Crew Personal Data Sheet

Rank
Name
Civil Status
Age
Date of Birth
Place of Birth
Landline/Mobile No.
Last School
Year Graduated
Last Agency
Your Email
Next of Kin
Relationship
Next of Kin Contact No.
Present Address
Provincial Address
POEA E-Registration No.
Polio Vaccine
Yellow Fever
Height(cm)
Weight(Kg)

Crew License and STCW Training Certificate

Philippine Passport
Seaman's Book
US Visa
Schengen Visa
Certificate of Competency (COC)

 

Other COC *Please include II/4, II/5 , III/4, III/5, NCs, if any
Certificate of Endorsement (COE)
GMDSS General Operator Certificate (GOC)
Panama Booklet
Panama SDSD / SSO
Panama ECDIS
Panama GMDSS
Other Panama Endorsements
Liberian License/Book
BT COP
PSCRB COP
AFF COP
MEFA COP
MECA COP
SSO COP
SDSD COP
BTLGT COP
BTOC COP
ATLGT COP
ATCT COP

Training Certificates (Full Course or Refresher)

Basic Safety Training (BT)
Prof. In Survival Craft and Rescue Boat (PSCRB)
Adv. Training in Firefighting (AFF)
Medical First Aid (MEFA)
Medical Care (MECA)
Ship Secuirty Office (SSO)
Seafarers With Designated Security Duties (SDSD)
Basic Training in Liquified Gas Tanker (BTLGT)
Basic Training in Oil and Chemical Tanker (BTOC)
Advanced Training for Liquefied Gas Tanker Cargo Operation (ATLGT)
Advanced Training for Chemical Tanker Cargo Operation (ATCT)
Bridge Resource Management (BRM) / Bridge Team Management (BTM)
Engine Resource Management (ERM)
Ship Simulator and Bridge Teamwork 
ECDIS Generic
ECDIS Specific
Shipshandling and Maneuvering
Catering Management
Messman/Steward Course

SEA SERVICE RECORD (From Present to Past)

Vessel Name
Flag
Agency
Vessel Type/Cargo
GRT
Engine Type
Rank
Route
From (day / month / year)
Until (day / month / year)
Causes of Disembarked
Officers