UNISEAS
MARINE SERVICES
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Uniseas Marine Services
Level-13, Platinum Techno Park
Plot No-17 / 18
Sector - 30A,Vashi,
Navi Mumbai - 400705.

Tele : +91 22 61818329
Mail : manav@uniseas.co.in
Web : www.uniseas.co.in
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Copyright © 2015 Uniseas Marine Services All Rights Reserved.
RPSL No. 328
ISO 9001-2008
ISO
Application

APPLICATION FORM
(FPSO1)

PHOTO
APPLICATION DATE: POSITION: POSITION APPLIED FOR:
ID NO (FOR OFFICE USE ONLY): AVAILABILITY DATE:

PERSONAL DETAILS:

Name as in Passport                                                                 
Date/Place of Birth Nationality:
Permanent address Tel No.:
Mobile No.:
Email Id:
Present address if any
Mobile No.:

EDUCATION BACKGROUND:

Qualification School/College From To Percentage/grade

TECHNICAL BACKGROUND:

Degree / Diploma Institute/College From To Percentage/grade
Pre Sea training
Apprentice ship

IDENTITY DOCUMENTS:

Document Country Number Issue Date Expiry Date Place of Issue
Passport Indian
Seaman book Indian
Other
Do you hold a US Visa ‘C1/D’? Yes/No Issue Date: Expiry Date:
Do you hold a Schengen Visa Yes/No Issue Date: Expiry Date:
Indos. No. (for Indians Only):
Union Membership (MUI/NUSI):

FAMILY DETAILS (IF UNMARRIED KINDLY GIVE DETAILS OF FATHER/MOTHER):

Name Relation D.O.B PPT No. Place of issue Issue Date Expiry ECNR

NEXT OF KIN DETAILS:

Full Name of kin: Relationship:
Address of next of kin: Tel No.:
Mobile No.:
Email Id:

CERTIFICATES (HIGHEST CERTIFICATE OF COMPETENCY HELD):

Grade/Class of COC Issuing country Date of passing exam Certificate no. Issue date Placed issued Expiry date

CERTIFICATES (HIGHEST CERTIFICATE OF COMPETENCY HELD):

Courses Certificate no. Issued by Issue Date Expiry Date
Advanced Fire Fighting (AFF)
Medical First Aid (MFA)/Medicare
Proficiency in Survival Craft & Rescue Boat (PSCRB)
Personal survival &social Responsibility (PSSR)
SSO (Ship Security Officers Course)
ECDIS
BTM(Renewed every 5 years)
ARPA(Automatic Radar plotting Aid)
GMDSS
Rader Observer/RANSCO Simulator
GMDSS Endorsement
Oil Tanker Familiarization (OTFC)/TASCO
DCE Oil-support/Operation/Management
Chemical Tanker Familiarization(CTFC)/CHEMCO
DCE Chemical-Support/Operation/ Management
Specialized Training Programme On oil Tanker Operations(STPOTO)
Framo Course
Revalidation Course For Deck/Engine Officers
Refresher & UP Gradation Course for Deck/Engine Officers

DETAILS OF COURSES &CERTIFICATES FOR RATINGS:

Courses Certificate no. Issued by Issue Date Expiry Date
FIRE PREVENTION&FIRE FIGHTING(FPFF)
ELEMENTARY FIRST AID (EFA)
Personal Survival Technique(PST)
Personal Survival & SocialResponsibility(PSSR)
ISPS Course
Oil tanker Familiarization(CTFC)
DCE oil –support
Chemical Tanker Familiarization(CTFC)
DCE Chemical-support
AB/MM Course
Watch keeping Certificate Ratings Deck/Engine)
Pump Man Course
Cookery Course certificate
Fitter Course/Class Certi.

OTHERS:

ISPS Course
Ship Safety Officers Course/Risk Assessment
Ship Maneuvering simulator
BRM/MRM/BERM(Renewed every 5 years)
Electrical/electronics for Marine Engineers - Basic/Advance

FOR ENGINEERS (PLEASE PROVIDE DETAILS):

Generators Boilers Cranes Framo(no.OF Vessels)

TOTAL SALING EXPERIENCE:

Crude Tankers Product Tankers Chemical Oil/Chemical Others

MEDICAL HISTORY (IF THE ANSWER IS YES TO ANY OF THE BELOW, PLEASE GIVE FULL DETAILS AND ATTACH A SEPARATE PAGE IF NECESSARY):

Have you ever signed off a ship due to medical reasons? Yes/No
Have you Undergone any Surgery/Accident? Yes/No
Do you have any Health disability problems now? Yes/No

GENERAL:

Have you ever been the subject of a court of enquiry or involved in a Maritime accident? Yes/No
Have you ever had a professional license suspended or revoked? Yes/No
Dou you have any pending criminal inquiry Yes/No

BANK ACCOUNT DETAILS:

Account Holder’s Name:
Name of Bank & account no: Branch & address:
BOILER SUIT SIZE:
SAFETY SHOE SIZE:

DECLARATION:

I hereby affirm that all the information provided by me in this application is true and correct.

Applicant’s signature
Date:

FOR OFFICE USE ONLY:

Checked on with Mr./MS rep.of ( Last employer)& received Satisfactory/unsatisfactory report regarding his professional experience & attitude.
By
Interviewed on found satisfactory/unsatisfactory.
By

RECORD OF PREVIOUS SERVICE (KINDLY START FROM YOUR FIS

Company Vessel name Vessel type DWT/GRT Year
Built
Type of Engine
(please give full details)
BHP Rank Sign On
(dd/mm/YY)
Sign Off
(dd/mm/yy)
Reason for
sign off
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+91 22 61818329