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Individual information
Name Surname
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Nationality
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Afganistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antartica
Antigua And Barbuda
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Carribbean
Cayman Islands
Cayman Islands
Central African Republic
Chad Republic
Chile
China
Christmas Island
Cocos (Keeling) Islands
Columbia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'lvoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada and Carriacuou
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea South
Kosovo
Kuwait
Kygyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Maderia
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia Federated States
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion Island
Romania
Russia
Rwanda
San Marino
Sao Tome
Saudi Arabia
Senegal Republic
Serbia Republic of
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St Helena
St Pierre And Miquelon
St. Kitts
St. Lucia
St. Vincent
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands, U S
Wallis and Futuna Islands
Western Samoa
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
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Date Of Birth
*
Day
01
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04
05
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10
11
12
13
14
15
16
17
18
19
20
21
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28
29
30
31
-
Month
January
February
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April
May
June
July
August
September
October
November
December
-
Year
1949
1950
1951
1952
1953
1954
1955
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1980
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1991
1992
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1994
1995
1996
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1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
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Female
Marital Status
Single
married
Military Obligation
Not done
Done
Postponed
Exempt
Adress
Cellular Phone
E-Mail Adress
*
Password
*
Drivers Licence
not existing
Existing
have finished school
Education Completion Year
Language 1 / Condition
/
Average
Good
Very Good
Language 2 / Condition
/
Average
Good
Very Good
Language 3 / Condition
/
Average
Good
Very Good
Skills And Activities (Professional)
Skills And Activities (Special)
Additional Information
Working Experience
Working Area
Office
Vessel
Office & Vessel
Working Experience
Company Name
Your Task
Working Year / Duration
Ship Name
DWT
/
/
/
References
Company Name
Person
Work Phone
Cellular Phone
Ship Licence No
Date Of Expiry
Seamanbook No
Competency
Port Of Registry
Registry No
Visa Expiry
STCW Certificates
not existing
Existing
GOC Certificate
not existing
Existing
GOC Date Of Expiry
REO Certificate
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Existing
REO Date Of Expiry
ISPS Certificate
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Existing
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