ASP Online Application

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Rank applied for:

Contact Details

First Name: *
Middle Name:
Last Name: *
Permanent Address: *  
Street 1
Street 2
Street 3
City
ZIP / Postal Code
Country
Local Address: *  
Street 1
Street 2
Street 3
City
ZIP / Postal Code
Country
Region: *
Telephone: *
Email:
Mobile:

Personal Information

Date of Birth:
Place of Birth:
Nationality:
Height:
Weight:
Blood Group:
Overall Size:
Safety Shoe Size:
Yellow Fever Iss. Date:
Home Town Airport:
Religion:

Document Information

Document Number Place of Issue Date of Issue Expiry
Passport:
Seaman's Book:
US VISA - C1/D:
INDOS NO.

Academic Background

Institution City + Country From To Qualification Grade
Pre-Sea Training Institute: From: To:
Apprenticeship / Jr. Eng.: From: To:

Certificate of Competency

  Grade Number Date of Issue Issuing Expiry Remarks
National C.O.C.:
GMDSS:
DCE - OIL.:
DCE - CHEM.:
DCE - GAS:

Minimum STCW Certificates

  Number Date of Issue Issuing Country Date of Expiry Name of Institute
Fire Fighting (BASIC):
Fire Fighting (ADV):
Personal Survival Tech.:
PSC & RB:
PSSR:
Medical Care:
Medical First Aid:
Elementry First Aid:
Fast Rescue Boats:

Other STCW Certificates

  Number Date of Issue Issuing Country Date of Expiry Name of Institute
ARPA:
Radar Simulator:
RANSCO:
Oil Tanker Safety :
Chemical Tanker Safety.:
Gas Tanker Safety:
Oil Tanker Famil:
Chemical Tanker Famil:
Tanker Famil:

Other Courses

*For follow up by ASPCM

Practical Experience

Have you experience of the following
New Building
Steam Turbines Cargo Pumps
Engine Driven Cargo Pumps
Cargo Pump type
a) Centrifugal pumps
b) Screw pumps
c) FRAMO pump
Deck crane type
a) Thyrister control
b) Electrical
c) Electro hydraulic
d) Gantry
Planned Maintenance System
(a) Computerised (Specify)
 
Reefer container
Reefer Cargo
Dry dock
Major repairs
Hae you sailed with milti national crews?
Reason for application:
May we approach your PRESENT employer for Reference?:
Present Employer Name:
Present Employer Phone:
May we approach your PAST employer for Reference?:
Past Employer Name:
Past Employer Phone:
Have you ever had to leave a company other than voluntarily?:
What date are you available for sea service?:

Sea Service (for last 10 years)

Company Vessel IMO Rank Type Flag DWT / GRT From To BHP Engine Type UMS (Y/N) TEU Capacity Reason for Signoff