Hind Offshore Pvt. Ltd.


	Anchor Handling

	Offshore Supply

	Pipe & Cargo Transportation

	Offshore Accommodation

	Diving Support

	Topside Maintenance

	Towing

	Personnel Transfer

Download Crew Application Form

Crew Application Form

Name :

Rank :

Nationality :

INDos No :

Date of Birth :

Place of Birth :

Marital Status :

Present Address :

Permanent Address :

Email Address :

Contact No. :

Mobile No. :

Name of Next of Kin :

Address of Next of Kin :

Relationship :

Passport No.	Place of Issue	Date of Issue	Expiry Date

C.D.C. No.	Place of Issue	Date of Issue	Expiry Date

Boiler Suit Size :

Safety Shoe Size :

WATCH – Keeping Certificate (Deck & Engine Ratings)

Rank	Cert. No.	Date of Issue	Place of Issue

Details Of Certificate Of Competency

Certificate	Rank	Cert. No.	Place of Issue	Date of Issue	Date of Expiry
National :

Trade / Graduate & Other Certificate

Certificate	Rank	Cert. No.	Place of Issue	Date of Issue	Date of Expiry

Type	Vessel Name	Grt/Engine Type / Kw	Rank	From	To	Months	Days	Agent / Principal

Record Of Stcw Certificated Held

Name Of Certificate	Certificate No.	Place Of Issue	Issue Date	Expiry Date
PSCRB/Personal Survival Technique
Advance Fire Fighting / FPFF
MFA / EFA
PSSR
Radar Observer / ARPA / RANSCO
GMDSS / GOC
SSO Cert. / ISPS Familiarization Course

Applicant Declaration

Please answer the following question		If yes, please provide details
Have you previous injuries of sickness ?	Yes No
Have been dismissed or logged for mischief ?	Yes No
Any criminal offence ?	Yes No
Any medical restrictions / drugs / allergies ?	Yes No
Any past history or medical / mental condition ?	Yes No
Can we make reference check with ex employer ?	Yes No

Last Wages / Salary :

Expected Salary :

I certify that the information given herein are true and correct to the best of my knowledge. Any false information may be subjected to legal actions voiding of any benefits arising form my employment contracts.

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