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Application & Applicants' Registration Form

Mariners interested in applying for a specific position, or who would like to be listed in our
inventory as available for future positions, should complete and submit the Application/Registration form below. You may use abbreviations applicable to your country. Please note "Fields Required" in the green bars.

This form is protected using Industry Standard SSL (Secure Sockets Layer.) The information submitted to us on the form (or in any manner) is used to contact applicants and/or employers, and is exchanged between these parties in order to determine and match their needs. Please see also our Privacy Policy statement.

     Personal Information                   All Fields Required EXCEPT THOSE prefixed by √
If applying for job(s) listed on the "Jobs Available"
page, please quote the Job number(s):  
First Name:   Last Name: 
Marital Status:   Nationality: 
Birth Date (yyyymmdd):   Place of Birth: 
Address:   √ Address Line 2: 
Municipality:   Province/State: 
Postal/Zip Code:   Country: 
Telephone:   √ Telephone 2: 
√ Cellular/Mobile:   Nearest Airport: 
Email 1:
√ Email 2:
Next of Kin First Name:   Last Name: 
Relationship:   Telephone: 
     Education, Skills and Experience                   Complete all fields THAT APPLY TO YOU
Rank requested:   Preferred Vessel Type: 
Professional Schooling: Other Skills: 
Foreign Crew Experience: ENTER REQUIRED INFORMATION FOR EACH EXPERIENCE LISTING IN THIS ORDER:
Name of Ship, Registry, DWT, Type, Rank, Engine, Sign On Date, Sign Off Date, Total Days.
EXAMPLE:
Carleton, Canadian, 20,903, Tanker, 2nd Engineer, Sulzer 6500KW, May 1, 1998, June 30, 1998, 61.

Space is unlimited - box will scroll as needed. Press "Enter" on your keyboard at the end of each experience listing
Availability Date: 
English language Skills (Please rate as "None", "Fair", "Good" or "Very Good"):
Spoken:   Written:
Other Languages:   Minimum Salary: 
Further Remarks?
     Travel Documents and Medical Certificates                   Complete all fields THAT APPLY TO YOU
Passport (Country):   Number: 
Date issued:   Expiry Date:   
US Visa:   Number: 
Date issued:   Expiry Date:   
Seaman's Book (Country):
Date issued:   Expiry Date:   
Medical Exam (Country):
Date issued:   Expiry Date:   
     List Certificates (All Certificates should be current and issued under STCW95 if applicable)
                  Complete all fields THAT APPLY TO YOU
Certificate 1:   Date issued: 
Place issued:   Expiry Date:   
Certificate 2:   Date issued: 
Place issued:   Expiry Date:   
Certificate 3:   Date issued: 
Place issued:   Expiry Date:   
Certificate 4:   Date issued: 
Place issued:   Expiry Date:   
Same details of other Recognized Certificates:

Please review your entries before submitting; if you wish you may clear ALL entries and start over.

  

PLEASE REVIEW YOUR ENTRIES BEFORE SUBMITTING

AND CLICK "SUBMIT" ONCE ONLY. Thank you.




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