Contacts
+3 8 04841 65 444 +3 8 063 937 87 42 +3 8 097 229 30 35
crew@windrose.od.ua av.Suvorov 74, of. 51

APPLICATION FORM

1. PERSONAL INFORMATION

2. ADDRESS (PERMANENT) 3. NEXT OF KIN

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:

6. CERTIFICATES
TYPE OF DOCUMENT NUMBER CAPACITY PLACE of ISSUE
(city/country)
DATE of ISSUE VALID UNTIL
Add more
7. LICENSES
LICENSE TYPE NUMBER PLACE of ISSUE
(city/country)
DATE of ISSUE VALID UNTIL
Add more

7. PROFICIENCY IN ENGLISH

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

/
/
/

/
/
Add more

10. REFERENCES
VESSEL SHIPOWNER SHIPOWNER STATE PHONE NO. EXTENSION PHONE NO.
(if any)
E-MAIL
Add more

10. ADDITIONAL INFORMATION

 

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