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(Tanker) CV

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ULTRA MAJOR SHIPPING CO.,LTD.

(TANKER)
Applied to Office in City / FILE NO : (office use only)
Country

Present Rank Date of Application

Rank Applied Date of Availability

1. PERSONAL DETAILS:
Surname First Name Middle Name
Name
Date of Birth Place of Birth Nationality
Permanent Present /
Address Correspondence
Address

City & Pin Code City & Pin Code


Mobile Telephone
E-mail ID (1) E-mail ID (2)
Nearest Domestic Nearest International
Airport Airport

2. NEXT OF KIN / FAMILY PARTICULAR(S):


Name / Relation
Address

Name Date of Birth ID Proof (P/P etc.) Issued /Validity


Wife S
Child (M / F)
Child (M / F)
Child (M / F)
Child (M / F)

3. INDOS, PASSPORT & VISA DETAILS:


Number Place of Issue Date of Issue Date of Expiry
Seafarer Profile created and updated on DG Shipping website.
INDOS
Passport
US Visa (C1/D)
ECNR
Page No: 1 Version: 1.0 Date: 20.03.2018 Approved by:- M.D. Prepared by:- M.R.

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ULTRA MAJOR SHIPPING CO.,LTD.
4. CONTINUOUS DISCHARGE CERTIFICATE(S):
CDC Number Place of Issue Date of Issue Date of Expiry
Indian
Panama
Liberian
Others

5. PROFESSIONAL / ACADEMIC QUALIFICATION:


Course Institution Qualification Grade From To

6. LICENCE / CERTIFICATES OF COMPETENCY (OFFICER / ENGINEER):


Issuing Grade Number Date of Issue Date of STCW
Date
Authority Expiry 95/2010
Revalidated
Y N
Indian
UK
Panama
Others

7. WATCHKEEPING / C.O.P. (RATINGS):


Issuing Grade Number Date of Issue Date of Date STCW
Authority Expiry Revalidated 95/2010
Y N
Indian
Panama
Others

8. PERSONAL DETAILS:
Height Weight
Color of Eyes Color of Hair
Se Allergy to
Blood Group
x Medicines
Boiler Suit Size Safety Shoe Size
Any Major Illness /
Injury

9. STCW AND VALUEADDED COURSES:


Date of Date of Issuing Authority/
Certificate No
STCW Courses Issue Expiry Institute
P.S.S.R.
E.F.A.
M.F.A.
Medicare.

Page No: 2 Version: 1.0 Date: 20.03.2018 Approved by:- M.D. Prepared by:- M.R.

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ULTRA MAJOR SHIPPING CO.,LTD.

P.S.T.
P.S.C.R.B.
F.P. & F.F.
A.F.F.
S.T.S.D.S.D.
R.O.C.
A.R.P.A.
G.M.D.S.S.
G.M.D.S.S. ENDORSEMENT.
Refresher & Updating
R.A.N.S.C.O.
N.A.R.A.S.
NAV. Control
Certificate Revalidation Course
Simulator Training
Engine Simulator
B.T.M.
E.C.D.I.S. (IMO 1.27)
E.C.D.I.S. Type Specific
Ice Navigation.
B.R.M.
E.R.M.
Large Vessel Handling Simulator
Tanker Courses
T.A.S.C.O.
O.T.F.C.
C.H.E.M.C.O.
C.T.F.C.
G.A.S.C.O.
G.T.F.C.
DCE Oil
DCE Chemical
DCE Gas
Liquid Cargo Simulator
Crude Oil Washing Course
Augmentation Course
Other Value-Added Courses
I.S.P.S.
Hazmat
S.S.O.
Cookery Course
Welding 2G, 3G, 6G
D.P Maintenance Course
D.P. [Full / Advance / Basic]

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ULTRA MAJOR SHIPPING CO.,LTD.

10. SEA TIME EXPERIENCE (In Reverse Order):


Vessel
Main Engine Service Period Reason for Sign
Company Year Off
Name Type DWT GRT Rank Make Model BHP UMS From To M/D
Build

Page No: 4 Version: 1.0 Date: 20.03.2018 Approved by:- M.D. Prepared by:- M.R.

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ULTRA MAJOR SHIPPING CO.,LTD.
11. REFERENCES:
Name Company/Designation Contact Details.

12. HOW DID YOU COME TO KNOW ABOUT US:


A Company Presentation/Seminar B Marine Club Notice Board C Marine Magazine Advertisement
Told by Seagoing
D Newspaper Advertisement E F Direct Mail from Company
Colleagues
G Others (Please Specify)

13. DECLARATION:
I declare that the information given by me in filling up this form to the best of my knowledge are true complete. I
also declare that the documents submitted to Blackhull Maritime Services Private Limited are genuine, given and
signed by the persons whose names appear on them. Any false declaration may render me liable for termination
or dismissal.

Date: 23/06/2019 Signature of Applicant:

14. OFFICIAL USE:


Assessment Grade Application Status Date
Personality Forwarded to Principal
Attitude
Technical Knowledge Accepted Yes No
English Knowledge Reference
Overall Assessment

Grade: A: Excellent, B: Good, C: Satisfactory, D: Average, E: Poor

Interviewed by ____________________________________ Date: __________________

INTERVIEWER’S COMMENTS

Page No: 5 Version: 1.0 Date: 20.03.2018 Approved by:- M.D. Prepared by:- M.R.

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