Prospectus For Deck Cadets     Prospectus For Trainee Marine Engineers  
  Application Form

 		 
 
Rank Applied For :
Availability :

A. Personal Particulars (As In Passport)

Surname
First Name
Middle Name
Date / Place of Birth
Nationality
Permanent Address
Telephone Number
Email Address
Next of Kin
Relationship
Marital Status
Name & DOB of Children (1)
(2)
(3)
Address

B. Documents Held

Documents Number Date / Place of Issue Valid Till
Passport
CDC (Indian)
CDC (Others)

C. Highest Certificate Of Competency Now Held

  Issuing Authority Grade / Certification Date of Issue Date of Expiry
1
2
3

D. Visas

  Issued At Date of Issue Valid Till
US C1/D
Others
Have you ever been rejected any visa applied for Yes No

E. Academic Qualifications

Diploma / Degree Institution / University Year of Passing Class

F. Training / Apprenticeship

 

G. List Of S.T.C.W. / Other Courses Done

  Courses Cert. No. Date/Place Issued
1 Advanced Fire Fighting
2 Basic Fire Fighting
3 Proficiency in Survival Craft
4 Survival at Sea
5 First Aid at Sea
6 Ship Capt. Medical (Medicare)
7 Tanker's Safety (Chemical)
8 Tanker's Safety (Petroleum)
9 DCE Petroleum / Gas / Chemical
10 Radio Telephony
11 GMDSS
12 ARPA

13

 Radar Observer
14 Radar Simulator
15 Other (Specify)

H. Sea Service : (Start from last vessel served)

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)

I do hereby declare that all information furnished above is true to best of my knowledge and belief.

Date : Rank :

 

  
   
     
 
Managed by: