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Medical information

Medical examination

Drug & alcohol test

Yellow fever



National License


















Sea expirience::


Offshore Vessels:




Oil/Chem Tanker Fleet:


General informations:







Knowledge of languages (on top of your mother language):




Previous Sea Services (last 5 years):

Name of vessel Year of built Company Flag Type of vessel DWT Type of main engine BHP Rank From dd/mmm/yyyy To dd/mmm/yyyy
Another States Seamen’s Books Rank Document No Issued Valid
Another States Certificates of competency Rank Document No Issued Valid

Please complete addresses of your previous employers for references: