Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

Declaration of The Authorized Representative: Privacy Coordinator

Download as pdf or txt
Download as pdf or txt
You are on page 1of 5

PROTECTED B (WHEN COMPLETED)

Declaration of the Authorized Representative

Collection and use of personal information is in accordance with the Privacy Act. This information is collected to issue, to the holder of a valid foreign certificate, a
Canadian Endorsement that permits this certificate to be accepted in lieu of a certificate issued under Part 3 of the Canada Shipping Act, 2001. The information is
collected under the authority of section 16 of the Canada Shipping Act, 2001. The information collected is described in personal information bank entitled
Seafarers' Certificates and Documents (TC PPU-030). In some cases, information may be disclosed without your consent pursuant to subsection 8(2) of the
Privacy Act. All personal information collected in relation to the issuance of a Canadian Endorsement is to be retained for two (2) years following the expiry of the
Canadian Endorsement. The Privacy Act states that you have the right to access your personal information and to request changes to incorrect information. For
more information, please contact your Privacy Coordinator.

PART 1. AUTHORIZED REPRESENTATIVE DETAILS


Company name Company contact

Address
Number Street City Province Postal code

Email Telephone number

PART 2. EMPLOYMENT DETAILS (Foreign Seafarer Details) Nautical Engineering Dual Capacity
Surname Given names Date of birth (dd-mm-yyyy)

I declare that I intend to employ the foreign seafarer listed above for the period from to
Employment start date (dd-mm-yyyy)
as on board the following vessel:
Employment end date (dd-mm-yyyy) On board position
Vessel name Official number Port of registry Labour market impact or Work permit number
/IMO number assessment no. (begins with a "U")

Voyage classification

PART 3. AUTHORIZED REPRESENTATIVE DECLARATION


I declare that the foreign seafarer listed above holds a valid Certificate of Competency, valid Certificates of Proficiency (if required), and a valid Medical
Certificate issued by a state with which Canada has entered into a Reciprocal arrangement with.
I declare that the foreign seafarer listed above has completed an Application for a Canadian Endorsement. The Application form and the supporting
documents are enclosed.
I declare that the foreign seafarer listed above has sufficient knowledge of Canadian maritime legislation and regulations to enable safe and efficient ship
operation as set out per the criteria of assessment contained within this form. (For initial application only)
I declare that the foreign seafarer listed above can understand, speak, read and write English or French at level that allows the seafarer to carry out their role
as set out per section 2.5 of the guidance notes contained within the Application for a Canadian Endorsement (Form 82-0786).
(For initial application only)
I hereby affirm that all the information provided by me in this Application and the supporting documents are true and correct to the best of my knowledge and
belief.

Signature Date (dd-mm-yyyy)

Name Position in company

82-0787E (2211-04)
Page 1 of 5
CRITERIA ASSESSMENT FOR KNOWLEDGE OF ONE OF THE TWO OFFICIAL LANGUAGES

WHEN TO USE
The Assessment method outlined below is for use when the authorized representative is required to assess the English or French language proficiency of a
foreign seafarer for a Canadian Endorsement, as set out per section 2.5 of the guidance notes contained within the Application for a Canadian Endorsement
form (82-0786). The Checklist should be used to confirm proficiency of English or French and as an auditable record for all foreign seafarers wishing to apply for
a Canadian Endorsement.
THE ASSESSMENT
This Assessment is to be conducted in person, or online if adequate measures are in place to avoid cheating and to ensure the authenticity of the assessment,
with a native English or French speaker (hereinafter “interviewer”). It should consist of 4 separate sections, as defined below, and should last approximately 1
hour in duration. Questions and answers must be noted or when possible, the Assessment should be recorded. When noted, the answers given maybe in the
form of short phrases but it must be sufficiently clear that it can be used as an aide-mémoire for the purpose of the verification by Transport Canada.
The assessment must be conducted at the appropriate level, operational or management, based on the level of responsibility of the certificate of competency for
which the Canadian endorsement is seeking, and not based on the position that the foreign seafarer will be employed.
At the end of the Assessment, all of the criteria should have been evaluated. Where there is doubt as to whether a criteria is being met, there may be a need to
retry during the Assessment, but if the point must be pressed, it should be left as not met.
Section 1 - Oral interview
This should cover general topics, for example career to date, future plans. The questions should enable and encourage discursive responses allowing the foreign
seafarer the chance to ask questions or seek clarification.

