CREW MANNING AGENCY ” VEGA Z ”
Address: 11, KUGU STREET, RIGA, LATVIA, LV-1048
Phone number: +371 67 614 107; e-mail: [email protected]
___________________________________________________________________________________________________________________
photo
RANK
Nearest Airport
ID number:
Date available:
1. SEAMAN’S PERSONAL INFORMATION
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Surname
First name
Nationality
Date of Birth (dd /mm / yyyy)
Place of Birth (City & Country)
Full style home address (Permanent)
Home / Mobile phone numbers
E-Mail / SKYPE
2. SEAMAN’S TRAVEL DOCUMENTS
2.1
2.2
2.3
Description
Passport No
Seaman Book No
Seaman ID
Number
Issue Date
Expire Date
Place of Issue
3. SEAMAN’S LICENCIES / ENDORSEMENTS
3.1
3.2
3.3
Description
Certificate of Competency
Certificate of Competency
Flag Seaman’s book
4. USA visa
Issue Date
4.1
5.1
5.2
5.3
5.4
5.5
5.6
5.7
Grade
Number
Issue Date
Expire Date
Place of Issue
4. Schengen visa
Expire Date
Issue Date
4.2
5. SEAMAN’S STCW CERTIFICATES
Number
Description
Basic Safety Training (VI/1,1)
Proficiency in Survival Crafts (VI/2,1)
Designed Security Training (A-VI/6-1) (A-VI/6-2)
Basic training for oil and chemical tanker (A-V/1-1-1)
Basic training for liquefied gas tanker (A-V/1-2-1)
Medical Examination Report (National)
Vaccination (Yellow Fever)
Page 1 of 2
Expire Date
Issue Date
Expire Date
Place of Issue
SEA SERVICE:
FOUR TOP OFFICERS LAST 10 YEARS (MASTER, CHIEF OFFICER, CHIEF ENGINEER, SECOND ENGINEER)
RATING, JUNIOR OFFICERS LAST 5 YEARS
TYPE OF
VESSELS
NAME OF
VESSELS
GRT
ENG.TYPE / MARK
KW
FLAG
NAME OF COMPANY / MANAGEMENT
PERIOD OF SERVICE
FROM
TO
RANK
D
EDUCATION
NAME / YEAR OF COMPLETION
ENGLISH LEVEL
NEXT OF KIN
MARLIN TEST %
NAME
CES 5.1 TEST %
RELATIONSHIP
MOB./HOME TELEPHONES
PERMANENT ADDRESS
Y
D
M
ADDITIONAL INFORMATION
CLOTHES SIZE
Page 2 of 2
M
WEIGHT
SHOES
HAIR COLOUR
HEIGHT
EYEES COLOUR
Y