Marine Crew Member Personal Data Sheet Template
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Complete Marine Crew Member Personal Data Sheet Template with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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1P ERS O NA L
D ATA S H E ET
Crewmember Information
Request Type
Today’s Date
New employee: Fill out all fields
Returning crew: Revise as appropriate
Last Name
First Name
Middle Initial
Sex:
Date of Birth (DD/MMM/YY)
Marital Status
M
F
Single
Married
Divorced
Separated
City of Birth
Country of Birth
Nationality
Home Address
City
Country
Postcode
Nearest International Airport
Phone Number
Mobile/Cell Number
Alternate Number
E-mail Address
U.S. Citizen/Green Card Holder
ARC/Green Card Number
Yes
No
Next of Kin/Emergency Contacts
Relationship to You
Mother
Father
Wife
Husband
Other (please specify)
Last Name
First Name
Street Address
City
Country
Postcode
Phone Number
Alternate Phone Number
Documentation (enter dates as DD/MMM/YY)
Passport Number
Place of Issue
Date of Issue
Expiry Date
Seaman’s Book
Country of Issue
Date of Issue
Expiry Date
Visas
Date of Issue
Expiry Date
Medical Certificate
Date of Issue
Expiry Date
USA C1/D:
Yes
No
Yes
No
Please attach copy of passport details page/medical certificate/C1D visa/copy of W–4 form (if US)
CPSC/SCC
Date of Issue
Country of Issue
Lifeboat Certificate Number
Yes
No
First Language
Fluency Level
Basic
Conversational
Fluent
Second Language
Fluency Level
Basic
Conversational
Fluent
Third Language
Fluency Level
Basic
Conversational
Fluent
GEN 0007B 0611
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Parent category: Business