This should also cover specific job topics and be tailored to the vocabulary relating to the specific functions to be undertaken by the foreign seafarer. This may
include listening to radio messages, loudspeaker announcements, and should certainly include the testing of comprehension and communication of the types of
orders, statements and requests that the foreign seafarer is likely to hear or have to make.

Section 2 - Live listening/comprehension

The interviewer should, at a steady pace, read a passage lasting 3-5 minutes of a maritime nature, e.g. an incident or a procedure. The foreign seafarer may take
notes throughout (in their own language if preferred). The foreign seafarer should be allowed 2-3 minutes to look over their notes and then be asked to describe
the incident in their own words, summarizing the main points.

Section 3 - Reading comprehension

The foreign seafarer should read a document relating to its specific functions to be undertaken e.g. a publication, a report, manufacturers' manuals or a
procedure. They should be allowed 4-5 minutes to read it and then be asked to describe the document in their own words, summarizing the main points.

Section 4 - Written expression

The foreign seafarer should write, using marine technical terminology, a document relating to its specific functions e.g. write technical notes or notices to crew,
complete forms and report on daily occurrences in the nautical or engineering department.

CRITERIA CHECKLIST (met or not met)

This Criteria Checklist is to help establish levels of listening, speaking, reading and writing abilities and are to be filled in each time an English or French language
Assessment is performed on a foreign seafarer wishing to apply for a Canadian Endorsement.

The criterias are to be used as a checklist and where the interviewer decides that a criteria has not been met, then it is to be noted and must be taken into
account in the final result. It will be for the authorized representative (AR) to decide whether failure to meet one or more criteria(s) means the foreign seafarer's
level of English or French would not be sufficient to carry out their functions safely and effectively.

The completed Criteria Checklist and the assessment must be sent with the Application.

OPERATIONAL LEVEL
Listening Comprehension
Understand short work exchanges containing introductions, casual small talk and greetings. Met Not Met

Understand short descriptive or narrative communications on specific job topics. Met Not Met

Understand common sequentially presented instructions and directions related to familiar, everyday situations. Met Not Met
Oral Expression
Use courtesy formulas and some casual small talk. Met Not Met

Give a set of simple instructions and directions. Met Not Met

Give brief description of professional experience, situations or simple processes. Met Not Met

Ask for and give information about needs and feelings related to common everyday activities. Met Not Met

Make and respond to a range of requests and offers. Met Not Met

82-0787E (2211-04)
Page 2 of 5
Reading Comprehension
Understand simple work message. Met Not Met

Understand short, simple, clearly sequence instructions and technical texts of familiar everyday situations. Met Not Met

Understand the purpose, main idea, key information and specific details in simple short texts related to Met Not Met
everyday familiar situations and topics.

Identify information in simple texts at short texts related to work. Met Not Met

Writing Skills
Convey short, personal, informal work messages related familiar work situations. Met Not Met

Copy or record expanded information from short texts. Met Not Met

Complete simple forms with basic familiar information and provide some responses to simple questions. Met Not Met
Write simple service messages and, a short paragraph to describe a familiar situation, event, professional Met Not Met
experience or future plans.

MANAGEMENT LEVEL
Listening Comprehension

Understand the gist and some details in moderately complex common and predictable work exchanges and Met Not Met
communication intended to influence or persuade.

