SONGA CREWMANAGEMENT LTD.

Application for Employment

1. Personal Data
First Name Middle Name (s) Last Name / Surname

Citizenship: Country of Date of Birth: Place / City of Birth

Origin Click here to enter a
date.
(DD/MM/YYYY)

Marital Status: Gender :

Rank applied for: Willing to accept lower rank? Available From (date):
Click here to enter a date.

(DD/MM/YYYY)

Primary / Permanent Address (Street): Alternative / Temporary Address (Street):

City: Post Code: City: Post Code:

Country: Nearest Airport : Country: Nearest Airport:
Mobile Ph: Home Ph.: Phone: Mobile Ph:
Skype: Email:

Height : Weight: Hair Colour : Eyes Colour :

Boiler suit Size : Sweater Size : Shirt Size : Trousers Size : Shoes Size:

2. Next of Kin & Family Details

Full Name of Nominee for compensation in case of Relationship2 Gender :
fatality: Citizenship:

Address(Street):
City: Post Code: Country: Tel: Mobile :
Number of dependent Children ( up to 21 ) :
2
Select From: ●Spouse ●Partner ●Child ●Parent ●Grand Parent ●Other Relative (Please Specify)

3. Personal ID / Documents / Visa

Type of Document / Country of No. Date of Issue Issued at Valid Until
ID 3 Issue (DD/MM/YYYY) (Place) (DD/MM/YYYY)

Seaman’s Book (National) Click here to enter a Click here to enter a

date. date.

Passport Click here to enter a Click here to enter a

date. date.

US Visa C1/D Click here to enter a Click here to enter a

date. date.

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Yellow fever vaccination Click here to enter a Click here to enter a

date. date.

Other Click here to enter a Click here to enter a

date. date.

Click here to enter a Click here to enter a

date. date.

Click here to enter a Click here to enter a

date. date.

3
Select as applicable: ●Passport ●Seamans Book ●Seaman Passport ●Seafarers’ Identity Document ● ●Health Insurance ● Driving Licence ●Visas
●Yellow Fever.

4. Maritime Educational Institution ( MEI )

Diploma Year of
Name of MEI Grade
Number Graduation

5. STCW-1978 ( amended 1995) Compliant Certificates / Courses and Other Qualifications: -

(A) Reg II / 1-4, III / 1-4 Officers Certificate of Competency & Ratings Watch-keeping Certificate
Certificates of Competency: 5 Date of Date of Issuing
Country Issue Expiry Place of
Number Authority /
of Issue (DD/MM/ (DD/MM/ Issue
YYYY) YYYY)
Body
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.

(B) Tanker endorsement

Level Date of Date of
Descriptio Country Place of Issuing Authority /
( Management or Number Issue Expiry
n of Issue (DD/MM/YYYY) (DD/MM/YYYY) Issue Body
Operational )
Oil Click here to Click here to
enter a date. enter a date.
Chemical Click here to Click here to
enter a date. enter a date.
Gas Click here to Click here to
enter a date. enter a date.
5
Enter here actual description given in the Competency Certificate / Watchkeeping Certificate held by you

(C) GMDSS Certificate

Date of Date of
Certificate of Competency: Country Issue Place of Issuing Authority /
Number Expiry
of Issue (DD/MM/ (DD/MM/YYYY) Issue Body
YYYY)
GMDSS Click here to Click here to
enter a date. enter a date.

(D) Reg VI / 1 – Basic Safety Training ( SOLAS )

Date of
Date of
Country Issue Place of Issuing Authority /
Description of Cert / Course Number (DD/MM/
Expiry
of Issue (DD/MM/YYYY) Issue Body
YYYY)
Personal Survival Techniques Click here to Click here to
enter a date. enter a date.
Elementary First Aid Click here to Click here to
enter a date. enter a date.
Fire Fighting & Fire Prevention Click here to Click here to
enter a date. enter a date.
Personal Safety & Social Resp. Click here to Click here to
enter a date. enter a date.

(E) Reg VI / 2 –4 Additional Training

Date of
Date of
Country Issue Place of Issuing Authority /
Description of Cert / Course Number (DD/MM/
Expiry
of Issue (DD/MM/YYYY) Issue Body
YYYY)
Proficiency in Survival Craft & Rescue Boat Click here to Click here to
enter a date. enter a date.
Fast Rescue Boats Click here to Click here to
enter a date. enter a date.
Advanced Fire Fighting Click here to Click here to
enter a date. enter a date.
Medical First Aid Click here to Click here to
enter a date. enter a date.
Medical Care Click here to Click here to
enter a date. enter a date.

(F) Reg V / 1 – Special Requirement for Tankers

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Date of
Date of
Country Issue Place of Issuing Authority /
Description of Cert / Course Number (DD/MM/
Expiry
of Issue (DD/MM/YYYY) Issue Body
YYYY)
Tanker Familiarisation ( Oil ) Click here to Click here to
enter a date. enter a date.
Tanker Familiarisation ( Gas ) Click here to Click here to
enter a date. enter a date.
Tanker Familiarisation ( Chem ) Click here to Click here to
enter a date. enter a date.
Special Tanker Safety ( Oil ) Click here to Click here to
enter a date. enter a date.
Special Tanker Safety ( Gas ) Click here to Click here to
enter a date. enter a date.
Special Tanker Safety ( Chem ) Click here to Click here to
enter a date. enter a date.

