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Sea Crown Marine services Co., Ltd
Document Title	Application Form
Document No	SC-QMS-CRW-F-001
Issue Date	09 May 2013	Prepared by	QMR
Revision No	0	Page No	1 of 2
Review by	QMR, OPM	Approved by	Managing Director

Post Applied for

Readiness

PERSONAL DETAILS

Name		Date of Birth
Age		Place of Birth
Religion		Marital Status
Height		Weight
Education		Mark
Father Name		Mother Name
Shoe size		Overall size
Next of Kin		Relation
Address		Phone
Address		Email

SEAMAN’S DOCUMENTS

No	Holding Certificates	Number	Date Of Issues	Date Of Expire
01	Passport ( PP)
02	Seafarer Identification and Record Book (SIRB)
03	Certificate of Competency (COC)
04	GOC / GMDSS (SOLAS – 74 – STCW -78 )
05	G.O.C (Endorsement )(STCW-95- I/2)
06	Radar Observer (STCW-95-II/2)
07	Radar And ARPA (STCW – 95 –I/2)
08	S.S.O (ISPS-CODE-PART-A,P-12& PART B-P-13)
09	Advanced Fire Fighting (STCW-95-A-VI/3)
10	Medical First Aid (STCW-95-A.VI/4-1)
11	Medical Care (STCW-95-A-VI/4-2)
12	Tanker Familiarization (TF)
13	Advanced Oil Tanker Operation (STCW-95-A-V/I)
14	Advanced Chemical Tanker Operation (STCW-95-V/I-2)
15	Advanced Gas Tanker Operation (STCW-95-A-V/I)
16	Hazardous Cargo Training (STCW-95) (HCT)
17	Bridge Team Management (BTM)
18	Bridge or Engine Resource Management (BRM) or (ERM)
19	ECDIS
20	ESDIS (Type Specific)
21	Basic Safety Training (BST)
22	Efficient Desk Hand ( E.D.H)
23	Watch keeping (WK)
24	Efficient Engine Room (EER)
25	Survival Craft And Rescue boat (PSCRB)
26	Ship Security Awareness (SSA)
27	Ship Security Duties (DSD)
28	Hazardous Cargo Training (HCT)
29	Cook Certificate
30	Other Certs ( Malaysia / Hong Kong / Liberia )

SEA SERVICE RECORD (FROM LAST TO FIRST)

No	Name of Vessel	Rank	Type	GRT	BHP	Main Engine	Sign On	Sign Off	Ship Owner
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15

DECLARATION

BACKGROUND INFORMATION	YES	No
Have previous injuries or sickness?	Yes	No
Premature termination of contract?	Yes	No
Have been dismissed or logged for misconduct?	Yes	No
Have been refused entry by any country?	Yes	No
Any special diet or religious restriction?	Yes	No
Any Medical restrictions / drug / allergies?	Yes	No
Any alcohol drinking habits?	Yes	No

Remark:
I confirm that, the information given by me herein is above mentioned data are true correct.
All documents are authentic, not fraudulence.

Name
CDC
DATE