Desired position

Date of availability Position applied for

Desired salary (EUR) Desired contract duration (week)

ENGLISH

Personal Data

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NAME SURNAME DATE OF BIRTH PLACE OF BIRTH CITIZENSHIP

HEIGHT WEIGHT COLOUR OF EYES COLOUR OF HAIR CIVIL STATUS

NUMBER OF CHILDREN NEXT OF KIN (NAME) RELATION FAMILY NUMBER ADDRESS NEXT OF KIN

Contact information

PERMANENT ADDRESS PHONE NUMBER

MOBILE NUMBER EMAIL ADDRESS

NEAREST AIRPORT

Documents

DOCUMENTS GRADE

NUMBER PLACE OF ISSUE

ISSUED VALID

Sea service

FOR TOP OFFICERS LAST 10 YEARS, junior officers and ratings last 5 years

TYPE OF VESSEL FLAG RANK

SHIP IMO NAME OF VESSEL NAME OF COMPANY

GRT ENG TYPE

HP dWT

PERIOD_FROM PERIOD TO

References

COMPANY

TELEPHONE

OTHER I hereby confirm that I give consent with regards to the fully processing of my personal data for the all formalities and purposes related of my employment on board the vessels. I understand that my personal data will be stored and will be distributed for service purposes and reporting when required. I have been well-informed on the right to request to access and rectification or erasure of my personal data and the right to withdraw this consent at any time. This consent does not have a date of expiration and is given of my own free will.terms and conditions must be accepted to processed