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Employment Application Form
POST APPLIED FOR
MASTER/Shore base Marine Job
ARE YOU WILLING TO JOIN A RANK LOWER IF CURRENT POSITION IS NOT AVAILABLE
N
DATE AVAILABLE FROM
NOW
HEIGHT – 181 CM
EYE SIGHT -
6/6
WEIGHT – 80 kgPERSONAL DETAILS NATIONALITY: BANGLADESHI DATE OF BIRTH
09/06/1958PLACE OF BIRTH; DHAKA IDENTITY DOCUMENTS DOCUMENT PLACE OF ISSUE NUMBER DATE OF ISSUE DATE OF EXPIRY PASSPORT: DHAKA BJ0698756 28/12/2015 27/12/2020 OTHER VALID VISA: USA DHAKA 20062534020035 12/02/2012 12/02/2017 SEAMAN BOOK
CHITTAGONG C/0/0604 03/04/2006 03/04/2021 FLAG STATE
SINGAPORE
VALIDYELLOW FEVER YES ENSURE AT LEAST 2 BLANK PAGES IN YOUR PASSPORT : YES DATE OF ISSUE:
02/09/2010
CLOSEST AIRPORT: Dhaka International Air PortDATE OF EXPIRY:02/09/2020 US VISA: VALID TIL 12/*02/2017 20062534020035 DATE OF ISSUE:12/02/2012 DATE OF EXPIRY:12/02/2017 Certificates Grade Number Issued Validity Issued at Certificate of Competency / Watch keeping MASTER
UNLIMITEDCoC0011885 19/05/2001 16 of October 2020 MCA/UK Endorsement to Certificate of Competency GMDSS (GOC) SING H 0536 17/11/2014 16/11/2019 iDA SINGAPORE.
Applied for revalidation.GMDSS (Endorsement) NA NA NA NA STCW Certification Grade Number Issued Validity Issued at Personal Survival Techniques Proficiency in Survival Craft and Rescue Boats/ PSC-RB PSCRB 1107/04 30.11.2011 30.11.2016 Maritime Institute of Science & Technology Personal Safety and Social Responsibilities PSSR 1107/07 13.12.2011 12.12.2016 Maritime Institute of Science & Technology Elementary First Aid FASC 24.05.1983 NA GOVT.MARINE ACADEMY CH Medical first Aid / Master's Medicare 99100 18.12.2011 18.12.2016 International Institute of Maritime Technology Fire Prevention and Fire Fighting Advanced Fire Fighting FFC2133 29.06.2012 28.12.2016 GOVT.MARINE ACADEMY CHT Tanker Familiarization (Oil) Tanker Familiarization (Chemical) Tanker Familiarization (Gas) Advanced Tanker Safety(TASCO) - Petroleum Advanced Tanker Safety(CHEMCO)- Chemical Advanced Tanker Safety(GASCO)- Gas Radar Observer 14/0239 08.06.1984 NA S .TYNE S COLLEGE. UNITED KINGDOM Radar Simulator Automatic Radar Plotting Aids 14/00672 26.02.1988 NA S .TYNE S COLLEGE. UNITED KINGDOM Yellow Fever 02.09.2010 01.09.2020 DHAKA ECDIS ECDIS 23.04.2015 28/05/2009 UMA
MCA approvedOther Certification Grade Number Issued Validity Issued at Ship Security Officer SSO/1305/05 26.02.2013 26.02.2018 International Institute of Maritime Technology Liquid Cargo Handling Simulator Bridge Team Management (BTRM / BRM) SIN-02-0044 12.09.2003 NA SINGAPORE POLYTECHNIC Bridge Simulator 0088 20.02.2001 NA PSA SINGAPORE Engine Room Simulator Inert Gas Systems Hazmat Course BMTI/01032669 29.08.2007 NA BMTI Fast Rescue Boat (FRB) PSC 1371 24.05.2012 23.05.2017 GOVT.MARINE ACADEMY CH Ship Safety Officer Course Revalidation COURSE Ref & Updating Trg License and Certification Information
COMPANY
VESSEL NAME
VESSEL TYPE
D.W.T ./ GRT
VSL AGE
TYPE OF ENGINES – MANDATE
RANK
SIGN ON DATE
SIGN OFF DATE
DURATION Y/M/D
REASONS FOR S/OFFUNITED OCEAN SHI MANAGEMENT.
