SEAMAN REGISTATION FORM
船員登記表
1、BASIC INFORMATION基本信息
Name(中/英文姓名) |
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Rank(職務(wù)) |
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D.O.B(出生日期) |
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P.O.B(出生地) |
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ID No.(身份證號碼) |
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TEL(電話) |
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Address(家庭住址) |
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Kin/Name(親屬姓名) |
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Relationship(關(guān)系) |
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TEL(電話) |
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Weight(體重/kg) |
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High(身高/cm) |
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Shoe(鞋號) |
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Blood type(血型) |
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Suitability situation (適任狀況) |
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Safety record(安全記錄) |
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Health(健康狀況) |
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Education(畢業(yè)學(xué)校/時間/專業(yè)) |
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Degree(學(xué)歷) |
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2、CERTIFICATES證書情況
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Number (證書號碼) |
Date of Issue (簽發(fā)日期) |
Expired Date (期滿日期) |
Place of Issue (簽發(fā)地點) |
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Seaman’s Book(海員證) |
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Seaman’s Record Book(服務(wù)簿) |
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Competency Certificate (適任證書) |
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GMDSS Certificate(GMDSS證書) |
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Passport (護照) |
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Medical Certificate For Seafarers (海船船員健康證書) |
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Other License/Certificate(其他證書) |
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Medical CXAM.EXP. (健康證有效期) |
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Cholera EXP. (霍亂有效期) |
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Yellow Fever EXR. (黃熱有效期) |
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3、DETAILS OF COURSE/CERTIFICATES專業(yè)培訓(xùn)證書
Certificates Type(證書名稱) |
Number (證書號碼) |
Date of Issue (簽發(fā)日期) |
Expired Date (期滿日期) |
Certificate of Professional Training(專業(yè)培訓(xùn)合格證書) |
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Basic Safety Training(基本安全) |
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Survival Craft and Rescue Boats(救生艇、筏) |
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Advanced Fire Fighting(高級消防) |
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Medical First Aid(精通急救) |
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Ship Captain Medicare(船上醫(yī)護) |
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Proficiency For Ship Security Officer(船舶保安員) |
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4、Previous Sea Experience(Last vessel first)海上資歷(從最近的一條船開始)
Company Name 公司名稱 |
Ship’s Name 船名 |
TYPE-VSL/ENG. BUILT-Y 船舶類型/主機型號 |
Flag 船旗 |
GRT 總噸 |
BHP 馬力 |
Rank 職務(wù) |
Sign-on Date 上船日期 |
Sign-off Date 下船日期 |
Areas 航區(qū) |
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REMARK 備注:YES/NO(是否可用) |
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QLQP-05A-07
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