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    Reederei NORD GMBH Seafarers Application Form

    Uploaded by

    Rajat Somalingam
    This document is a seafarer application form for Reederei Nord GmbH. It requests personal details such as name, date of birth, nationality, licenses held, medical documents, courses completed, sea service history, and references. The form collects information to evaluate candidates for shipboard positions. It requests availability date and signatures to finalize applications.

    Copyright:

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

    Reederei NORD GMBH Seafarers Application Form

    Uploaded by

    Rajat Somalingam
    19 views4 pages
    This document is a seafarer application form for Reederei Nord GmbH. It requests personal details such as name, date of birth, nationality, licenses held, medical documents, courses completed, sea service history, and references. The form collects information to evaluate candidates for shipboard positions. It requests availability date and signatures to finalize applications.

    Original Title

    Reederei NORD GmbH Seafarers Application Form

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    © © All Rights Reserved

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    This document is a seafarer application form for Reederei Nord GmbH. It requests personal details such as name, date of birth, nationality, licenses held, medical documents, courses completed, sea service history, and references. The form collects information to evaluate candidates for shipboard positions. It requests availability date and signatures to finalize applications.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    19 views4 pages

    Reederei NORD GMBH Seafarers Application Form

    Uploaded by

    Rajat Somalingam
    This document is a seafarer application form for Reederei Nord GmbH. It requests personal details such as name, date of birth, nationality, licenses held, medical documents, courses completed, sea service history, and references. The form collects information to evaluate candidates for shipboard positions. It requests availability date and signatures to finalize applications.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 4

    REEDEREI NORD GmbH

    Astraturm – Zirkusweg 2
    20359 Hamburg
    Germany
    Tel.: +49-40-3690-20
    Mail: personnel@reederei-nord.de

    SEAFARER APPLICATION FORM


    Please
    insert
    photo
    RANK:
    Manning agent:
    PERSONAL DETAILS:
    Surname: Name: Availability date:

    Date of Birth: Place of Birth: Other names: Nationality:

    Address: Tel.No: Mobile:

    Nearest Airport:: E-mail: Civil Status:

    Next of Kin/ Relationship: Address: Tel.No / Mobile:

    TRAVEL DOCUMENTS:
    Number Issue date Expiry date Place
    Passport:
    National Seaman’s Book:

    USA Visa:

    LICENSES:

    License Grade of License Number Issue date Expiry date Place


    Cert. of
    Competency:
    Flag Certificates:

    MEDICAL DOCUMENTS:

    Number Issue date Expiry date Place


    Health Certificate:
    Yellow Fever Vacc.:

    Shoe Size (European standard) Overal size (S/M/L/XL)


    Height (cm) Weight (KG)
    COURSES & CERTIFICATES

    Course name Level Issue date Expiry date Number


    Fire Fighting BASIC / ADV
    ELEMENTARY First Aid /
    Medical MEDICAL FIRST AID
    MEDICAL. CARE
    Personal Safety & Social Resp.
    Personal Survival Techniques
    Survival Craft & Rescue Boats
    Fast Rescue Boats
    ARPA
    GMDSS
    Generic ECDIS
    Type specific ECDIS 1
    Type Specific ECDIS 2
    Type specific ECDIS3
    Ship Security Officer
    Bridge Resource/ Team Mgmt.
    Designated Security Duties

    MARLINS / Language-lTest:

    TOTAL % LISTENING % GRAMMAR % VOCABULARY % Issue date

    TIME AND NUMBERS PRONUNCIATION % READING % Place of Issue


    %

    Last wages Required wages


    SEA SERVICE:

    Ship-Owner Rank Date Date Type of vessel Name of vessel GRT / KW If container Engine Type Flag
    signed on signed off Nr. of TEU

    Person or Company to contact for references, together with contact details.


    1.
    2.
    3.

    SIGNATURE DATE and PLACE:

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