Rpsl No:-Rpsl- Mum -207
JOB APPLICATION FORM
Computer No. (Assigned by STSSM):
Application for Rank:
Preferred ship type:
Date Available for Joining:
US Visa: YES / NO - US Visa Expiry Date:
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RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
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S / Surname : / First Name :
NOTE: Name must appear as it does on your passport! Dates must be in DAY/MONTH/YEAR format!
Middle Name: / Nationality:
Date of Birth: / Place of Birth:
Marital Status: / Name of Spouse:
Permanent Address:
Telephone No.: / Height: cm Weight: kg
Mobile No.: / Nearest InternationalAirport:
Email Address:
Passport No.: / Place of Issue:
Date of Issue: / Date of Expiry:
Seaman’s Book No.: / Place of Issue:
Date of Issue: / Date of Expiry:
NOTE: Give particulars of your immediate family members and indicate your relationship with them.
Name / Relationship / Occupation
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
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N / LICENCE PARTICULARS
Country / Grade / Cert. No. / Date/Place of Issue / Date of expiry
National License
United Kingdom
Liberian
Bermuda
Cayman Islands
Other
S. T. C. W. COURSES
Basic safety training evidence / Course Name / Yes/No? / Date/Place of Issue
Personal survival techniques
Fire fighting
Elementary first aid
Personal safety and social responsibility
Personnel assigned with other safety functions / Proficiency in surv craft and rescue boat
Advanced fire fighting
Medical first aid
Medical care
Safety Officer (2/O ONLY)
Ship Security Officer (Captains ONLY)
GMDSS navigation / GMDSS only GOC (see note)
ECDIS
Bridge team management
Personnel on tankers / Tanker familiarization
Oil specialized
Chemical specialized
Liquefied gas specialized
Ship handling course (Captains ONLY)
NOTE: We only employ candidates holding GOC and NOT ROC
Academic Qualifications and Professional Qualifications
Name of College/Institute/Academy etc. / Name of Degree/Diploma/Qualification / Date Completed
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
DETAILS OF PREVIOUS SEA SERVICE (Please give Maximum details.)
Name of Vessel / Type of vessel / DWT / Rank (see note 2) / Period of service / Name of vessel manager or operator
Flag / Year / Type of Engine (see note 1) / TEU and Engine Power / Sign On / Sign Off / Contact No. of company & person in charge
(see note 3)
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6
If you have more than 6 vessels, please continue on page 9.
NOTE 1: Please give full details of engine / make / model. e.g.: MAN B&W 6S70 MC NOTE 2: For Engineer ranks please use our company format i.e.: C/E, 1A/E, 2A/E, 3A/E
NOTE 3: Please only show kW engine sizes. Please convert if necessary, (1Kw= 1.3HP) / . And also state max TEU intake if ship is a container.
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
SUMMARY OF OFFICER EXPERIENCE (In months)
EXPERIENCE AS / BULK CARRIER / CONTAINER CARRIER / CHEMICAL TANKER / LPG TANKER / OIL TANKER / PURE
CAR
CARRIER / GENERAL CARGO / OTHER / TOTAL
CPT / C/E
C/O / 1/E
2/O / 2/E
3/O / 3/E
CDT
E/E
TOTAL
FOR ENGINEER APPLICANTS ONLY / FOR ALL APPLICANTS
TYPE OF ENGINE / DURATION (Months)
Please specify all nationalities you worked with!
MAN / NATIONALITY / DURATION (Months)
B & W
SULZER
S.E.M.T PIELSTICK
STEAM TURBINE
U.M.S.
DECK CARGO CRANE EXPERIENCE (SPECIFY TYPE/MAKE)
Reason For Leaving Last Company:
Whether Agreeable To Join Vessel Trading In War Zone : Yes / No
INTERVIEW RESULTS (FOR OFFICERS ONLY)
To be completed by Manning Office Manager
NOTE: Please give a score from 1 to 5; one being the best, and five being the worst.
Score / Score
Theoretical knowledge / Willingness to Learn & Improve
Safety Awareness / Officer like Quality
Integrity / Initiative & enthusiasm
Alertness / Spoken English
General Ability / Appearance
Attitude
Overall Score:
PROFICIENCY/KNOWLEDGE
Interviewers Comments
Time in Rank
Type of vessels and/or Engines
Trading Areas
Personality
Presentation
Strengths
Weakness
Incidents Experienced
PSC/USCG/AMSA
Reason for leaving last company
Reason for applying with Zodiac
Will he quickly adjust to STSSM Culture
Maintenance Philosophy
Managerial Instincts
Multinational crew
Permit to work system
Environmental Issues: MARPOL/OWS/ODME/GARBAGE
Interview Date: / Interviewed by: / Result: Accepted/Rejected
Crew Department Notes:
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
Notes to Manning Agents
1.Please attach Seaman book copies showing pages of identity and the sea services. If this is not possible then you will need to advise the reason on your cover message.
2.If you have already checked any references before sending application to us, please indicate clearly for which ship and which company you have referenced from.
3.If applicant is still with his previous company and he does not wish us to check reference with them please indicate in your cover message.
