ID (For Office): Form No. QD-REC-03 Rev.1 / 22 OCT.
2021
DATE APPLIED: M: APRIL D: 28 Y: 2022
POSITION ENGINE CADET
APPLYING FOR: 5th Floor Zen Tower Center 1111 Natividad A. Lopez Street Ermita PHOTO
Manila
AVAILABILITY IMMEDIATELY: YES | NO
AFTER (Date): M: MAY D: 02 Y: 2022
SEAFARER’S APPLICATION FORM
I. APPLICANT
NAMES LASTNAME FIRST NAME MIDDLE NAME AGE DATE OF BIRTH
APPLICANT: ANCERO JOHN PAUL GESOYOT 22 08-18-1999
Addresses Information (Put “SAME” if address of Permanent same as the Present)
ADDRESS TYPE HOUSE NO./STREET BRGY. /TOWN CITY ZIP COUNTRY
PRESENT PH10B PKG6 BLK85 LOT7 BRGY.176 BAGONG CALOOCAN CITY 1428 PHILIPPINES
PERMANENT PH10B PKG6 BLK85 LOT7 BRGY.176 BAGONG CALOOCAN CITY 1428 PHILIPPINES
Telephones & Contact Information
TELEPHONE MOBILE EMAIL FB
APPLICANT 09383874822 [email protected] JOHN PAUL ANCERO
Personal Education (Most Recent on Top)
LEVEL SCHOOL COURSE / DEGREE PLACE FROM TO
COLLEGE DR. CARLOS S. LANTING COLLEGE BS MAR-E QUEZON CITY
SR. HIGH SCHOOL ST. CLARE COLLEGE OF CALOOCAN TVL-ICT CALOOCAN CITY
JR. HIGH SCHOOL KALAYAAN NATIONAL HIGH SCHOOL SECONDARY CALOOCAN CITY
ELEMENTARY KALAYAAN ELEMENTARY SCHOOL PRIMARY CALOOCAN CITY
II. NEXT OF KIN
NAME LASTNAME FIRST NAME MIDDLE NAME AGE DATE OF BIRTH RELATION
NEXT OF KIN ANCERO RUFINA GESOYOT 85 07-18-1938 MOTHER
ADDRESS TYPE HOUSE NO./STREET BRGY. /TOWN CITY ZIP COUNTRY
PERMANENT PH10B PKG6 BLK85 LOT7 BRGY.176 BAGONG CALOOCAN 1428 PHILIPPINES
Telephones & Contact Information CITY
TELEPHONE MOBILE EMAIL FB
NEXT OF KIN
III. Foreign Languages (Put “Y” in your native language)
LANGUAGE FLUENCY (1-10) NATIVE LANGUAGE FLUENCY (1-10) NATIVE
1 TAGALOG 10 Y 3
2 ENGLISH 8 4
IV. Foreign Crew Work Onboard Ship
Please advise nationalities
V. MEDICAL HISTORY
Medical issues / Medical Clinic
VI. GOVERNMENT ID’s
SSS No. 35-1143326-0 PAG-IBIG No. PHILHEALTH No. 03-026632129-1
VII. Documents (DOC)/Licenses (LIC)/Trainings (TRA)/Medicals (MED)/Certificates (CER)
T. Doc/Cert/Tra/Lic Yes No VAL T. Doc/Cert/Tra/Lic Yes NO EXPIRE
Ex Some Document Name Ex Some Document Name
LIC MARINA STCW COE: / TRA Ship Safety Officer: /
LIC MARINA STCW COC (II/4; III/4) / TRA Risk Assessment: /
LIC MARINA STCW COC (II/5; III/5) / TRA Incident Investigation: /
DOC TESDA NCI/NCIII: / TRA HIGH VOLTAGE /
DOC PASSPORT: / TRA TRA ECDIS GENERIC: /
T. Doc/Cert/Tra/Lic Yes No VAL T. Doc/Cert/Tra/Lic Yes NO EXPIRE
Ex Some Document Name Ex Some Document Name
DOC SEAMAN BOOK: / TRA ECDIS SPECIFIC: /
DOC USA VISA: / TRA Bridge Resource Mgmt. /
DOC SCHENGEN VISA / TRA SMAW /
DOC AUSTRALIAN MCV: / TRA Ship Simulator and Bridge Teamwork /
DOC YELLOW FEVER VACCINATION: / TRA Ship Handling Course: /
DOC CHOLERA VACCINATION: / TRA INMARSAT: /
DOC PANAMA SIRB: / TRA GMDSS: /
DOC PANAMA GOC: / TRA ARPA/ROPA: /
DOC LIBERIA ENDORSEMENT: / TRA ENGINE ROOM MANAGEMENT /
DOC LIBERIA BOOK: / TRA Engine Room Simulator: /
DOC CYPRUS ENDORSEMENT: / TRA Auxiliary Machinery System: /
DOC CYPRUS BOOK: / TRA Control Engineering: /
DOC MARSHAL ISLAND ENDORSEMENT: / TRA Hydraulics and Pneumatics: /
DOC MARSHAL ISLAND BOOK: / TRA Dangerous & Hazardous Materials: /
DOC BAHAMAS ENDORSEMENT: / TRA MARPOL (CONSOLDATED): /
DOC BAHAMAS BOOK: / TRA Deck / Engine Watch keeping: /
DOC MALTA ENDORSEMENT: / TRA Welding Course /
DOC MALTA BOOK: / TRA Lathe Machine Course: /
CER BASIC TRAINING: / TRA Culinary / Catering Courses: /
CER Prof. In Survival Craft & Rescue / TRA Messman Course: /
Boat:
CER Advanced Fire Fighting: / TRA CROWD and CRISIS MGT.: /
CER Medical Emergency First Aid: / TRA Crude Oil Washing: /
CER Medical Care: / TRA Inert Gas System: /
