Date of Application

    Position Applied

    Lowest Position Acceptable

    Previously Employed by SOUTH POINT

    Available to Join from

    Accepted Salary

    Nearest Airport

    Personal Detail

    First Name

    Last Name

    Date of Birth

    Place of Birth

    Nationality

    Maritial Status

    Gender

    Religion

    Weight (Kg)

    Height (Cm)

    Coverall Size (Ch)

    Safety Shoe (Ch)

    Address

    City

    Postcode

    State

    Country

    Telephone

    Email

    Travel Document Information

    Document

    No.

    Place of Issue

    Date of Issue

    Date of Expiry

    Passport

    US Visa

    Schengen Visa

    Other Visa

    Work Permit

    Travel Document Information

    Document

    No.

    Place of Issue

    Date of Issue

    Date of Expiry

    Seaman Book

    Seaman ID

    Marshall Island CDC

    Panama CDC

    Liberian CDC

    Cook Island CDC

    Next of Kin and Emergency Contact

    First Name

    Last Name

    Relationship

    Gender

    Religion

    Address

    City

    Postcode

    State

    Country

    Telephone

    Email

    Family Details

    Relationship

    First Name

    Last Name

    Date of Birth

    Physical Declaration

    Medical Inspection

    Date Issued

    Date of Expiry

    Country of Issue

    Malaysia

    Other

    Vaccination

    Date Vaccination

    Date of Expiry

    Country of Issue

    Yellow Fever

    Cholera

    Other

    Covid-19 Vaccination

    Vaccination Type

    Date Vaccination

    Country of Issue

    1st Dose

    2nd Dose

    HAVE YOU EVER SIGNED OFF DUE TO MEDICAL REASON? HAVE YOU EVER SUFFERED OR ARE SUFFERING FROM ANY AILMENT OR DISEASE THAT IS LIKELY TO RENDER YOU UNFIT FOR SEA SERVICE OR LIKELY TO ENDANGER THE HEALTH/WELL BEING OF OTHERS? DO YOU HAVE ANY BODILY DEFECTS OR DEFICIENSIES? ARE YOU ADDICTED TO ALCOHOL OR DRUGS OF ANY KIND? ARE YOU A MEMBER OF ANY RELIGIOUS OR POLITICAL GROUP? HAVE YOU EVER DEPORTED, DENIED VISA OR BANNED FROM ENTERING ANY COUNTRY? HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OR DRUG OFFENCE OR HAVE ANY PENDING OFFENCES? DO YOU HAVE ANY OBLIGATIONS TOWARDS YOUR CURRENT/ PREVIOUS EMPLOYERS?

    Medical History

    Certificates and Qualifications

    Documents Held

    STCW'95

    Flag State

    Number

    Issued

    Expiry

    Foreign Certificate of Competency (s)

    STCW II – Deck

    STCW III – Engine

    STCW IV – Radio

    Ratings Watch keeping Cert - Deck

    STCW A-II/4

    Ratings Watch keeping Cert - Engine

    STCW A-II/4

    Basic Safety Training

    1. Personal Survival Technique

    2. Fire Prevention and Fire Fighting

    3. Elementary First Aid

    4. Personal Safety and Social Responsibility

    STCW A-VI / 1

    Proficiency in Survival Craft and Rescue Boats

    STCW A-VI / 2

    Proficiency in Fast Rescue Boats

    STCW A-VI / 2-2

    Ship Handling & Manoeuvring

    STCW A-II / 2

    Bridge Team Management or Bridge Resource Management

    STCW A-II / 1 (IMO Model 1.22)

    Generic ECDIS

    STCW A-II / 1 (IMO Model 1.27)

    Engine Room Simulator or Engine Room Resource

    STCW A-III / 1&2 (IMO Model 2.07)

    STSDSD or SSO

    STCW A-VI / 6 or 5

    Basic Tanker Training (Oil/Chem/Gas)

    STCW A-V/1-1.1 & 2.1

    Advanced Tanker Training (Oil)

    STCW A-V/1-1.2

    Advanced Tanker Training (Chem)

    STCW A-V/1-1.2

    Advanced Tanker Training (Gas)

    STCW A-V/1-1.2

    FRAMO experience

    Centrifugal Pumps with Pump Room

    Wartsila-Sulzer RT-flex experience

    Centrifugal Pumps with Pump Room

    Record of Pervious Sea Service (Last Vessel on top)

    Company

    Vessel Name

    Vessel type

    DWT / TEU

    TYPE ENG / KW

    Rank

    Duration Of Service DD/MM/YY

    Seatime Y-M-D

    Reason of disembarkation

    On

    Off