(G) V/2 and V/3 – Special requirement for Passenger / Ro-Ro Passenger Vessels
Date of
Date of
Country Issue Place of Issuing Authority /
Description of Cert / Course Number (DD/MM/
Expiry
of Issue (DD/MM/YYYY) Issue Body
YYYY)
Crowd Management Click here to Click here to
enter a date. enter a date.
Crisis Management & Human Click here to Click here to
Behaviour enter a date. enter a date.
Pax Safety, Cargo Safety & Hull Integrity Click here to Click here to
enter a date. enter a date.
Pax Safety Click here to Click here to
enter a date. enter a date.
Familiarisation Training Click here to Click here to
enter a date. enter a date.
Safety Training Click here to Click here to
enter a date. enter a date.

(H) Other mandatory/recommended Certificates / Courses – (as applicable)

Date of
Date of
Country Issue Place of Issuing
Description of Cert / Course Number (DD/MM/
Expiry
of Issue (DD/MM/YYYY) Issue Authority / Body
YYYY)
ARPA & Radar (Reg II/1 + Solas) Click here to Click here to
enter a date. enter a date.
Bridge Team / Resource Mgmnt Click here to Click here to
enter a date. enter a date.
Shiphandling Simulator Click here to Click here to
enter a date. enter a date.
ECDIS Click here to Click here to
enter a date. enter a date.
Shipboard Security Officer Click here to Click here to
enter a date. enter a date.
Framo cargo pumps Click here to Click here to
enter a date. enter a date.
Engine Room Simulator Click here to Click here to
enter a date. enter a date.
Liquid Cargo Simulator Click here to Click here to
enter a date. enter a date.
Hazmat (US – 49CFR) Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.

6. Sea Experience : ( for the last 5 years )

Type Date From Date To
Company Ship’s Name Flag (6) DWT Main Engine (7)
BHP Rank (DD/MM/ (DD/MM/
YYYY) YYYY)
Click here to Click here to
enter a date. enter a date.
DR Click here to
enter a date.
Click here to
enter a date.
G Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.

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Click here to Click here to

enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
enter a date. enter a date.
Click here to Click here to
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(6)
Use only the following abbreviations for vsl types:
B/C Bulk Carrier FPSO FloatgProdStorOffld MLP Multi-purpose PAS Passenger Ship YAT Yacht
g
CON Cellular Container GCD General Cargo MSV MultiServiceVessel RFG Reefer Vessel TNB Tanker(Bitumen)
CHM Chem Carrier IMO I-II HLV Heavy Lift Vsl NVL Naval Ship R/R Ro/Ro Carrier TNC Tanker(Crude)
CH3 Chem Carrier IMO III LSH Lash RIG OffShore Oil Rig PRR RoRo-Pax TNP Tanker(Products)
CH2 Chem Carrier IMO II LIV Live Stock Carrier OSV OffShore Supply Vsl SAL Sailing Vsl TNS Tanker(Storage)
DP Dynamic Positioning LNG LNG Carrier OBO Ore/Bulk/OilCarrier SRV Survey Vessel TNV Tanker(VLCC/ULCC)
FSH Fishing Vsl LOG Log/Timber O/O Ore/OilCarrier SUL Self-Unloader DRG Dredgers
FSO FloatingStorageOffld LPG LPG Carrier OTH Other TUG Tug
(7)
g
Engineers to give make/model of engines, e.g. “MAN 14V52/55A” or “SULZER 5RTA58”

Years in Rank Years on Tankers Years on this type of Vessel

Chief Do you have Class Approval from Last Which Class society:
Engineers: Company?

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7. Cargoes worked with (Applicable for Deck Department & Pumpmen only)

8. Multinational Crew Experience

9. Medical History:
(A) Have you ever signed off a ship due to
medical reasons?
If yes, please provide following details (If space is insufficient, attach additional sheets):
Name of vessel Date of occurrence Place of occurrence

Brief description of illness/injury/accident

(B) Have you undergone any operation in the past?

If yes, please provide following details:
Details of operation Date (DD/MM/YYYY) Period of disability Present condition

Click here to enter a date.

Click here to enter a date.

(C) For what illnesses or accidents have you consulted a doctor during the last 12 months?
Details of illness / accident Date (DD/MM/YYYY) Therapy/Treatment

Click here to enter a date.

Click here to enter a date.

(D) Please give details of any health or disability problem

Details:

10. General
(A) Have you ever been denied a foreign visa?
If yes, state which country and reason (if known)
(B) Have you been the subject of a court of enquiry or involved in a maritime accident?
If yes, please attach details
(C) Give details below of two recent employers who we may contact for references:
Reference 1 Reference 2
Name of Company
Name of person to contact
Country
Telephone

I hereby declare that the above, including Medical History, is true. I understand that this data will be stored in your databases in relation to my actual
or potential employment. Further, I confirm that the above may involve the transfer of my personal data to potential clients/principals

Place: Date: Signature:.……………………………

For Office Use only:

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