APPLICATION FORM ACROPOLIS MERITIME
DEPARTMENT: MIN. SALARY :
POSITION APPLIED FOR : Mother's name:
Surname: Name: Father's name:
Date of Birth: Place of Birth: Nationality:
Permanent Address:
Phone (home): Mobile/GSM: Tel: E-mail:
Marital Status: Children under 18 years: Next of kin:
Spouse name: Address:
  Phone:
Date of birth: Nearest airport:
   
Height met.: Weight kg.: Color of hair: Colour of eyes:
English (Required): Reading level: Speaking level:
Other language: Reading level: Speaking level:
CERTIFICATES
Officers / Ratings Number Issued Valid Place of issued
SEAMAN'S PASSPORT
OTHER SEAMAN'S BOOK
TRAVEL PASSPORT
CERTIFICATE OF COMPETENCY
ENDORSEMENT
CERT. OF COMPETENCY (UPDATE)
OTHER CERTIFICATES (STCW CODE)
PERSONAL SUR. TECHNIQUES (A-VI/1)
SURVIVAL CRAFT AND FAST RESCUE BOATS (A-VI/2)
ADVANCED FIRE FIGHTING (A-VI/3)
GMDSS (IV/2)
RADAR OBSERVATION (A-II/1)
ARPA (A-II/2)
DANGEROUS/HAZARDOUS (B-V/4, B-V/5)
TANKER'S FAMILIARISATION (A-V/1)
SHIP SAFETY/SECURITY OFFICER
BREATHING APPARATUS
CROWD MANAGEMENT(A-V/3)
YELLOW FEVER Vaccinated
VERITAS CERTIFICATE
SHIP'S
EDUCATIONAL INSTITUTION TOWN / COUNTRY FROM m/y TO m/y TYPE OF DEGREE DIPLOMA RECEIVED
PREVIOUS SEA SERVICE
(Please fill in completely and detail for last 5 years. Fill in last employment first)
VESSEL TYPE/DWT ENGINE/HP RANK S/ON S/OFF FLAG OWNERS
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I hereby certify that the statements contained here are true and correct to the best of my knowledge.