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Port Captain/P & I Surveyor.

Corporate / Senior Management

Employment Application Form

 
POST APPLIED FOR 		 
MASTER/Shore base Marine Job 		 
ARE YOU WILLING TO JOIN A RANK LOWER IF CURRENT POSITION IS NOT AVAILABLE 		 
 
N 		 
 
 
DATE AVAILABLE FROM 		 
     NOW 		 
HEIGHT – 181 CM
 
EYE SIGHT - 		 
6/6 		 
WEIGHT – 80 kg
PERSONAL DETAILS
NATIONALITY: BANGLADESHI DATE OF BIRTH
09/06/1958 		PLACE OF BIRTH; DHAKA
IDENTITY DOCUMENTS

DOCUMENT PLACE OF ISSUE NUMBER DATE OF ISSUE DATE OF EXPIRY
PASSPORT: DHAKA BJ069875628/12/2015 27/12/2020
OTHER  VALID VISA: USA DHAKA 2006253402003512/02/201212/02/2017
SEAMAN BOOK
  		CHITTAGONG C/0/0604 03/04/200603/04/2021
FLAG STATE
  		 
SINGAPORE 		 
 VALID 		   
YELLOW FEVER   YES   ENSURE AT LEAST 2 BLANK PAGES IN YOUR PASSPORT :  YES
DATE OF ISSUE:
02/09/2010 		 
CLOSEST  AIRPORT: Dhaka International Air Port
DATE OF EXPIRY:02/09/2020
US VISA: VALID TIL 12/*02/2017 20062534020035
DATE OF ISSUE:12/02/2012 DATE OF EXPIRY:12/02/2017
   
Certificates Grade Number Issued Validity Issued at
Certificate of Competency / Watch keeping MASTER
UNLIMITED  		CoC0011885  19/05/2001  16  of October 2020 MCA/UK
Endorsement to Certificate of Competency
GMDSS (GOC)   SING H 0536   17/11/2014 16/11/2019 iDA SINGAPORE.
Applied for revalidation.
GMDSS (Endorsement)   NA   NA NA  NA
STCW Certification Grade Number Issued Validity Issued at
Personal Survival Techniques        
Proficiency in Survival Craft and Rescue Boats/ PSC-RB    PSCRB 1107/04  30.11.2011  30.11.2016 Maritime Institute of Science & Technology
Personal Safety and Social Responsibilities    PSSR 1107/07 13.12.2011 12.12.2016  Maritime Institute of Science & Technology
Elementary First Aid   FASC  24.05.1983  NA  GOVT.MARINE ACADEMY CH
Medical first Aid / Master's Medicare   99100  18.12.2011  18.12.2016 International Institute of Maritime Technology
Fire Prevention and Fire Fighting        
Advanced Fire Fighting   FFC2133  29.06.2012  28.12.2016  GOVT.MARINE ACADEMY CHT
Tanker Familiarization (Oil)        
Tanker Familiarization (Chemical)        
Tanker Familiarization (Gas)          
Advanced Tanker Safety(TASCO) - Petroleum        
Advanced Tanker Safety(CHEMCO)- Chemical        
Advanced Tanker Safety(GASCO)- Gas        
Radar Observer   14/0239   08.06.1984 NA  S .TYNE S COLLEGE. UNITED KINGDOM
Radar Simulator        
Automatic Radar Plotting Aids    14/00672  26.02.1988  NA S .TYNE S COLLEGE. UNITED KINGDOM
Yellow Fever   02.09.2010 01.09.2020 DHAKA
ECDIS ECDIS 23.04.2015     28/05/2009 UMA
MCA approved
Other Certification Grade Number Issued Validity Issued at
Ship Security Officer   SSO/1305/05  26.02.2013  26.02.2018 International Institute of Maritime Technology
Liquid Cargo Handling Simulator        
Bridge Team Management (BTRM / BRM)    SIN-02-0044 12.09.2003   NA SINGAPORE POLYTECHNIC
Bridge Simulator   0088   20.02.2001  NA PSA SINGAPORE
       
Engine Room Simulator
Inert Gas Systems        
Hazmat Course    BMTI/01032669  29.08.2007  NA  BMTI
Fast Rescue Boat (FRB)  PSC 1371  24.05.2012  23.05.2017  GOVT.MARINE ACADEMY CH
Ship Safety Officer Course          
Revalidation COURSE          
Ref & Updating Trg          