SINGAOREM V UNITED SERENITY BULK CARRIER 82000 6 YEARS MAN MASTER 24/04/2015 28/08/2015 4M 03 D CMLETION OF CONTRACT WALLEM SHIP MANAGEMENT.HK CEDAR 6 BULK CARRIER 79224 MT 3.5 YEARS MAN/B&W MASTER 25/05/2014 27/09/2014 4 M 02 DA COMPLETION OF CCCCONTRACTCONTRACT WALLEM SHIP MANAGEMENT.HK PINE 2 MULTIPURPOSE VESSEL 34000 3 YEARS MAN MASTER 19/05/2013 14/10/2013 5 M OO D END OF CONTRACT ACCORD MARINE MANAGEMENT PVT LTD M V AASHMAN LOG CARRIER 25000/
15045 MT28 YEARS MAN MASTER
17/02/2012
13/07/20124 M 27D END OF CONTRACT SIMATECH SHIPPING LLC SIMA SAMAN CONTAINER
1500 TEUS18000 MT 4 YEARS MAN/B&W MASTER 19/05/2011 25/08/2011
03M 06DEND OF CONTRACT SIMATECH SHIPPING LLC SIMA PAYA CONTAINER
1300 TEUS17500 MT 4 YEARS MAN/B&W MASTER
25.09.2010
04.02.2011
04M 08DEND OF CONTRACT MANSHIP PTE/SINGAPORE QC VISION Container
991 TEUS9957 GRT MT 1 YEARS MAN MASTER 24/11/2009 16/05/2010 04M 22D END OF CONTRACT MANSHIP PTE/SINGAPORE M V GENIUS Container
991 TEUS9954 GRT MT 1 YEARS
MAN
MASTER24/11/2008 28/05/09 06M 04D END OF CONTRACT AL UNITED MARITIME EASTERN SEA MULTIPURPOSE /LOG CARRIER
800 TEUS10018 GRT 20 YEARS
SULZERMASTER 06/12/2007 24/06/2008 06M 00D END OF CONTRACT MAERSK LINE SEALAND INTEGRITY CONTAINER
4614 TEUS57075
GRT
22 YEARS MAN CHIEF OFFICER 26/03/2007 26/06/2007 03M 00 D END OF CONTRACT
MAERSK LINESEALAND INTEGRITY CONTAINER
4614 TEUS57075
GRT
22 YEARS4 MAN CHIEF OFFICER 04/06/2006 27/08/2006 02M 24D
END OF CONTRACT
MAERSK LINEMAERSK WIND
RO RO/PCTC
5200 UNITS51770 GRT 4 YEARS KAWASAKI CHIEF OFFICER 27/05/2004 09/10/2004 04 M 15 D END OF CONTRACT
MAERSK LINEMAERSK ANTWERP CONTAINER
992 TEUS14063
GRTKAWASAKI CHIEF OFFICER 13/10/2003 03/02/2004 03M 20D END OF CONTRACT MAERSK LINE
SEALAND INTREPIDCONTAINER
4060 TEUS49985 GRT 5 YEARS KAWASAKI CHIEF OFFICERR 28/03/2003 01/08/2003
04M 03DEND OF CONTRACT MAERSK LINE MAERSK ATLANTIC CONTAINER
992 teus14063
GRT4 YEARS KAWASAKI CHIEF OFFICER 20/08/2002 21/12/2002 04 M 03 D END OF CONTRACT Ocean Tramping.HK SEA DANIEL BULK CARRIER 36000 DWT 12 YEARS
DOXFORDCHIEF OFFICER 05/09/90 27/04/91 07M 22D
END OF CONOcean Tramping APT MARINER BULK CARRIER 44000 DWT 15 YEARS MAN CHIEF OFFICER 05/08/91 12/02/92 06M 07D
END OF CON
Sea time calculations mentioned above Mandate for all TOP FOUR officers being proposed, witMISCELLANEOUS – Please provide below details for further assessment A} DECK OFFICERS Sea Time in Rank – e.g 12 m 15 days
Sea Time on Type vsls
Overall Tanker Exp
MASTER = 41 M 07 DAYS/Cont & bulk
C/O = 41 M 28 DAYS cont & bulk/g CargoChemical: Type of Cargo Carried
NATanker: Type of Pumps
NAVetting:
NAB} ENGINEERS
Sea Time in Rank – e.g 12 m 15 days
Sea Time on Type vsls
Overall Tanker Exp
Automation: {Type}Vetting:
C}ELECTRICAL OFFICERS Automation:{Type}
EXP on Inert Gas System
PLC {NAME} D} GENERAL TRADING AREA OF VESSEL
E} OIL MAJOR INSPECTIONS
F}DRY DOCKING EXPERIENCE
G}PRE-SEA TRAINING {Period/Institution}
H} SCHOLASTIC EDUCATION
References (Please give the name and address of your current or immediate past employer) S. NO NAME ADDRESS TELEPHONE NO 1. Mr. Vikram United Ocean Ship mng MManagement Management 91 22 28533337 Officer Approved by : Officer Approved by Technical Team Signature : Signature : Date : Date :
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