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