4.For Deck applicants please do not miss to indicate DWT (if not available then GRT) and TEU (if ship is container)
5.For Engine applicants please do not miss to indicate DWT (if not available then GRT) and TEU (if ship is container) and ENGINE POWER (in KILOWATT)
6.Please do not leave “Date available for joining” and “USA Visa” sections blank. (On page 1)
7.In order to speed up our process please try to indicate last 2-3 companies’ telephone numbers. Not from website but from applicants themselves, as sometimes we can not reach some companies through website numbers.
8.If applicant served a short time in his last ship (about 1-2 months) then please ask him the reason and indicate it on application or on your cover message.
9.Please indicate for which SHIP TYPE(s) he is applying for. (On page 1)
10.In order to avoid extensive paperwork and attachments, please do not send copies of Sea Services and Appraisals given to them by their previous companies or masters or chief engineers, as we never rely on those papers. For us, Sea Service in application form and copies of seaman books are most important.
11.Copy of BTM, SSO, ECDIS and SHIP HANDLING course certificates must be attached to application, if available.
12.For Tanker officers/engineers’ applicants, please attach Tanker Service testimonials.
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
INFORMATION SHEET – GAS TANKERS
NOTE: Tick appropriate box for cargoes carried, and comment in the space provided.
Acetaldehyde
Anhydrous Ammonia
Butadiene
Butane
Butane / Propane Mixture
Butane
Diethyl Ether
Ethyl Chloride
Ethane
Ethylene Oxide / Propylene Oxide Mixtures
Isoprene
Isopropylamine
Methyl Acetylene – Propadiene Mixture
Methyl Chloride
Monoethylamine
Propane
Propylene
Vinyl Chloride Monomer
Vinyl Ethyl Ether
Vinylidene Chloride
Methane
Others Not Listed Above - Specify
OTHER INFORMATION / AREAS OF KNOWLEDGE / EXPERIENCE
LNG
Fully Pressurized Ships
Semi Pressurized / Refrigerated Ships
Ethylene Ships
Fully Refrigerated Ships
Oil Company Inspections / CDI (Please List)
USCG – Letter Of Compliance (Please List)
Compressor Types
Inert Gas
Gas Freeing
Trade Areas
Cargo Cooling Systems
Specialist Gas Training
Special Cleaning After Prop OX (Give Detail)
Special Cleaning After Butadiene (Give Detail)
Inhibited Cargoes (Please List)
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
INFORMATION SHEET – CHEMICAL TANKERS
NOTE: Tick appropriate box for cargoes carried, and comment in the space provided.
Dodecylbenzene (Lab)
Hydrogen Peroxide
Acrylonitrile
Sulfuric Acid
Nitric Acid
Phenol
Epichlorohydrin (ECH)
Caustic Soda
Hexane
Xylene
MDI / Diphenylmethane Diisocyanate
Toluene
Methanol
Palm Oils
Vegetable Oils
Molasses
Ethylene Dichloride (EDC)
Styrene Monomer
Benzene
Vinyl Acetate Monomer (VAM)
IPA / NBA
Methyl Ethylene Glycol (MEG)
Lub Additives / Lubrizol
Sodium Hydrosulphide
Phosphoric Acid
Propylene Oxide / Ethylene Oxide
Ethanol
Paraffin Wax
OTHER INFORMATION / AREAS OF KNOWLEDGE
Deep Well Pumps Experience (Types of Pumps)
Specialized Framo Course
Closed Loading / VECS.
CDI
Oil Company Inspections (Please List)
USCG – Letter Of Compliance
Cargo Heating – Oil/Steam/Deck htr (Please List)
Tank Coating Type – Zn / SS / EPOXY (Please List)
WallWash Testing (HC / CL)
Permangemate Testing (PTT)
Passivating Stainless Steel Tanks
Trade Areas (Please List)
N2 Padding
Cargo Cooling Systems
OPA 90 Training
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
Manning Office:Applicant Surname:
DETAILS OF PREVIOUS SEA SERVICE (Please give Maximum details.)Name of Vessel / Type of vessel / DWT / Rank / Period of service / Name of owner or operator
Flag Year / Type of Engine / TEU and Engine Power / Sign On / Sign Off / Contact telephone No. of person in charge
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9
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11
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012
/ SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTDJOB APPLICATION FORM
ACKNOWLEDGEMENT PERFORMA
NAME OF EMPLOYER:SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTD
ADRESSS : MERIDIAN BUSINESSS CENTRE ,403, PLOT NO 27, SECTOR 30,VASHI, NAVIMUMBAI 400705
RPSL LICENCE NOS: RPSL- MUM -207
VALIDITY OF LICENCE:10.08.2016
NAME:
RANK APPLIED FOR:
DATE:
SIGNATURE OF RECEIVER:
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ACKNOWLEDGEMENT PERFORMA
NAME OF EMPLOYER: SEA TRADING SERVICES & SHIP MANAGEMENT PVT LTD
ADRESSS : MERIDIAN BUSINESSS CENTRE ,403, PLOT NO 27, SECTOR 30,VASHI, NAVIMUMBAI 400705
RPSL LICENCE NOS: RPSL- MUM -207
VALIDITY OF LICENCE:10.08.2016
NAME:
RANK APPLIED FOR:
DATE:
SIGNATURE OF RECEIVER:
RPSL NO:-RPSL- MUM -207
Issued Date:-10.02.2012