Form Ref.: SPSEI-WI01-OPR01-01
Sea Power Shipping Enterprises, Inc.
APPLICATION FORM FOR NEW APPLICANT
NOTE: WRITE ALL ENTRIES IN CAPITAL LETTERS
Date: ______
Position Applied for: 1st Choice ______2nd Choice ______
General Information
Name: ______
(Surname)(Name) (Middle)
Address in Metro Manila: ______Tel: ______
Address in the Province: ______Tel: ______
Birth Date: ______Birth Place: ______Age: ______Religion: ______
Height: ______Civil Status: ______Weight: ______Complexion: ______
Name of Spouse: ______Number of Children: ______
Date of Birth: ______Place of Birth: ______
Name of Beneficiary/Address: ______
Father’s Name:______Mother’s Name: ______
Name of nearest relative: ______Address: ______
Relation to the above: ______Tel: ______
EDUCATIONAL ATTAINMENT
Name of School Degree Obtained Inclusive Dates
Secondary/College ______
Basic Seaman’s Course ______
Nautical/Marine Graduate ______
Vocational Training ______
Language Spoken ______
DOCUMENTS
SIRB Number: ______Date Issued: ______Expiration Date: ______
Passport Number: ______Date Issued: ______Expiration Date: ______
SRC Number: ______Date Issued: ______Expiration Date: ______
SOLAS Certificates: Authenticated? Yes No MARINA Endorsement: Yes No Expiration Date: ______
Philippine License Position: ______Number: ______Date Issued: ______Date Endorsed: ______
Liberian License Position: ______Number: ______Date Issued: ______Date Endorsed: ______
Liberian Seaman Book Yes No Number: ______Expiration Date: ______
Panama Seaman Book Yes No Number: ______Expiration Date: ______
USA Visa Yes No Valid Until: ______
SSS Number: ______Pag-ibig Number: ______TIN: ______
PLEASE ANSWER
1. Are you willing to accept assignment in any part of the world? ______
2. Are you willing to accept any assignment in warzone areas? ______
3. Of what Seaman’s Union are you a member? ______
4. Have you been involved in I.T.F. cases? ______
5. Have you ever been discharged for a cause? ______
6. Do you have a pending or finished case with the POEA? ______
7. Do you have any kind of sickness at present or in the past? ______
8. Were you recommended for the job by someone? If yes, please affix his name and his position as well as the last vessel he was connected with ______
FOR OFFICE USE ONLY
EX VG GOOD AVERAGE POOR
Appearance
Behavior
Intelligence
English Language (Marine)
Technical Knowledge
Personality
Date/Time of Interview: ______
Interviewed by: ______
For M / : ______
SEA SERVICE
Please register your latest Six (6) employments, filling up all spaces provided. Your latest service to be registered first and others to follow:
Foreign Principal/Nationality
Philippine Agency
Ship’s Name
Ship’s Type (BC, C, Tkr, Cont. etc.)
Ship’s Flag
GRT
Year Built
Position
Period (from-to)
Salary
Reason signed-off
(Only for Engine Crew/Electricians)
Engine Type/HP
Auxiliary engine
Type of gear on deck
Lathe Machine exp/nce (YES/NO)
Pipe fitting exp/nce(YES/NO)
Welding experience(YES/NO)
Foreign Principal/Nationality
Philippine Agency
Ship’s Name
Ship’s Type (BC, C, Tkr, Cont. etc.)
Ship’s Flag
GRT
Year Built
Position
Period (from-to)
Salary
Reason signed-off
(Only for Engine Crew/Electricians)
Engine Type/HP
Auxiliary engine
Type of gear on deck
Lathe Machine exp/nce (YES/NO)
Pipe fitting exp/nce(YES/NO)
Welding experience(YES/NO)
Total actual sea service: ______Total actual sea service in the position you apply: ______
Salary received in last vessel: Basic ______O/T ______
Recommended By: ______
Reference: 1, ______
I HEREBY CERTIFY that the foregoing information is true and correct. I also certify that I have not paid nor promised to pay any monetary consideration other than allowed by law. In case any of the foregoing information is not true or is misguiding, SEA POWER has the right to reject my application and be used against me.
______
Signature