NorteMare LLC

APPLICATION FORM

GENERAL INFORMATION
Position - oiler
Available from -
Family name - jawad
First name - jawad
Date and Country/Town of birth - 21 feb1988 peshawer pakistan
Home address - matrowell111.gulshaniqbal Karachi pakistan
Skype - jawad.ahmed923
Mob - 092331.0308688
English language knowledge - Excellent
Very Good
Marlins test Score-
Marital Status-
Next of kin ( name/relation/tel) -
Education - fsc
Schengen Visa No. 44711130
US Visa - No.

Min Sal. US$ - 600

Fathers name - ulfat ali
Nationality - pakistani
Nearest airport- karachi
international airport
E-Mail - jawadahmed88@outlook.com
Good yes Satisfactory
Poor
Other English Test Score -
Children (name/D.O.B.) -
Weight- 78
Height- 5.9
Boots size- 11
Overall size- madiam
Issued- /
Exp.- /
Issued- /
Exp.- /

RECORDS OF SEA SERVICE ( , )

No

Ships name

millennium 111

Type of
Vessel

GRT/(DWT)

supply

618

Main Engine
Type
(with
modification)

caterpeler

Power
BHP/(KW)

20

Flag

zanzibar

Owne
r/
Rank
Mana
ger

ahmed

4
5

/
/
Ref: Appl (1/15)

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Annex
1

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NorteMare LLC Application form

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Revision
4

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Page 1 of 3

oi
le
r

Period
from
(d/m/y)
till
(d/m/y)
1oct
2014
16 sep
2014
/
/
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/
//
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CONTACT DETAILS OF PREVIOUS EMPLOYERS

Ships name

Ship owner/Manager

Tel. / Email / Skype

Person in charge

millennium111

ahmed

burhan

NATIONAL PASSPORTS DETAILS

National Passport
International Passport (OVIR)
Seamans Passport

No. Dv8670981
Issued 07 aug 2012
Exp 06 aug 2017
Issued by -----------------------------------------------------------------No. Issued Exp No. 019129-s
Issued 31 Dec 2013
Exp 30 Dec2023

STCW- 78/95 COURSES

Number

Issued
Expired
6 FEB 2011 31 Oct2018

-------- -----

Competency Grade GP111

6130
Endorsement of Competency:

STCW- 78/95 A-VI/1 (Basic Safety)

---------(personal survival, fire prevention, elementary first aid & social responsibilities)
Proficiency in survival craft and rescue boats A-VI/2- ----------1
Advanced Fire Fighting A-VI/3
1484
4-05-2012
Medical first aid
A-VI/4-1
1492
9-5-2012
Ships medical care on Board

Radar Observation & Plotting

Automatic Radar Plotting Aids (ARPA)

GMDSS Operator (GOC, ROC) A-IV/2

Endorsement of GMDSS:

RO-RO / Passenger ships

ECDIS
A-II/1

RO-RO /Passenger ships Crowd Management Training

Ships Security Officer (SSO)

Bridge Team Management

Engine Team Management and Resources Management

Bridge Resources Management

Dangerous/Hazardous Cargo

C.O.W (Crude Oil Washing)

Refresh and Updating

Tanker Familiarization (Off & Ratings) A-V/1para.2-7

603
19-9-2012
Oil Tanker Safety/ Specialized Training V/1

Ref: Appl (1/15)

Annex
1

NorteMare LLC Application form

Country
pakistan

--------

-----

------

30-5-2018
30-5-2018

30-7-2018

pakistan
pakistan

Revision
4

Page 2 of 3

MEDICAL HISTORY
Ch. Tanker Safety/ Specialized Training

Have Safety/
you everSpecialized
signed off a Training
ship due toV/1
medical reason?
no
LPG. Tanker
you undergone
any medical operation in the past?
No
Inert GasHave
System
/IGS
Do you have any health or disability problem now? No
Large Vessels
Handling

Have you
consulted a doctor during the past 12 months for
illness/ accident? No
Maintenance of Elect. & Electron Equip.

Marine Environmental Awareness

GENERAL
QUESTIONS
ISM Familiarization

you ever signed off a ship due to drugs/alcohol or been dismissed? No

MedicalHave
Examination
Haveof
you
ever been
denied a foreign visa? No
Vaccination
Yellow
Fever

Have you been the subject of a court of enquiry or involved in a maritime accident? No
OTHER
ANDNoCERTIFICATES
Have you ever had a professional
licenceDOCUMENTS
suspended or revoked?

Personal safety and social responsibilities

1499
16-5-2012
30-5-2018
PersonalIfsurvival
techniques
1479
23-5-2012
30-5-2018
answer to any of the above is YES then give further details below or on a separate sheet

,

. ,

pakistan
pakistan

FLAG
STATE
DOCUMENTS

.

Document
Number
Issued
Expired
Country



, " 1
andros
603
3 sep,
2012
30-5-2018
pakistan
2010 marine
2297- ,

().

.
I declare that I recorded on this form all the required information, and the attachments given are
accurate and true, and this form is supplemented by me. I understand that any
intentional/unintentional misstatements or omissions may result in my immediate exclusion or
withdrawal of any appointment in the future. Hereby authorize NorteMare LLC or third parties
worldwide to maintain in electronic or other form, personal and medical data which are declared in
this form for recruitment purposes in accordance with the Law of Ukraine "On Protection of
Personal Data" from June 1, 2010 2297-UI and to check my previous references (employers). I
confirm accepting the special agreement for the prohibition of Drugs and Alcohol, test crisis.

Name/ :-__jawad________________________

Signature/ __jawad__________________
215_______________

Date/____9 -8-

INTERVIEWED

Ref: Appl (1/15)

Annex
1

NorteMare LLC Application form

Revision
4

Page 3 of 3