Offshore Application Form : Anglo Eastern Offshore

Checklist
Please make sure you have the following details to hand to assist you in completing this application form:
- Details of your previous employer (including the name, address, person in charge and contact number)
- Passport
- Certificate of Competence (CoC)
- Seaman’s Discharge Book
- Medical
- Offshore Survival (Industry approved i.e. OPITO, NOGEPA, OLF etc.)
- Visa Details
- MARLINS Test / English Language Test
You will also be required to provide your Sea Service Record (last 5 years) at the end of form, please make sure the information provided is accurate.

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Position
Position applied for*
Department*
Available Date*

Personal Details
Name*
First Last
Gender*
Date of Birth*
Nationality*
Place of Birth*
Nearest Airport*

Contact
Address*
Street Address Address Line 2 City
Mobile*
Include international dialling code
Home Telephone
Include international dialling code
Email*

Previous Employer
Name
Person in Charge
Address
Contact Number

Certificate of Competency
Number of Certificate
Date of Issue
Date of Expiry
Place of Issue

Passport
Passport Number*
Name on Passport*
Date of Issue*
Date of Expiry*
Place of Issue*

Seaman’s Discharge Book
Number*
Date of Issue*
Date of Expiry*
Place of Issue*

Medical
Offshore Medical
Number of Certificate
Date of Issue
Date of Expiry
Place of Issue
Seafarers Medical
Number of Certificate
Date of Issue
Date of Expiry
Place of Issue

Offshore Survival
Offshore Survival (Industry approved i.e. OPITO, NOGEPA, OLF etc.)
Number of Certificate
Type
Date of Issue
Date of Expiry
Place of Issue

VISA
Here you can supply details of relevant Visas
Visa 1
Type of Visa
Type of Visa
Date of Issue
Date of Expiry
Visa 2
Type of Visa
Date of Issue
Date of Expiry
Visa 3
Type of Visa
Date of Issue
Date of Expiry

English Test
Marlins Test / English Speaking Test
Number of Certificate
Date of Issue
Place of Issue
Score

GMDSS
Please only complete this section if you are applying for a Deck position
Number of Certificate
Date of Issue
Date of Expiry
Place of Issue

Dynamic Positioning
Please only complete this section if you are applying for a Deck position
Number of Certificate
Type (Limited/Unlimited)
Date of Issue
Date of Expiry
Place of Issue

Crane Operation
Please only complete this section if you are applying for a Crane Operator position
Number of Certificate
Stage
Date of Issue
Date of Expiry
Place of Issue

STCW
STCW
Have you attended STCW training?
- Yes
- No

Sea Service Record
Please provide enough details of your Sea Service Record to cover the last 5 years
Service 1
Company
Vessel
Rank
Sign On
Sign Off
Vessel Type
DP System
Engine Type
Crane Type
Reason for Sign Off
Service 2
Company
Vessel
Rank
Sign On
Sign Off
Vessel Type
DP System
Engine Type
Crane Type
Reason for Sign Off
Service 3
Company
Vessel
Rank
Sign On
Sign Off
Vessel Type
DP System
Engine Type
Crane Type
Reason for Sign Off

Brief Overview
To support your application please give brief overview of duties/responsibilities within your current/previous roles
Overview Text

Please Confirm*
- I hereby confirm that the information provided is true and factual to the best of my knowledge.
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ANGLO-EASTERN OFFSHORE

Offshore Application Form

Step 1 of 19

Checklist

Position

Personal Details

Contact

Previous Employer

Certificate of Competency

Passport

Seaman’s Discharge Book

Medical

Offshore Medical

Seafarers Medical

Offshore Survival

Offshore Survival (Industry approved i.e. OPITO, NOGEPA, OLF etc.)

VISA

Visa 1

Visa 2

Visa 3

English Test

Marlins Test / English Speaking Test

GMDSS

Dynamic Positioning

Crane Operation

STCW

Sea Service Record

Service 1

Service 2

Service 3

Brief Overview

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