APPLICATION FORM
|
Position applied for: |
Chief Engineer |
|
|
Identity documents |
||||||||||
|
|
|||||||||||
|
|
DOCUMENT |
COUNTRY |
NUMBER |
ISSUED |
PLACE |
EXPIRY |
|||||
|
|
Passport: |
India |
J1434688 |
28-12-2010 |
Bhopal |
27-12-2020 |
|||||
|
|
Seaman book: |
India |
CL41182 |
04-11-1974 |
Kolkata |
06-03-2025 |
|||||
|
|
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|||||
|
|
|
Other |
|
|
|
|
|||||
|
|
Do you hold a US Visa ‘C1’?
|
YES |
|
|
|
11-09-2017 |
|||||
|
|
Do you hold a US Visa ‘D’?
|
YES |
|
|
|
11-09-2017 |
|||||
|
|
Have you been rejected for any visa applied for? |
|
NO |
|
|||||||
|
|
If YES, please state the country and reasons |
|
|||||||||
|
|
Highest Certificates of Competency held |
||||||
|
|
|||||||
|
|
Class / Grade |
Issuing Country |
Certificate No. |
Date Issued |
Place Issued |
Valid Until |
|
|
|
CLASS I |
India |
95W-1988 |
26-07-2001 |
Kolkata |
12-05-2021 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Highest Certificates Of Competency issued by other countries (Issued by countries other than in Section 6) |
|
|||||||
|
|
|
||||||||
|
|
Class |
Issuing Country |
Certificate No. |
Date Issued |
Place Issued |
Valid Until |
|||
|
|
Chief Engineer Officer |
Singapore |
COE-E0120538 |
03-06-2016 |
Singapore |
|
|||
|
|
|
Panama |
|
|
|
|
|||
|
|
|
Bahamas |
|
|
|
|
|||
|
|
Courses attended and certificates obtained |
|||||||
|
|
||||||||
|
|
Sr.No. |
Course |
Institution |
Place |
Date |
Cert. No. |
Valid Until |
|
|
|
01 |
Medical First Aid (Basic/Advance) |
ARI |
Delhi |
02-04-2016 |
UGE(M) 16056 |
01-04-2021 |
|
|
|
02 |
Personal Survival Technique |
TRAINING SHIP ‘RAHAMAN’ |
MUMBAI |
24-08-1986 |
20674 |
28-02-2021 |
|
|
|
03 |
Basic Fire Fighting |
- |
- |
- |
- |
- |
|
|
|
04 |
Advanced Fire Fighting |
CMET |
Lucknow |
29-02-2016 |
CMETL/RT-AFF&FPFF/289/3734 |
27-02-2021 |
|
|
|
05 |
Proficiency In Survival Craft & Rescue boat |
CMET |
Lucknow |
01-03-2016 |
CMETL/RT-PSCRB&PST/285/3823 |
28-02-2021 |
|
|
|
06 |
Fast Rescue boat course |
|
|
|
|
|
|
|
|
07 |
Tanker Familiarization Basic (Oil/Chemical/Gas)
|
|
|
|
|
|
|
|
|
08 |
Advanced Tanker Course: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
09 |
Ship Master Medicare course |
|
|
|
|
|
|
|
|
10 |
GMDSS |
|
|
|
|
|
|
|
|
11 |
Bridge Team Management |
|
|
|
|
|
|
|
|
12 |
Bridge Resource Management |
|
|
|
|
|
|
|
|
13 |
Liquid Cargo Handling Simulator (LCHS) |
|
|
|
|
|
|
|
|
14 |
Ship Handling Simulator Course |
|
|
|
|
|
|
|
15 |
ECDIS |
|
|
|
|
|
|
16 |
Radar / ARPA |
|
|
|
|
|
|
17 |
Ship Security Office (SSO) |
FOSMA |
Noida |
15-07-15 |
104/10686/1515 |
Unlimited |
|
|
|
|
|
|
|
|
|
18 |
Ship Safety Officer |
|
|
|
|
|
|
19 |
Engine Room Simulator |
|
|
|
|
|
|
20 |
ISM Code |
|
|
|
|
|
|
VESSEL |
COMPANY# |
VESSEL TYPE |
FLAG |
DWT |
YEAR BUILT |
MAIN ENGINE |
B.H.P. |
RANK |
SIGN ON DATE |
SIGN OFF DATE |
|
MAKE |
TYPE |
||||||||||
|
GAIA LEADER |
WALLEM |
PCC |
SINGAPORE |
21286 |
|
UEC |
|
21129 PS |
C/E |
02-06-16 |
19-10-16 |
|
GAIA LEADER |
WALLEM |
PCC |
SINGAPORE |
21286 |
|
UEC |
|
21129 PS |
C/E |
30-07-15 |
16-02-16 |
|
VIRGO LEADER |
NYK |
PCC |
PANAMA |
61854 |
|
UEC |
|
21128 PS |
C/E |
23-10-14 |
07-01-15 |
|
FRONTIER EXPLORER |
NYK |
BULKER |
PANAMA |
93228 |
|
BMW |
|
18660 KW |
C/E |
11-03-14 |
24-07-14 |
|
LBC EARTH |
NYK |
BULKER |
MALTA |
42744 |
|
UEC |
|
10115 KW |
C/E |
20-07-13 |
05-12-13 |
|
NBA MONET |
NYK |
BULKER |
|
43013 |
|
UEC |
|
9710 KW |
C/E |
06-11-12 |
20-04-13 |
|
Safesea neha |
Noah ship management |
BULKER |
LIBARIAN |
48893 |
|
SULZER |
|
7700 KW |
C/E |
23-01-2017 |
05-05-2017 |
|
M.V Navdhenu sun |
Accord |
bulker |
INDIAN |
27193 |
|
BMW |
|
6880 |
C/E |
05-06-2017 |
13-11-2017 |