CER Ship Security Officer: / TRA Free-Fall Lifeboat Familiarization: /
CER BTOC: / TRA Human Relationship (Optional): /
CER ATCT: / TRA Tank Atmosphere & Gas /
Measurement (Optional):
CER ATOT: / TRA BTLGT: /
CER Fast Rescue Boat (FRB): /
CER SDSD: /
TRA FRAMO Course: /
TRA Environmental Management: /
TRA Bilge Water Waste Management: /
TRA Automatic Identification System: /
Consent and Certification Statement
I hereby given my consent to give personal information for the purpose of establishing an employment relationship.
I have read the above and agree: (Type “YES” or “NO”): __YES___
JOHN PAUL G. ANCERO April 28, 2022
Applicant’s Name and Signature Date
DETAILS OF SEA GOING EXPERIENCE (Starting with the latest in chronological order for the last 10 years of service) ID (For Office):
ENGINE Period Duration
Vessel Type Reason
Vessel Name Flag GRT DWT Maker BHP Rank Sign On Sign-Off Manning Agency Principal
Type / Model Sign Off
DETAILS OF WORK EXPERIENCE ASHORE, IF ANY
COMPANY ADDRESS POSITION FROM TO JOB DESCRIPTION REASON FOR LEAVING
Applicant’s Name and Signature Date
SEA SERVICE FORM
Additional requirements for applicant Number of years of sea service:
From the Start to join vessel up to present.
1. Number of years / months / days present position.
2. Type of vessel / Number of years / months / days.
3. Total sea experience ass OOW (for Master/ C/O / C. Engr. / 2nd Engr. Only)
4. Total sea service in all types of vessel experienced.
Present Position Number of Years Months Days Remarks
Type of Vessel Number of Years Months Days Remarks
Bulk
Crude Oil
Product Tanker
Oil Tanker
Others
Total Experience Number of Years Months Days Remarks
OOW/Jr. Officer
All types of vessel Number of Years Months Days Remarks
FOR TANKER VESSEL/VETTING EXPERIENCED YES NO
ECDIS Type (Deck)
Type of Cargo
Deck Officer
Engine Type/BHP
Engine Officer
Applicant Name & Signature: Vessel Assign/Principal:
88 Aces Maritime Services Incorporated
5th Floor, Zen Tower, N. Lopez St. Ermita, Manila 1000
Issuing Department: HR Title: HEALTH DECLARATION CHECKLIST QD-HUM-04
Date/Rev No.: 30 April 2021 / Rev. 0 Authorized by: President Page No.: 5
HEALTH DECLARATION CHECKLIST
For Employees and Visitors
TEMPERATURE:
Name : __________JOHN PAUL G. ANCERO_____________________________Sex : ___MALE________ Age : ___22_____
Residence : PH10B PKG6 BLK85 LOT7 BRGY 176 BAGONG SILANG CALOOCAN CITY__________
Nature of Visit: Official: □
Please check one Personal: □
If Official Fill in the following:
Company Name : ____________________________________________________________________________
Address : __________________________________________________________________________________
YES NO
1. Are you experiencing: a. Sore Throat
□ □
b. Body Pain
□ □
c. Headache
□ □
d. Fever for the past few days
□ □
2. Have you worked together or stayed in the same close environment of a confirmed COVID-
19 case? □ □
3. Have you had any contact with anyone with fever, cough, sore throat in the past 2 weeks?
□ □
4. Have you travelled outside of the Philippines for the last 14 days?
5. Have you travelled in any Area of the NCR aside from your home?
□ □
Specify _________________________________________________
□ □
I hereby authorize 88 ACES MARITIME SERVICES, INC. , to collect and process the data indicated herein for the purpose of effecting
control of the COVID-19 infection , I understand that my personal information is protected by RA 10173 , Data Privacy Act of 2012,
and that I am required by RA 11469, Bayanihan to Heal as One Act, to provide truthful information .
Signature : _______________________________________________ Date : ____APRIL 28, 2022___
