Career
APPLICATION FORM
- PERSONAL DETAILS
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PERSONAL BACKGROUND Name as in Passport Date/Place of birth Nationality Home address Tel No.: Mobile No.: Email ID.: Mumbai address if any Mobile No.: EDUCATION BACKGROUND Qualification School / College From To Percentage / Grade TECHNICAL BACKGROUND Degree / Diploma School / College From To Percentage / Grade Pre sea training / Apprentice ship IDENTITY DOCUMENTS Document Country Number Issue date Expiry date Place of issue Passport Indian seaman book Indian Others Do you hold a US Visa ‘C1/D’ ? YES NO Issue date: Expiry date: Do you hold Schengen Visa YES NO Issue date: Expiry date: Indos. No. (for Indians only): Yellow fever: Expiry date: Union Membership (MUI / NUSI ) Expiry date: FAMILY DETAILS
(IF UNMARRIED KINDLY GIVE DETAILS OF FATHER / MOTHER)Name Relation D.O.B PPT No. Place of issue Issue date Expiry date ECNR - NEXT OF KIN DETAILS
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NEXT OF KIN DETAILS Full name of kin : Relationship: Address of next of kin : Tel No.: Mobile No.: Email ID.: CERTIFICATES (HIGHEST CERTIFICATE OF COMPETENCY HELD) Grade / Class of COC Issuing country Date of passing exam Certificate no. Issue date Placed issued Expiry date DETAILS OF COURSES & CERTIFICATES FOR OFFICERS Courses Certificate no. Issued by Issue Date Expiry Date Advanced Fire Fighting (AFF) Medical First Aid (MFA) / Medicare Proficiency in Survival Craft & Rescue Boat (PSCRB) Personal Survival & Social Responsibility (PSSR) SSO (Ship Security Officers Course) ECDIS BTM (Renewed every 5 years) ARPA (Automatic Radar Plotting Aid) GMDSS Radar Observer / RANSCO Simulator GMDSS Endorsement Oil Tanker Familiarization (OTFC) / TASCO DCE Oil – Support / Operation / Management Chemical Tanker Familiarization (CTFC) / CHEMCO DCE Chemical – Support / Operation / Management Specialized Training Programme On Oil Tanker Operations (STPOTO) Framo Course Revalidation Course for Deck / Engine Officers Refresher & Up Gradation Course for Deck / Engine Officers DETAILS OF COURSES & CERTIFICATES FOR RATINGS Courses Certificate no. Issued by Issue Date Expiry Date FIRE PREVENTION & FIRE FIGHTING (FPFF) ELEMENTARY FIRST AID (EFA) Personal Survival Technique (PST) Personal Survival & Social Responsibility (PSSR) STSDSD OCTO DCE Oil – Support DCE Chemical – Support GAS TANKER FAMILIARIZATION (GTFC) DCE GAS - SUPPORT AB / MM Course Watch Keeping Certificate Ratings (Deck/Engine) Pump Man Course Cookery Course MMD Cookery Certificate Fitter Course / Class Cert. - OTHERS
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OTHERS : ISPS Course Ship Safety Officers Course / Risk Assessment Ship Maneuvring Simulator BRM / MRM / BERM (Renewed every 5 years) Electrical/Electronics for Marine Engineers – Basic / Advance FOR ENGINEERS (PLEASE PROVIDE DETAILS) Generators Boilers Cranes Framo ( No. of vessels ) TOTAL SAILING EXPERIENCE Crude Tankers Product Tankers Chemical Tankers Oil / Chemical Others MEDICAL HISTORY (IF THE ANSWER IS YES TO ANY OF THE BELOW, PLEASE GIVE FULL DETAILS AND ATTACH A SEPARATE PAGE IF NECESSARY) Have you ever signed off a ship due to medical reasons ? YES NO Have you undergone any Surgery / Accident YES NO Do you have any health disability problems now ? YES NO GENERAL Have you ever been the subject of a court of enquiry or involved in a maritime accident ? YES NO Have you ever had a professional license suspended or revoked ? YES NO Do you have any pending criminal inquiry YES NO BANK ACCOUNT DETAILS Account Holder’s Name : Name of bank Account no. Branch Address :
BOILER SUIT SIZE : SAFETY SHOE SIZE : DECLARATION I hereby affirm that all the information provided by me in this application is true and correct . Upload the Signature Image
Date
OFFICE USE ONLY Checked on with Mr/Ms rep. of (Last employer) & received satisfactory/unsatisfactory report regarding his professional experience & attitude.
