Strona główna

Application for employment


Pobieranie 173.97 Kb.
Data19.06.2016
Rozmiar173.97 Kb.


APPLICATION FOR EMPLOYMENT
STAR Reefers Poland Sp. z o.o.

(as agents only for Owners)

ul. Pulaskiego 6

81 – 368 Gdynia

Poland


Tel: + 48 58 764 76 20

Fax: + 48 58 764 76 21

e-mail: polecrew@star-reefers.com

Web: http://www.star-reefers.com





POSITION applied:

     

Nationality:      




Date available:

     

PESEL:      

e-mail address:      

First name:

     

Surname:

     

Date / place of birth:

      /      

Full address

Permanent address:

Present address:

     


     

Home telephone :

     

Contact telephones :

     

Weight (kg):      

Height (cm):      

Eye colour:      

Hair colour:      

Passport no:

USA Visa


     

type      



Issued by

Issued at:



     

     


on:

on:


     

     


till      

till     



Marital status:

     

Number of children under 18 years old:

     

Father’s name:

     

Next of kin: Name/ address:

      /      

Nearest airport:      




Shoe size:      

Boiler suit size:      




EDUCATION:

GDYNIA MARITIME UNIVERSITY 

SZCZECIN MARITIME UNIVERSITY 

OTHER:       

Department

     

     

     

Graduated year:

     

     

     


CERTIFICATES OF COMPETENCY :

GRADE

NUMBER

PLACE

DATE

EXPIRE

POLISH LICENCE:      

     

     

     

     

BAHAMIAN LICENCE:      

     

     

     

     

LIBERIAN LICENCE:      

     

     

     

     

POLISH SEAMAN’S BOOK

OTHER SEAMAN’S BOOK:      


     

     


     

     


     

     


     

     

HEALTH ( Drug and Alcohol tests)

     

     

     

     

Vaccination: YELLOW FEVER



     

     

     

PERSONAL SURVIVAL TECHN.

     

     

     

     

PERSONAL SAFETY & SOCIAL RESPONS.

     

     

     

     

BASIC FIRE FIGHTING

     

     

     

     

ELEMENTARY FIRST AID

     

     

     

     

ADVANCED FIRE FIGHTING

     

     

     

     

MEDICAL FIRST AID

     

     

     

     

MEDICAL CARE

     

     

     

     

PROFICIENCY IN SURVIVAL CRAFTS

     

     

     

     

FAST RESCUE BOATS

     

     

     

     

GMDSS

     

     

     

     

ARPA

     

     

     

     

HAZMAT

     

     

     

     

ECDIS

     

     

     

     

RADAR OBSERVER

     

     

     

     

SSO

     

     

     

     

OTHER:      

     

     

     

     

OTHER:      

     

     

     

     

OTHER:      

     

     

     

     

OTHER:      

     

     

     

     

OTHER:      

     

     

     

     

OTHER:      

     

     

     

     



LANGUAGES

ENGLISH :



very good



good



satisfactory



poor



none




ENGLISH TEST:

     

     

OTHER:

 very good

 good

 satisfactory

 poor

 none

SEA SERVICE


SHIP’S NAME

FLAG

OWNER

RANK

S- ON

S- OFF

VESSEL Type

ME Type

GRT / BHP

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     



Medical History




YES

NO

Have you ever signed off a ship due to medical reason?

     

     

Have you undergone any medical operations in the past?

     

     

Have you consulted a doctor during past 12 months for an illness/Accident?

     

     

Do you have any health disability problem now?

     

     

If answer to any of above is Yes then give further details below or an a separate sheet

     


REFERENCES

Company name /Person

Telephone


















NOTE: All STAR Reefers UK LTD Has STRICT Alcohol and Drug Policy, Which means ZERO TOLERANCE for alcohol and drugs





YES

NO

Have you ever been the subject of a court of enquiry or involved in a maritime accident?







Have you ever had a professional licence suspended or revoked?







If yes to any of above then please full details below or on separate sheet of paper










BANK ACCOUNT DETAILS

Owner Name:





Owner Address:





Bank Name:





Account No:




SWIFT code:








Office Remarks:







W związku z Ustawą z dnia 29.08.1997 r. „O ochronie danych osobowych” niniejszym wyrażam zgodę na przechowywanie i przetwarzanie moich danych osobowych złożonych w firmie STAR Reefers Poland Sp. z o.o. Jednocześnie zgadzam się na udostępnienie w/w danych armatorowi zagranicznemu w ramach działań, mających na celu moje zatrudnienie. Poinformowano mnie, iż mam prawo wglądu I poprawiania danych.
I confirm that the details given are to the best of my knowledge accurate and true, that I am in legal possession of the above qualifications and certificates. I also confirm that I have no unspent criminal convictions.



APPLICANT’S SIGNATURE: .................…………..................... DATE: ………………






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