Title

    MEO - Application Form (2)

    Copyright

    © © All Rights Reserved

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    XLSX, PDF, TXT or read online from Scribd

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    This document is a crew application form for Nimbus Maritime Service Pvt Ltd. It requests personal details such as name, date of birth, nationality, qualifications, medical certificates, sea time experience, and next of kin information. The form collects information on certificates of competency, flag state documents, medical certificates, safety and security training certificates, spouse and dependent details, and a record of sea time experience including vessel name, rank, company, period of employment and area of operation. The document was last revised on November 1st, 2018 and released as version 2 of the company's crew application manual.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    84 views7 pages

    MEO - Application Form

    Uploaded by

    Abdul Rahim
    This document is a crew application form for Nimbus Maritime Service Pvt Ltd. It requests personal details such as name, date of birth, nationality, qualifications, medical certificates, sea time experience, and next of kin information. The form collects information on certificates of competency, flag state documents, medical certificates, safety and security training certificates, spouse and dependent details, and a record of sea time experience including vessel name, rank, company, period of employment and area of operation. The document was last revised on November 1st, 2018 and released as version 2 of the company's crew application manual.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 7

    L3-CREW-FRM-56 CREW APPLICATION REV 0

    Company NIMBUS MARITIME SERVICE PVT LTD

    Date

    POSITION APPLIED

    Date of Availability

    Nearest Airport

    PERSONAL PARTICULARS
    Name Rank
    Date Of Birth Place Of Birth
    Marital Status Nationality
    Religion Blood Group
    E-mail PPE Size
    Home Tel. No Mobile No.
    Height (cm) Weight (kgs)

    Home Address
    Postal Code:
    TRAVEL DOCUMENTS NUMBER DATE OF ISSUE DATE OF EXPIRY PLACE OF ISSUE

    CERTIFICATE OF COMPETENCY CAPACITY DATE OF ISSUE DATE OF EXPIRY


    Certificate of Competency (Home Country)
    Certificate of Endorsement (Home Country)
    General Operator Certificate (GOC) (Home Country)
    FLAGSTATE DOCUMENTS CAPACITY DATE OF ISSUE DATE OF EXPIRY
    Singapore /Panama/ Malaysia / indonesia- COE / COR
    Singapore /Panama/ Malaysian / Indonesia - GOC / COR
    Singapore /Panama/ Malaysian / indonesia - SIRB / SID

    MEDICAL CERTIFICATE CLINIC DATE OF ISSUE DATE OF EXPIRY


    Petronas / BSP / PANAMA
    Others :
    NOS. TRAINING CERTIFICATES DATE OF ISSUE DATE OF EXPIRY
    1 Basic Safety Training
    2 Personal Survival Techniques
    3 Fire Prevention and Fire Fighting
    4 Elementary First Aid
    5 Personal Safety and Social Responsibilities
    6 Proficiency in Fast Rescue Boat
    7 Advance Firefighting
    8 Medical First Aid
    9 Proficiency in Survival Craft and Rescue Boats
    10 Radar Observation
    11 Automatic Radar Plotting
    12 ARPA Simulator

    Page 1 of 7
    14 Radar Simulator
    13 Ship Security Officer (SSO)/ Security Awareness(SAT) / Designated Security Duties(SDSD) 1/18/2014 1/17/2019
    14 Bridge Resource Management
    15 Engine Room Resource Management
    16 Global Maritime Distress Safety System (GMDSS)
    17 Food handling Certificate (COOK)
    18 Medical Care Onboard
    19 BOSIET
    20 HUET
    21 DP Maintenance
    22 DP Simulator
    23 Rigging & Slinging Certificate
    24 HLO / HLA
    25 Proficiency in Fast Rescue Boat (PFRB)
    26 Electronic Chart Display AND Information System (ECDIS)
    NEXT OF KIN (NOK) DETAILS (to be contacted in case of Emergency)
    Name Relationship

    Address
    Tel. No
    SPOUSE PARTICULARS
    Spouse Name Date of Birth

    Address
    Tel. No
    DEPENDENTS / CHILDREN PARTICULARS
    No. Name Relationship Date of Birth Age
    1
    2
    3
    4
    5

    Page 2 of 7
    Page 3 of 7
    Page 4 of 7
    L3-CREW-FRM-56 CREW APPLICATION REV 0

    SEA TIME EXPERIENCE

    Area of Type of Client Period (d-mmm-yy)


    No Name of Vessel Rank Vessel Type GRT / HP Company
    Operation Operation (Charterers Name) From To
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10

    13
    14
    15
    16
    17
    18
    19
    20
    21
    22
    23
    24
    25

    Page 5 of 7
    L3-CREW-FRM-56 CREW APPLICATION REV 0
    CREW APPLICATION

    REVISION LOG

    Initials in the approval boxes confirm that the document has been approved.
    Only the last 3 revision logs are printed on this document. Refer to the Document Management System (DMS) for the full revision log
    and electronic approvals.

    Rev Effective Description of Changes Issued By


    0 1-Nov-18 Released for Manual’s Version 2 Sandra J.
    m (DMS) for the full revision log

    Approved By
    Mohsen M.

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