Checked on with Mr/Ms rep. of (Last employer) & received satisfactory/unsatisfactory report regarding his professional experience & attitude.
by by - RECORD OF PREVIOUS SERVICE ( KINDLY START FROM YOUR FIST SHIP ):
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RECORD OF PREVIOUS SERVICE ( KINDLY START FROM YOUR FIST SHIP ): Company Vessel Name Vessel Type DWT / GRT Year Built Type of Engine
(Please give full details)BHP Rank Sign on (dd/mm/yy) Sign Off (dd/mm/yy) Duration (dd/mm/yy) Reason for Sign off
CANDIDATE INFORMATION FORM
- CANDIDATE DETAILS
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CANDIDATE DETAILS DATE Post Applied For Willing to accept Lower rank(YES/NO) A.PERSONAL DETAILS Last Name First Name Sex (M/F) Date of Birth Place of Birth Indos No. Present Address Tel No.: Mobile No.: Email ID.: Permanent Address CDC COC Country Number Issued Expiry Country Grade Number Issued Expiry EDUCATION BACKGROUND Type of Certificate Board / University Period(yrs) Pass Year Pass % PRE-SEA TRAINING Course Name Maritime Institute From To - STCW AND OTHER COURSE
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STCW AND OTHER COURSE COURSE NAME MARITIME INSTITUTE CERT NUMBER ISSUED DATE EXPIRY DATE EMPLOYMENT HISTORY (OTHER THAN SEA SERVICE ) Employer Name Designation From To Reason For Leaving LANGUAGE PROFECIENCY Language Speak Read Write V Good Good Fair V Good Good Fair V Good Good Fair English Italian German French French Hindi - SEA SERVICE RECORD
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SEA SERVICE RECORD VESSEL FLAG OWNER MANAGER TYPE GRT ENGINE BHP RANK SING ON SING OFF PERIOD - DETAILS OF NEXT KIN ; AND COMPENSATION DISTRIBUTION TO NOK
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DETAILS OF NEXT KIN ; AND COMPENSATION DISTRIBUTION TO NOK FULL NAME OF NOK ADDRESS & CONTACT DETAILS. RELATION AGE(YRS) % COMPENSATION
PERSONAL DECLARATION 1. To the best of my knowledge I am medically and physically fit to carry out ship board duties. 2. I am neither under any medical treatment nor taking any regular prescribed medicines. 3. I agree that prior joining I will be subjected to a drug and alcohol abuse test as well as a HIV test. This is apart from the full medical examination conducted. 4. I have never been denied visa to any country. 5. My passport ( Present and all past ones) are clean and do not have any remarks. 6. There is no litigation pending against me in any court of law. 7. I was never convicted or involved in any civil or criminal proceedings involving the Police during my employment. 8. I have no affiliations with any political or religious groups. Nor will I join any such group during my employment. 9. Have you ever applied to this company before? If so with what results. 10. I declare that the information provided here in is true to the best of my knowledge and also that all personal documents submitted are true and authentic. Further also state that I will be solely responsible for any false information provided and will not hold SMSMPL or its officers and agents liable for any reason. SMSMPL USE ONLY: New Applicant Rank Ex Crew Rank Interviewed On / By Last valuation score Questionnaire sheet No & Score Briefing done date Remarks & Signature Remarks & signature
SEAFARER AWARENESS FORM
- SEAFARER DETAILS
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SEAFARER BACKGROUND Seafarer’s Name: Rank: CDC No.: Indos No. Vessel Name:
S.N. TOPIC YES / NO 1 I have been informed of my rights and duties under the employment agreements prior to or in the process of engagement. YES NO 2 I have been advised of any particular conditions applicable to the job for which I am being engaged and of the particular ship-owners polices relating to the employment and also advised on possible problems of signing on a ship that flies the flag of a state which has not ratified the MLC, 2006. YES NO 3 I have examined my employment agreement before to seek advice before signing, and after it has been signed, and I have received a signed original of the agreement YES NO 4 I have been explained and familiarized with on-board complaint procedures, as applicable on the ship. YES NO 5 I haven’t been subject to exploitation by the SM or by their personnel, with regard to the offer of engagement on particular ships or by particular companies. YES NO 6 I haven’t been subject to exploitation by the SM or by their personnel, with regard to the offer of joining advances or any other financial transaction between the ship owner and me. YES NO 7 I observed that SM staff was polite to me. YES NO 8 I have read and understood Seafarer Recruitment Policy of SM. YES NO 9 All the certificates submitted by me for employment are genuine and checked by me. YES NO Note : On Board Complaint management Procedure
- 1. In case the seafarer employed through the company have any grievance or complaints they can approach the Master of the vessel.
- Master of the vessel will inform the company, owner or Manager and try his level best to address/resolve the grievance.
- However if the grievance is not sorted then Master of the vessel should consult the Ship Owners/Clients or our Director who shall try its best to address the grievance of the seafarer.
- Moreover, if the grievance is not sorted by any of the seafarer has the right to approach to the Director General of Shipping or Seaman’s Employment Office of the relevant flag authority.
- The company will co-operate fully with the seafarer and the authorities to resolve the grievance of the seafarer.
- Seafarer has the right to refer complaints against the Company directly to Director- General of Shipping or the suitable authority of the country to which the ship belongs.
Our 24 hrs (emergency) contact number is as follows:
a)Upload the Signature Image : Date :