Anglo Eastern

Note :The date pop-ups currently accepts values in MM/dd/yyyy format.

 APPLICATION FORM
Rank Applied  
                
 
   Date Applied: 9/21/2017 8:49:35 AM  Date of Availability:      
 PERSONAL DESCRIPTION AND INFORMATION
  Given Name:
 (First / Middle)

  
                 
   Last Name :      
  
    
  Country of Residence   
  Height (cm) :      Weight (Kg) :   
   Birth Date :     
  Place :       Nationality :
    
  
   Address :     
  
   City :   
 
  Pincode :
  
 
 
  State :   
Contact Details :    Country-Area-Number
      
   Mobile 1 :  
Alt Mobile 2 :
  

  
   E-mail :   


  INDOS:
  
*applicable only for Indian sea-farers
 
  Martial Status :   
  Last Salary Drawn:      
  Nearest Airport:   
 LAST EMPLOYER
  Company Name  Name of Person & Designation   Phone Number
     
         
  Country       Area                         Number
  Refer 2 Senior Officers you have sailed with  
Name Company Rank Contact
                      
                      
      EDUCATIONAL BACKGROUND [ please include pre-sea training ]
  Academic Qualification/Year :       Last School / College :   
  Pre Sea Training Institute/Year       Apprenticeship :   
  TRAVEL DOCUMENTS    
  Documents  Number   Place of issue   Date of issue  Date of Expiry
  Passport :

  
 
 
      Clear   
 
Continuous Discharge Certificate/ Seamen Book :

  
 
 
        
 
 U.S. Visa - C1/D:

 
 
     
 Yellow Fever :


 
     
 Flag CDC/COC :                                                
 
Certificate of Competency and  Grade    Country of issue   Number Date of Issue  Date of Expiry
    
  

  

  
  
  Dangerous Cargo Endorsement  Number  Date of Issue  Date of Expiry  Place of Issue
  PETROLEUM           
  CHEMICAL            
   GAS            
     SEA SERVICE
 Vessel Name  Vessel Type         Company Name
  Rank From To Total
  Months Days
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PERSONAL SUMMARY

  
 
      VALUE ADDED EXPERIENCE / TRAINING
Yard Delivery Major Conversion Dry Dock Gantry /
Self Unloader
Crane / Grab
ME / RT Engine Experience Framo Pump Experience Ice Navigation Experience BTM Course STCW
Upgradation




 

                                          INFORMATION SHEET - CHEMICAL TANKERS              

CARGOES CARRIEDMSTRC/O2/O3/OC/E2/E3/E4/E
1DODECYLBENZENE (LAB)
2HYDROGEN PEROXIDE
3ACRYLONITRILE
4SULPHURIC ACID
5NITRIC ACID
6PHENOL
7EPICHLOROHYDRIN (ECH)
8CAUSTIC SODA
9HEXANE
10XYLENE
11MDI / DIPHENYLMETHANE DIISOCYANATE
12TOLUENE
13METHANOL
14PALM OILS
15VEGETABLE OILS
16MOLASSES
17ETHYLENE DICHLORIDE (EDC)
18STYRENE MONOMER
19BENZENE
20VINYL ACETATE MONOMER (VAM)
21IPA / NBA
22METHYL ETHYELENE GLYCOL (MEG)
23LUB ADDITIVES / LUBRIZOL
24SODIUM HYDROSULPHIDE
25PHOSPHORIC ACID
26PROPYLENE OXIDE / ETHYLENE OXIDE
27PARAFFIN WAX
28TALLOW
29METHYL TETRA BUTYLE ETHER (MTBE)
OTHER INFORMATION / AREAS OF KNOWLEDGEMSTRC/O2/O3/OC/E2/E3/E4/E
1DEEP WELL PUMPS EXPERIENCE
2SPECIALISED FRAMO COURSE
3CLOSED LOADING / VECS.
4CDI
5OIL COMPANY INSPECTIONS ( BP, SHELL, EXXON)
6USCG - LETTER OF COMPLIANCE
7CARGO HEATING - OIL/STEAM/DECK HTR.
8TANK COATING TYPE - S.S, RUBBER COATED
9WALL WASH TESTING (HC/CL)
10PERMANGEMATE TESTING (PTT)
11PASSIVATING STAINLESS STEEL TANKS
12ISM / ISO
13TRADING IN US WATERS
14N2 PADDING
15CARGO COOLING SYSTEMS
16OPA 90 TRAINING / VGP