Application Form / Wind Rose Shipping

APPLICATION FORM

1. PERSONAL INFORMATION

RANK APPLIED

ALTERNATIVE RANK (IF ANY)

LAST NAME FIRST NAME MIDDLE NAME

MARITAL STATUS

NATIONALITY

SEX

No. OF CHILDREN (under 18)

BIRTH PLACE

State	Region
City/Village

DATE OF BIRTH Y.M.D

WEIGHT (kg)

HEIGHT (cm)

COLOR OF EYES

COLOR OF HAIR

2. ADDRESS (PERMANENT)

3. NEXT OF KIN

ADDRESS

NEXT OF KIN NAME

First name

Last name

Middle name

TEL./FAX

Address

Same address

MOBILE

RELATION

E-MAIL

TEL./FAX

Postal code

4. PERSONAL & TRAVEL DOCUMENTS
DOC./VISA	TYPE	DOC./VISA NO.	ISS.DATE	EXP. DATE	PLACE OF ISSUE
PASSPORT
SEAMAN'S BOOK
US C1/D VISA
OTHER COUNTRIES SEAMAN'S BOOKS
OTHER COUNTRIES SEAMAN'S BOOKS
OTHER COUNTRIES SEAMAN'S BOOKS
OTHER COUNTRIES SEAMAN'S BOOKS

5. EDUCATION
SCHOOL / ACADEMY NAME		FROM:		TO:
SCHOOL / ACADEMY NAME		FROM:		TO:

7. PROFICIENCY IN ENGLISH

NILL	POOR	SATISFACTORY	GOOD	EXCELLENT

8. SEAFARER'S SAILING RECORD AT LAST FIVE YEARS
VESSEL NAME / COMPANY NAME	RANK / VESSEL TYPE	GT / DWT	MAIN ENGINE TYPE / MAIN ENGINE MODEL	Engine Total HP	FLAG	SIGNED ON / SIGNED OFF
/	/	/	/			/
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10. ADDITIONAL INFORMATION
DATE AVAILABLE FROM	EXPECTED MONTHLY SALARY IN USD

I hereby affirm that all the information provided by me in this Form is true and correct to the best of my knowledge.

Date: