CHIEF ENGINEER
APPLICATION FORM |
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Position chief engineer ID/PD No. (For Office Use Only) _______________________ |
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Position applied for: |
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Are you willing to accept any other positions? If YES, which positions would you consider? |
NO |
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Are you responding to a media advertisement? If YES, please state which publication |
NO |
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From what date will you be available? ( Ready to join Any Time) |
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2 |
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Personal details |
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Name: |
(Surname) NADUKKUDY |
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(First Names) MOIHEEN |
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(Middle Name) ALIAR |
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Date/Place of Birth: |
15/02/1960 |
Nationality: |
INDIAN |
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Permanent address: |
NADUKKUDYIL HOUSE,PAIMATTOM,PAREKKANNY.P.O, E K M (Dist.) KERALA(State) |
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INDIA. |
Pin Code: -686693 |
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E-Mail: |
nadukkudy@gmail.com |
Tel No:-Mobile:-9987765179 |
Mobile |
9820487716 |
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Local address: |
403-SWATI, AKASH GANGA COMPLEX,VIJAY GARDEN, GAUD BUNDER ROAD, |
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THANE (WEST), MAHARASRA (STATE) INDIA. |
Pin Code: 400615 |
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E-Mail: |
nadukkudy@ymail.com |
Tel No.04722802023/8655050151 |
Mobile |
9496195812 |
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3a |
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Educational Background
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Qualification |
School / College |
From |
To |
Percentage/ Grade |
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S S L C |
ST JOHNS H S |
1974 |
1975 |
70 / First class |
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PRE DEGRE |
MAR AHENESIOUS COLLEGE |
1976 |
1978 |
83 / First class |
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Technical Background
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Degree/ Diploma |
Institute/ College |
From |
To |
Percentage / Grade |
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B E MECHANICAL |
MAR AHENESIOUS COLLEGE |
1979 |
1984 |
72/ First class |
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M B A |
I I B M INSITUE OF BISNESS MGT |
2013 |
2014 |
A PLUS |
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4 |
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Identity documents |
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DOCUMENT |
COUNTRY |
NUMBER |
DATE OF ISSUE |
PLACE OF ISSUE |
DATE OF EXPIRY |
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Passport: |
INDIAN |
J 9456157 |
17/01/12 |
COCHIN |
16/01/22 |
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Seaman Book: |
National |
MUM 105155 |
30/05/12 |
MUMBAI |
29/05/22 |
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PANAMA C D C |
Panama |
200248589 |
24/11/16 |
PANAMA |
15/11/21 |
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Liberian |
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Honduras C D C |
HONDURAS |
T I R-51-RH -21326 |
03/06/15 |
HONDURAS |
03/06/20 |
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Do you hold a US Visa ‘C1/D’?
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YES |
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Issue Date: |
21/11/08 |
Expiry Date: 18/11/13 |
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Do you hold a US Visa ‘B1/B2’?
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NO |
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Issue Date |
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Expiry Date: |
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Have you been rejected for any visa applied for? |
NO |
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If YES, please state the country and reasons |
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INDOS No: (only for Indian) 0IEL 1632 |
YELLOW FEWER - LOT NO : 039-Exp Date-12/01/2022
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MUI NO : E 043130 |
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Family Details: (If Unmarried kindly give details of Father / Mother) |
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NAME
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Relation |
DOB |
POB |
PASSPORT NO. |
PLACE OF ISSUE |
DATE OF ISSUE |
DATE OF EXPIRY |
ECNR |
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DR SHAFNU R.S. |
WIFE |
22/09/72 |
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6 |
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Certificates (Highest certificate of competency held) CHIEF ENGINEER |
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Grade/Class Of COC Country |
Issuing Country |
Date of Passing Exam |
Certificate No. |
Date Issued |
Place Issued |
Valid Until |
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CHIEF -ENG |
PANAMA |
29/10/16 |
CT040550/16 |
24/11/16 |
PANAMA |
15/11/21 |
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CH ENG |
HONDURAS |
14/08/09 |
MN-1942-M- |
03/06/15 |
HONDURAS |
03/06/20 |
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Certificates Of Competency issued by other countries (Issued by countries other than in Section 6) |
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Issuing Country |
Certificate No. |
Date Issued |
Place Issued |
Valid Until |
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HONDURAS |
MN-1942-M |
14/08/09 |
HONDURAS |
03/06/20 |
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8 |
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Details of Courses |
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ALL Courses UP Dated -2010 |
Certificate No. |
Issued By |
Date Issued |
Date Of Expiry |
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FPFF / AFF |
REF/AFF-98-14/001053 |
URO TEC |
07/07/14 |
06/07/19 |
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MEDICARE |
REF/MFA-43-14/000554 |
URO TEC |
18/07/14 |
17/07/19 |
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PSCRB |
REF/PSCRB-99-14001179 |
URO TEC |
08/07/14 |
07/07/19 |
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PST |
REF/PST-152-14/001852 |
URO TEC |
08/07/14 |
07/07/19 |
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PSSR – Personal Safety & Social Responsibilities |
PSSR/EMA-926-14/015436 |
URO TEC |
10/07/14 |
UNLIMITED |
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SSO – Ship Security Officers Course |
REF/SSO-1/19-14/001348- |
URO TEC |
18/07/14 |
UNLIMITED |
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S S O LICENCE PANAMA (ENDORDEMENT) |
SSO- 00143288 |
PANAMA |
16/11/16 |
07/10/21 |
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S S O LICENCE-HONDURAS (ENDORSEMENT) |
MN-1026 |
HONDURAS |
03/06/15 |
03/06/20 |
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MEDICAL FIRST AID |
MFA-006/01/APR/16 |
SEVEN SEAS |
06/04/16 |
05/04/16 |
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Chief engineer updated course( FROM SHIP RAHMAN) |
PEC-055-2009 |
Ship Rah Rahman |
14/08/09 |
UN LIMITED |
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ELEMENTRY FIRST AID |
EFA-0011/01FEB/16 |
SEVEN SEAS |
26/02/16 |
UNLIMITED |
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Chief engineer updated course (Panama) |
CC/14-01-076 |
Prof Mariti |
25/11/14 |
UNLIMITED |
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TANKER ENDORSEMENT |
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Oil Tanker endorsement(TASCO) MGT LEVEL |
CTB 230690 |
Panama |
30/07/2014 |
29/04/2019 |
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Chemical Tanker Endorsement(CMEMCO) MGT LEVEL |
CTB 230690 |
Panama |
27/01/2014 |
16/01/2019 |
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Gas Tanker Endorsement (GASCO) MGT LEVEL |
CTB 230690 |
Panama |
08/01/2014 |
19/12/2018 |
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TANKER COURSES |
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Tanker safety (TASCO) |
EMA/47-10/373 |
UroTech |
30/04/2010 |
Un limited |
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Chemical Tanker Safety (CMEMCO) |
SCTO/2371/2009 |
O E R C |
14/05/2009 |
Un limited |
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Gas Tanker Safety ( GASCO) |
STPLGT/1100/2013-14 |
O E R C |
19/12/2013 |
Un limited |
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Tanker vetting Inspection |
Cert.No.201 |
UNIVAN |
04/02/08 |
Unlimited |
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Instrumentation & Shipboard Control Systems |
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Automation and Controls |
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Container Refrigeration |
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Hydraulics for Engineers (Basic / Advance) |
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Hazmat (In compliance with STCW-95 Section-B -V/b & V/c & CFR – 49) CFR-49 |
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Hydraulics and Pneumatics Workshop |
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PROFICIENCY IN FAST RESCUE BOATS |
0105/01/OCT/2016 |
SEVEN SEAS |
05/10/16 |
04/10/16 |
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Applied Electronics (AELC) |
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Practical Marine Electrical Workshop |
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Engine Equipment Maintenance Workshop |
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Basic Electrical and Fluid Technology |
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Reefer Container and Maintenance Course |
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ENGINE ROOME RESOURSE MGT |
ERM-0113/02/SEP/16 |
SEVEN SEAS |
21/09/16 |
2O/09/21 |
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LEADER SHIP AND TEAM WORK |
LSTW-0158/02/OCT/2016 |
SEVEN SEAS |
14/10/16 |
13/10/21 |
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MARINE ENVIRONMENTAL AWARENESS |
MEA-0156/01/OCT/2016 |
SEVEN SEAS |
29/10/16 |
28/10/21 |
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ENGINE ROOM SIMULATOR |
ERS-0061/01SEP/16 |
SEVEN SEAS |
15/09/16 |
14/09/21 |
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S T S D S D ( From B P Marine) |
STS/3762/2014 |
B P Marine |
14/11/2014 |
Unlimited |
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POLICE CLEARENCE CERTIFICATE |
SB /VRFN/PVT JOB/ |
THANE |
18/12/15 |
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09000/2015 |
SPOFFICE |
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Note:- Application for the post for chief engineer on oil/chemical/product /Bitumen /storage Tanker /container,
Bulk carrier/Ahts/off shore vessel.
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9 9 |
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Record of previous service |
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(Please give a full record starting with the last vessel on which you served) |
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COMPANY |
VESSEL NAME |
VESSEL TYPE |
GRT |
CONTS TEU’S |
VSL AGE |
TYPE OF ENGINES (Please give full dtls) |
B.H.P |
RANK |
SIGN ON dd/mm/yy |
SIGN OFF dd/mm/yy |
DURATION yy/mm/dd |
REASONS FOR S/OFF |
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Integrity ship mgt |
M.T. Ark Pioneer |
Che T |
4526 |
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25 |
Akasakh Mitsubhishi |
4200 |
Chen |
21/11/16 |
20/01/17 |
2 Months |
Short contract |
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Integrity ship mgt |
M.V. Yangtze |
B/C |
38678 |
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16 |
Mitisui BMW |
13238 |
Chen |
08/04/16 |
03/09/16 |
4M 27Days |
Contract comp |
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Integrity ship mgt |
M.V.Feng |
B/C |
39464 |
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32 |
Hitachi BMW |
12500 |
Cheng |
22/10/15 |
10/11/15 |
20 Days |
Repair job |
Note:- Application for the post for chief engineer on oil chemical/product/bitumen/storage tanker/bulk carrier/container/Ahts/off shore vessel.
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9 9 |
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Record of previous service |
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(Please give a full record starting with the last vessel on which you served) |
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COMPANY |
VESSEL NAME |
VESSEL TYPE |
GRT |
CONTS TEU’S |
VSL AGE |
TYPE OF ENGINES (Please give full dtls) |
B.H.P |
RANK |
SIGN ON dd/mm/yy |
SIGN OFF dd/mm/yy |
DURATION yy/mm/dd |
REASONS FOR S/OFF |
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D N S ship mgt |
M.T.Dawn 1 |
Chm Tkr |
6253 |
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18 Year |
Mitsubishi |
4900 |
Ch eng |
19/02/14 |
20/06/14 |
4 Months |
Contract compli |
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Shan ship mgt |
M.V.Ruby star |
B/C |
24926 |
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5 |
B & W-Doosan |
11426 |
Ch eng |
10/11/13 |
07/12/13 |
27 days |
Safe manning |
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Shan ship mgt |
M.V.Ruby star |
B/C |
24926 |
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5 |
B & W-Doosan |
11426 |
Ch eng |
17/09/13 |
15/10/13 |
29 days |
Safe manning |
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Aquarius ship |
M.T.Armada gema |
Chm Tkr |
5387 |
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17 |
B & W |
5280 |
Ch eng |
18/12/12 |
05/03/13 |
2 m 17 days |
Dry dock work |
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Accord ship mgt |
M.V.Don Raul |
B/C |
22060 |
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22 |
Sulzer 6Rta-58 |
9870 |
Ch eng |
23/03/12 |
16/06/12 |
2M 26 days |
Short contract |
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Trans ocean ship mgt |
M.T.Vrinda |
Chm Tkr |
3075 |
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19 |
Watsilla |
1820Kw |
Ch eng |
21/07/11 |
28/12/11 |
5 M 08 days |
Contract compl complit/ |
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Idico Marine Time |
M.V.Doce River |
CapBu B/C |
79184 |
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20 |
Man B & W |
17100 |
Ch eng |
14/04/11 |
14/05/11 |
1 M 01 days |
Delivery voyage |
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Star ship mgt |
M.T.Rising om |
Chm Tkr |
2237 |
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23 |
Watsilla 6R32 |
2275 k |
Ch eng |
01/10/10 |
13/01/11 |
3 M 13 days |
Contract compl |
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Hind offshore |
M.V.Hind khush |
Ahts |
16210 |
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19 |
Berger Kvmb12 |
12200 |
Ch eng |
13/06/10 |
23/07/10 |
1 M 15 days |
Contract compl |
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Lilly Maritimes |
M.T.A E |
Tank |
3800 |
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16 |
Daihatsu |
3300 |
Ch eng |
19/1109 |
27/03/10 |
4 M 16 days |
Contract compli |
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E c ship mgt |
M.V.Gem Haldia |
B/C |
37324 |
|
17 |
B & W 7167gfca |
15200 |
2ndeng |
18/02/09 |
26/04/09 |
2 M 08 days |
License expired |
|
E c ship mgt |
M.V.Saga |
B/C |
29235 |
|
16 |
Sulzer 7RTa 58 |
12170 |
2ndeng |
04/12/08 |
09/01/09 |
1 M 05 days |
Dry dock work |
|
Univan ship mgt |
M.T.Almasilah |
Prdt Tkr |
8750 |
|
16 |
B & W5L45gfca |
4990 |
2ndeng |
07/02/08 |
10/07/08 |
5 M03 days |
Contract compli |
|
S N P shipping service |
M.V.Protector |
B/C |
24924 |
|
18 |
Sulzer 6RTa 58 |
9870 |
2ndeng |
02/05/07 |
02/09/07 |
4 M 02 days |
Contract complit |
|
S N P shipping |
M.V.Nds Princes |
B/Container |
16564 |
|
17 |
Sulzer 8Rnd68 |
15266 |
2ndeng |
09/08/06 |
02/12/06 |
3 M23 days |
Contract complit |
|
Karasan ship mg |
M.V.Aliya |
B/C |
9814 |
|
23 |
Sulzer Rd 68 |
7200 |
2ndeng |
12/03/05 |
28/12/05 |
8 M 16 days |
Contact complit |
|
Karasan ship mg |
M.T.Tam River |
Crud Tkr |
31977 |
|
20 |
Man K7sz-78 |
16100 |
2ndeng |
12/07/03 |
13/09/03 |
2 M 01 days |
Demolution |
|
A B S Marine serve |
M.V.Angavel |
Ahts |
125 |
|
6 |
B & W |
3482K |
2ndeng |
04/06/02 |
20/06/02 |
16 days |
Short contrct |
|
A B S Marine serv |
M.V.Miriam |
G Cargo |
753 |
|
24 |
Wikspoor |
1100 |
2ndeng |
05/08/01 |
21/09/01 |
1 m 16 days |
Short contract |
|
Karasan ship mgt |
M.V.Hider Bey |
B/C |
24984 |
|
16 |
Sulzer 6Rlb 56 |
11000Hcp Sulzer |
3rdeng |
25/05/00 |
26/09/00 |
4 M 02 days |
Contract complit |
|
S N P shipping co |
M.V.Ogooue |
B/contaner |
16564 |
|
15 |
Sulzer 8 Rnd 68 |
15266 |
3rdeng |
12/03/98 |
05/06/99 |
2 M 23 days |
Short contract |
|
Bright star ship co |
M.V.Navigator |
GCD |
960 |
|
18 |
Deutz |
1060 |
2ndeng |
05/11/96 |
11/07/97 |
7M/16 days |
Contract complit |
|
Bright Star ship co |
M.V.Ocean bride |
GCD |
3226 |
|
17 |
Mak6M453 |
3250 |
3rdeng |
04/10/95 |
10/02/96 |
3M/14days |
Contract complit |
|
Bright star ship co |
M.T.Victory |
Crd Tkr |
10334 |
|
16 |
Mitsubhishi |
9300 |
3rdeng |
08/10/94 |
02/07/95 |
8M/24Days |
Contract Compl |
|
European Navigat |
M.V.Lilly |
B/C |
24626 |
|
18 |
Man B&W |
12100 |
4ttheng |
02/12/92 |
05/06/93 |
6M/01Days |
Contract compl |
|
European Naviga |
M.T.Calanda |
Crud T |
29262 |
|
17 |
B&W |
15040 |
4theng |
18/02/92 |
15/09/92 |
8M.03Days |
Contract compl |
|
10 |
|
For Engineers (Please provide details) |
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GENERATORS
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ALL TYPES OF GENERATORS |
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PURIFIERS &BOILERS
|
ALL TYPES OF PURIFIERS & BOILERS |
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TYPES OF CRANES / PUMS |
ELECTRICAL&HYDRO ELECTRIC CREANES / MECHANICAL&HYDROLIC GRABES PUMPS:- SCREW P/P,CENTRIFUGEL P/P & FRAMO P/P |
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11 |
|
Sailing Experience: (Please advise PRESENT RANK EXPERIENCE on each type of vessel) |
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CONTAINER |
BULK CARRIER |
REFER |
TANKER |
Others |
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EXPERENCE IN CONTAINER |
EXPERENCE IN BULK & CAP BULK |
EXPERENCE IN REFER |
OIL CHEMICAL/PRODUCT& CRUDTANKER |
AHTS&OFF SHORE VESSEL |
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LAST SALARY DRAWN (PLEASE MENTION CURRENCY) USD- - NAGOSHIABLE |
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12 |
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Medical history |
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Have you ever signed off a ship due to medical reasons?
|
NO |
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Have you undergone any operation in the past?
|
NO |
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Have you consulted a doctor during the last 12 months for an illness/accident?
|
NO |
|
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Do you have any health or disability problems now? |
NO |
|
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Note: - I STARTED MY SHIPPING CARRIER ON 1990 AS A FIFTH ENGINEER Work shop experience: - 5 years work shopexperience in Diesel engine repairing&overhauling/All types of general engineering works/Fabrication of pipe lines&tankes/experience in ship gas tight/weather tight/Air tight& water proof doors/ Fabrication of expansion bellows/Installing of generators/pumps &Motors. |
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13 |
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General |
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Have you ever been the subject of a court of enquiry or involved in a maritime accident? |
NO |
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Have you ever had a professional license suspended or revoked? |
NO |
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Note:- I HAVE 6 VESSEL DRY DOCK EXPEREANCE (IAM READY TO DO DRY DOCK JOB/ REPIR JOB&DEMOLUTION) |
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14 |
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References (Please give the name and address of your current or immediate past employer) |
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Name of company |
1) D N S MARINE SERVICESES |
2) INTEGRITY SHIP PVT LTD |
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Name of person to contact |
FLEET PERSONNEL |
FLEET PERSONEL |
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Address |
MR A.K .SINGH |
Mr Anil Pandai/+917059555165/8584019652 |
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|
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022, 65364777 |
Mr Absel+ 919007856301/9903564381 |
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No. |
+91,7718844057/9322338228 |
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15 |
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Review |
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If immediate employment is not available do you wish to be considered for future vacancies? |
YES |
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If YES, please give any alternative contact details not shown in Section 2- 7994505809/8655050151/9496195812
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16 |
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Declaration |
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I hereby that the above particulars are true and authorise you to contact the referees listed above. |
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Date- 22/06/17 |
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Signature |
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17 |
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BOILER SUIT SIZE: XXL SAFETY SHOE SIZE: 42 SIZE/8’’ |
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