Understand simple to moderately complex directions and instructions for generally familiar and relevant procedures. Met Not Met

Understand descriptive or narrative monologues or presentations related to everyday or specific job situations. Met Not Met
Oral Expression
Participate in basic work conversations. Met Not Met

Give instructions and directions for everyday activities and processes. Met Not Met

Give and respond to informal requests, permission, suggestions and advice. Met Not Met

Ask for and give information related to routine daily activities. Met Not Met

Describe sequences of events; incidents in the past, present or future; or describe scene, picture or daily routines. Met Not Met
Reading Comprehension

Understand simple to moderately complex professional and public work messages, step-by-step instructions and for multistep Met Not Met
procedures related to everyday situations and descriptive or narrative texts on familiar topics.

Interpret information contained in formatted texts. Met Not Met

Locate and use one or two pieces of information from moderately complex formatted text. Met Not Met
Writing Skills
Convey professional messages in short, formal and informal correspondence. Met Not Met

Reduce short, factual, oral discourse to notes; and, an information page to a list of details. Met Not Met

Write short correspondence for routine professional needs. Met Not Met

Complete a form with detailed professional information. Met Not Met

Write a paragraph about a familiar sequence of events or a description. Met Not Met
Authorized Representative Assessment

I can confirm that the standard of English of at the


Name
level of responsibility was assessed on
Operational or Management Date (dd-mm-yyyy)
and was found to be Acceptable Not Acceptable by

Authorized representative
SEAL
Date (dd-mm-yyyy)

Signature of authorized representative

82-0787E (2211-04)
Page 3 of 5
CRITERIA ASSESSMENT FOR KNOWLEDGE OF CANADIAN MARITIME LAW
WHEN TO USE
The Assessment method outlined below is to be used by the Authorized Representative (AR) to assess the knowledge of Canadian maritime legislation and
regulations of a foreign seafarer wishing to apply for a Canadian Endorsement attesting the recognition of a foreign certificate of competency issued in
accordance with the provisions of the Regulation II/2, III/2, III/3 or VII/1 at the management level, as defined in the STCW Code.
THE ASSESSMENT
This assessment is to be conducted in person, or online if adequate measures are in place to avoid cheating and to ensure the authenticity of the assessment, by
a qualified person who holds a certificate of competency at the management level relevant to the discipline of the foreign seafarer (hereinafter “interviewer”).
Questions and answers must be noted, or when possible, the assessment should be recorded. When noted, the answers given may be in the form of short
phrases but it must be sufficiently clear that it can be used as an aide-mémoire for the purpose of the verification by Transport Canada.
The assessment must be conducted at the management level, based on the level of responsibility of the certificate of competency for which the Canadian
endorsement is seeking, and not based on the position that the foreign seafarer will be employed.
At the end of the Assessment, the interviewer must be satisfied that the foreign seafarer has sufficient knowledge of applicable Canadian maritime legislation and
regulations to enable safe and efficient operation of the vessel.
CRITERIA CHECKLIST
The criterias are to be used as a checklist and where the interviewer decides that a criteria has not been met, it is to be noted and must be taken into account. It
will be for the AR to decide whether failure to meet one or more criteria(s) means the foreign seafarer's level of knowledge of applicable Canadian maritime
legislation would not be sufficient to carry out their functions safely and effectively.

The completed Criteria Checklist and the assessment must be sent with the Application.
Identify the principal Government departments, acts and regulations regulating the marine industry. Met Not Met
Explain purpose, general content, structure of acts and regulations listed below according to the function on board. Met Not Met

Knowledge of where to look for information regarding the following topics according to the function on board: hull, machinery, Met Not Met
tackle and lifting appliances inspection, safe working practices, occupational health and safety, labour standards, emergency drills,
safety management system, administrative monetary penalties.

