Seafarer'S Application Form Page 4
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5Darya Shipmanagement Pvt Ltd.
FORM : PER -1
.
9. REFERENCES
(Please give two references/companies whom we can ask about your seagoing experience)
Name
Company/
Telephone / Contact
Name
Company/
Designation
No.
Designation
REMARKS
9A. REF. CHECK
YES / NO
10. HOW DID YOU COME TO KNOW ABOUT US?
(Please tick the appropriate medium)
A
Company presentation/seminar
B
C
Marine magazine advertisement
D
Newspaper advertisement
E
F
Direct Mail from Company
G
Other (Please Specify)
11. DECLARATION
I declare that the information given by me in filling up this from to the best of my knowledge are true and complete. I also declare
that the documents submitted to Darya Shipmanagement PVT LTD. are genuine, given and signed by the persons whose names
appear on them. Any false declaration may render me liable for termination or dismissal
Date:
SIGNATURE OF APPLICANT:
12. SPACE FOR OFFICIAL USE
Assessment:
Grade
Application Status:
Date :
Personality
Forwarded Owners
Attitude
OWNER’S ACCEPTANCE DETAILS
ACCEPTED
YES
NO
Technical Knowledge
REF.
English Knowledge
Over Assessment
Grade : A – Excellent, B-Good, C-Satisfactory,
D – Average. E- Poor
Interviewed by
Date :
INTERVIEWER’S REMARKS:
Version No: 01
Dated: 01-Jan-2015
Page 4 of 5
Approved by : CEO
CONTROLLED DOCUMENT
File: Office
Frequency: During Crew Selection
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