Application form

15.06.2016
Application Form
(enter your name)
Certified for:
(enter your rank)
Dimajio-Marine ID
Main info
Your photo:
Name / Surname:
Position applied for: Desired Vessel Type:
Minimum salary $: Birthday / place of birth:
Phones: Citizenship:
E-mail: Country / city of residence:
Skype: Home address:
English level speech: Closest airport:
English level writing: Knowledge of other languages:
USA visa valid up: Schengen visa valid up:
Passports / Smbk No. Date of issue Country of issue Valid up
Seaman's book Ukraine
International passport Ukraine
Diplomas
Title of document No. Date of issue Country of issue Valid up
Rank
Professional license
Endorsement
Certificates No. Date of issue Country of issue Valid up
Add line
Medical certificates No. Date of issue Country of issue Valid up
Add line
Flag Documents and Other Countries Seaman's Books
Add line
Country Document type No. Date of issue Valid up
Sea service (last 5 years)
Add line
Position Vessel Name Flag Vessel type / DWT ME Type / kW From - Till Shipowner /
Country
Biometrics
Sex: Height: Overall size:
Eyes color: Weight: Shoe size:
Next of Kin
Next of kin: Kin phone:
Kin name, Surname: Kin address:
Additional info
Note: