Seafarer Application Form Page 2

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Sea-Service
(most recent vessel first)
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
Rank
Vessel
Type
GRT
DWT
TEU
From
To
Main Engine
Power
Vessel's
Make - Type
kW
Flag
Employer
Charterer
Trading
Area
By sending this application I am accepting below terms and condition:
1) I hereby affirm that all the information provided by me is true and correct to the best of my knowledge and belief. I further affirm that no certificate of Competency or License issued to me has ever
been revoked or suspended. I understand that previous employers may be asked for information concerning my employment record with them and I hereby release from liability or damage those
individuals or companies who provide such information.
2) I hereby agree to the use of my personal data included in my job application as acquired by the recruiting process (according to the Polish law of August 29,1997 in respect of a protection of personal
data Dz. Ust. Nr 133 poz.833).

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