Additional rank(-s)

Personal information

Surname

Marital Status

bachelor married

First name

Children’s quantity

Father’s name

Special features

Birth date

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January FebruaryMarchAprilMayJuneJuly AugustSeptemberOctoberNovemberDecember

Height (cm)

Weight (kg)

Birth place

Eyes’ colour

Hair colour

Nationality

Uniform size

Shoes’ size

ADDRESS  (including telephone country & area codes; secondary or contact addresses if any)

Street & Nr.

Nearest airport

City, town

E-mail

State, country

Mobile phone

Postal (zip) code

Residence phone

NEXT OF KIN INFORMATION (notify party in case of emergency & insurance beneficiary)

Surname

Street & Nr.

First name

City, town

Father’s name

State, country

Relationship

Mobile phone

Nationality

Residence phone

Remarks

The last salary

Minimum salary

English language level

Spoken

Written

Read

Other foreign languages

Marine school\academy: name & period (from…... to …….)

Foreign Crew Experience

Other Skills

Further Remarks

TRAVEL DOCUMENTS AND MEDICAL CERTIFICATES

Document Name (Description)

Document No.

Country

Issue place

Issue date

Expiry date

National passport

Travel passport

Seaman’s Book (national)

Seaman’s Book (flag state)

Seaman’s Book (flag state)

Visa – United States (type C1/D)

Other visas, work/resid.permits

Medical Examination Report

Drug & Alcohol Test

Vaccination against yellow fever

Others