License and Certification Information
 
COMPANY 		 
VESSEL NAME 		 
VESSEL TYPE 		 
D.W.T ./ GRT 		 
VSL AGE 		 
TYPE OF ENGINES – MANDATE 		 
RANK 		 
SIGN ON  DATE 		 
SIGN OFF DATE 		 
DURATION Y/M/D 		 
REASONS FOR S/OFF
UNITED OCEAN SHI MANAGEMENT.
SINGAORE 		M V UNITED SERENITY BULK CARRIER 82000 6 YEARS MAN MASTER 24/04/2015 28/08/2015 4M 03 D CMLETION OF CONTRACT
WALLEM SHIP MANAGEMENT.HK CEDAR 6 BULK CARRIER 79224 MT 3.5 YEARS MAN/B&W MASTER 25/05/2014 27/09/2014 4 M 02 DA COMPLETION OF CCCCONTRACTCONTRACT
WALLEM SHIP MANAGEMENT.HK PINE 2 MULTIPURPOSE VESSEL 34000 3 YEARS MAN MASTER 19/05/2013 14/10/2013 5  M OO D END OF CONTRACT
ACCORD MARINE MANAGEMENT PVT LTD M V AASHMAN LOG CARRIER 25000/
15045 MT 		28 YEARS MAN MASTER  
17/02/2012		 
13/07/2012		4 M 27D END OF CONTRACT
 SIMATECH  SHIPPING LLC SIMA SAMAN CONTAINER
1500 TEUS 		 18000 MT  4 YEARS MAN/B&W MASTER 19/05/2011  25/08/2011   
03M 06D 		END OF CONTRACT
 SIMATECH  SHIPPING LLC  SIMA PAYA CONTAINER
1300 TEUS 		17500  MT 4 YEARS MAN/B&W MASTER  
25.09.2010 		 
04.02.2011 		 
04M 08D 		END OF CONTRACT
 MANSHIP PTE/SINGAPORE QC  VISION Container
991 TEUS 		9957 GRT MT 1 YEARS MAN MASTER 24/11/2009  16/05/2010  04M 22D END OF CONTRACT   
 MANSHIP PTE/SINGAPORE  M V GENIUS Container
991 TEUS 		 9954 GRT MT 1 YEARS  
 MAN 		 
 MASTER 		24/11/2008  28/05/09  06M 04D END OF CONTRACT  
 AL UNITED MARITIME  EASTERN SEA MULTIPURPOSE /LOG CARRIER
800 TEUS 		 10018 GRT 20 YEARS  
 SULZER 		MASTER 06/12/2007  24/06/2008   06M 00D END OF CONTRACT  
 MAERSK LINE  SEALAND INTEGRITY CONTAINER
4614 TEUS 		 57075
GRT
  		  22 YEARS MAN CHIEF OFFICER 26/03/2007  26/06/2007  03M 00 D END OF CONTRACT  
 
MAERSK LINE 		  SEALAND INTEGRITY CONTAINER
4614 TEUS 		 57075
GRT
  		 22 YEARS4 MAN CHIEF OFFICER 04/06/2006  27/08/2006  02M 24D
  		END OF CONTRACT  
 
MAERSK LINE 		 MAERSK WIND  
RO RO/PCTC
5200 UNITS 		51770 GRT   4 YEARS   KAWASAKI CHIEF OFFICER27/05/2004  09/10/2004  04 M 15 D END OF CONTRACT  
 
MAERSK LINE 		  MAERSK ANTWERP CONTAINER
992 TEUS 		14063
GRT  		    KAWASAKI CHIEF OFFICER  13/10/2003 03/02/2004   03M 20D END OF CONTRACT  
MAERSK LINE  
SEALAND INTREPID 		  CONTAINER
4060 TEUS 		49985 GRT  5 YEARS KAWASAKI  CHIEF OFFICERR 28/03/2003  01/08/2003  
04M 03D 		END OF CONTRACT
 MAERSK LINE  MAERSK ATLANTIC CONTAINER
992 teus 		14063
GRT  		 4 YEARS  KAWASAKI CHIEF OFFICER  20/08/2002   21/12/2002 04 M 03 D END OF CONTRACT
Ocean Tramping.HK SEA DANIEL BULK CARRIER 36000 DWT  12 YEARS  
DOXFORD 		CHIEF OFFICER 05/09/90 27/04/91 07M 22D  
END OF CON
Ocean Tramping APT MARINER BULK CARRIER 44000 DWT 15 YEARS MAN CHIEF OFFICER 05/08/91 12/02/92 06M 07D  
END OF CON
 


MISCELLANEOUS – Please provide below details for further assessment  
A} DECK OFFICERS    
Sea Time in Rank – e.g 12 m 15 days
Sea Time on Type vsls
Overall Tanker Exp                             
  		MASTER = 41 M 07 DAYS/Cont & bulk
C/O = 41 M 28 DAYS cont & bulk/g Cargo 		 
Chemical: Type of Cargo Carried  
NA 		 
Tanker: Type of Pumps  
NA 		 
Vetting:  
NA 		 
B} ENGINEERS    
 
Sea Time in Rank – e.g 12 m 15 days
Sea Time on Type vsls
Overall Tanker Exp                             
  		 
  		 
 
Automation: {Type} 		   
Vetting:  
  		 
C}ELECTRICAL OFFICERS    
Automation:{Type}  
  		 
EXP on Inert Gas System  
  		 
PLC {NAME}    
D} GENERAL TRADING AREA OF VESSEL  
  		 
E} OIL MAJOR INSPECTIONS  
  		 
F}DRY DOCKING EXPERIENCE  
  		 
G}PRE-SEA TRAINING {Period/Institution}  
  		 
H} SCHOLASTIC EDUCATION  
  		 
References (Please give the name and address of your current or immediate past employer)  
   
S. NO NAME ADDRESS TELEPHONE NO
1. Mr. Vikram United Ocean Ship mng MManagement Management 91 22 28533337
       
 Officer Approved by : Officer Approved by Technical Team  
 Signature        : Signature :  
 Date                 : Date         :  
Sea time calculations mentioned above Mandate for all TOP FOUR officers being proposed, wit
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