Please be so kind to send your photo in electronic format to the e-mail:
crew@rokosm.lv
ROKO SHIPMANAGEMENT Ltd.
APPLICATION FORM
Authorization for employment
Position
Surename
Firstname
Nationality
Sex
M
W
Height
Eyes Color
BLACK
BLUE
BROWN
DARK
GREY
GREEN
HAZEL
Place of birth / Date of birth
Clothes size
Shoes size
PERMANENT ADDRESS
Street
City/Country
Telephone
Mob.tel.
NEXT OF KIN
Surname/Name
City/Country
Telephone
Post code
LANGUAGES
English test performed on(date)
Certificate valid up to
Mother language
Other Languages
DOCUMENTS/CERTIFICATES OF COMPETENCY
Documents name
Number
Date/place of issue
Expire
1.Passport
2.Seaman book
CERTIFICATE OF COMPETENCY (A II/1-4, A III/1-4)
Date of issue
Date of expiry
Type of license
Date of issue
Date of expiry
Endorsement
Institution
Educational background
From
To
Degree
STCW - 95
Regulation STCW-95
Cert.Nr.
Date/place of issue
Expire
Basic Safety Course (vi/1)
Advanced Fire Fighting (vi/3)
Survival Craft and Rescue boats (vi/2-1)
Proficiency in Fast Rescue boats (vi/2-2)
Medical First Aid (vi/4-1)
Medical care (vi/4-2)
Automatic Radar Plotting Aids (ARPA)
Radar Observation & Plotting Simulator Course
GMDSS General Operator
Yellow fewer
Health certificate
Other TANKER COURSE
SPECIAL REQUIREMENTS FOR TANKERS (A V/1)
COW
Inert Gas
Date of issue
Date of expiry
Oil Tanker Advanced
Date of issue
Date of expiry
Tanker familiarization
Date of issue
Date of expiry
Chem. Tanker
Date of issue
Date of expiry
Covering
Oil
Gas Tanker Advanced
Date of issue
Date of expiry
Chemical
Gas
ADDITIONAL QUALIFICATIONS (welder, electrician, turner, navigator, engineer, PC specialist, ...)
Qualification
License No
Experience (time period, company, ...)
TRAINING COURSES / SEMINARS / UPGRADING COURSES OTHER THAN STCW/FLAG REQUIREMENTS
Training Course / Seminar
Location
Duration
Date
PC programs (point out names)
ISM Code
OPA 90
Framo course
Engine room resource management
SEA SERVICE
VSL NAME/FLAG
TYPE/GRT
ME Type/HP
OWNER & MANAGER
POSITION
DURATION