Specific requirements according to the function on board: administrative monetary penalties and notices; investigation procedures;
enforcement; occupational health and safety; hours of work and rest; rights and duties of employer and worker; refusal to work if Met Not Met
danger; reporting requirements for accidents, incidents and hazardous occurrences, personal injury or death to Transport Canada
and Transportation Safety Board; permitted discharge of pollutants; emission control areas; ballast water control and management;
pollution certificates; NORDREG; inspection certificates; load line certificates; conditions for issue and renewal certificate;
authorities and powers of Transport Canada and Transportation Safety Board of Canada; authorities and powers of Marine Safety
inspectors; authorities and powers of delegated health and safety officers; vessel traffic schemes and reporting requirements; charts
and publications to be carried on board; ECDIS training; Canadian Collision Regulations and buoy/aids to navigation system.
LIST OF APPLICABLE ACTS FOR THE ASSESSMENT
ENGINEERS NAUTICAL
● Canada Shipping Act, 2001 ● Canada Shipping Act, 2001
● Arctic Waters Pollution Prevention Act ● Arctic Waters Pollution Prevention Act
● Canadian Transportation Accident Investigation and Safety Board Act ● Marine Liability Act, 2001
● Canada Labour Code, Part II ● Canada Labour Code, Part II
LIST OF APPLICABLE REGULATIONS FOR THE ASSESSMENT
ENGINEERS NAUTICAL
● Administrative Monetary Penalties and Notices (CSA 2001) ● Administrative Monetary Penalties and Notices (CSA 2001)
Regulations SOR/2008-97 Regulations SOR/2008-97
● Arctic Waters Pollution Prevention Regulations C.R.C., c. 354 ● Arctic Waters Pollution Prevention Regulations C.R.C., c. 354
● Ballast Water Regulations SOR/2021-120 ● Ballast Water Regulations SOR/2021-120
● Cargo, Fumigation and Tackle Regulations SOR/2007-128 ● Cargo, Fumigation and Tackle Regulations SOR/2007-128
● Fire and Boat Drills Regulations SOR/2010-83 ● Collision Regulations including Canadian amendments C.R.C.,
c. 1416
● Life Saving Equipment Regulations C.R.C., c. 1436
● Fire and Boat Drills Regulations SOR/2010-83
● Load Line Regulations SOR/2007-99
● Life Saving Equipment Regulations C.R.C., c. 1436
● Marine Machinery Regulations SOR/90-264
● Load Line Regulations SOR/2007-99
● Marine Personnel Regulations SOR/2007-115
● Marine Personnel Regulations SOR/2007-115
● Maritime Occupational Health and Safety Regulations SOR/2010-120
● Maritime Occupational Health and Safety Regulations SOR/2010-120
● Policy Committees, Work Place Committees and Health and Safety
Representatives Regulations SOR/2015-164 ● Navigation Safety Regulations 2020 SOR/2020-216
● Safety Management Regulations SOR/98-348 ● Safety Management Regulations SOR/98-348
● Steering Appliances and Equipment Regulations SOR/83-810 ● Safe Working Practices Regulations C.R.C., c. 1467
● Tackle Regulations C.R.C., c. 1494 ● Shipping Casualties Reporting Regulations SOR/85-514
● Vessel Safety Certificates Regulations SOR/2021-135 ● Steering Appliances and Equipment Regulations SOR/83-810

82-0787E (2211-04)
Page 4 of 5
ENGINEERS NAUTICAL
● Vessel Fire Safety Regulations SOR/2017-14 ● Vessel Fire Safety Regulations SOR/2017-14
● Vessel Pollution and Dangerous Chemicals Regulations ● Vessel Pollution and Dangerous Chemicals Regulations
SOR/2012-69 SOR/2012-69
● Canadian Vessel Plan Approval and Inspection Standard TP 15456 ● Vessel Safety Certificates Regulations SOR/2021-135
● Canadian Vessel Plan Approval and Inspection Standard TP 15456

Authorized Representative Assessment


I confirm that the knowledge of the applicable Canadian maritime legislation and regulations of

at the management level of responsibility was assessed on


Name

and was found to be acceptable not acceptable by


Date (dd-mm-yyyy)

Print name of authorized representative

Signature of authorized representative


SEAL

Print name of witness

Signature of witness

82-0787E (2211-04)
Page 5 of 5

You might also like