adams offshore limitedadams offshore limited section 1 - position applied for date of availability...

Copyright @ Adams Offshore Limited of 6

First/ Given Name

Al Saffar House, Fourth FloorBuilding No.1042

Road no.3621, Block 436Seef District, Manama

Kingdom of Bahrain

ADAMS OFFSHORE LIMITED

SECTION 1 - Position applied for

Date of availability

Position applied for

SECTION 2 - Personal Details

Date of Birth

Nationality

Place of Birth

Family / Surname

Sex

Present address is same as permanent address

Zip CodeState

Country

City

Address2

Address1

PERMANENT ADDRESS:

Zip CodeStateCity

Address2

Address1

PRESENT ADDRESS:

CONTACT DETAILS:

Telephone 1 Telephone 2 Mobile

Fax Number How do prefer to be contacted?

NEXT OF KIN:

Zip CodeStateCity

Address1

Full Name Relationship

Tel 1 Tel 2

Mobile

Are you married? Enter wedding anniversary (wedding date)

Note: Adams is an equal opportunity employer .

Lowest Position acceptable

Note: Drop down fields are editable

Last Position held

Note: If present address is same as permanent address, after filling in permanent address, check the checkbox above



DP FLEET - ONLINE APPLICATION FORM

Email1 Email2

Country

Country

NOK Email


SECTION 3 - Certificate of Competency / Licenses heldClass/Grade Issuing Country Certificate No.: Date Issued Expires on

Expires onDate IssuedCertificate No.:Text

Basic Sea Survival

Proficiency in Survival Craft

Personal safety & Social Responsibility

Fire Fighting

Advanced Fire Fighting

Medical & First Aid

Ship Captains Medical Course

GMDSS

Ship Security Officer Course (SSO)

Personal Survival Techniques

Medical Fitness Certificate

Medical Care

Radar Observer

Radar Simulator

ARPA

Bridge Team Management

Bridge Resources Management

ISM Code

Class/Grade Issuing Country Certificate No.: Date Issued Expires onClass/Grade Details of Limitations

Certificate No.: Expires onDate IssuedIssuing Institute/Place

SECTION 4 - Details of STCW certificatesName of Course/Certificate



SECTION 5 - Details of Offshore Training Courses and certificates obtained

Initial Standby vessel crews training

Offshore Survival

H2S Course

Re-Breather training

Civil Aviation Authorities - Helicopter

Medical & First Aid

Proficiency in RESCUE CRAFTS

Proficiency in RESCUE BOATS

Advanced Medical Aid

Helicopter Underwater Escape Training

H2S/BA Certificate

Dynamic Positioning Induction Course

Dynamic Positioning Simulator Course

DP Operators Certificate

DP Maintenance Course

DP Log book Details

Expires onDate IssuedCertificate No.:Issuing Institute/PlaceName of Course/Certificate

SECTION 6 - Details of Other Educational Qualification or TrainingExpires onDate IssuedCertificate No.:Name of Course/Certificate

SECTION 7 - Medical History

Do you have any health or disability problem now?

Have you consulted a doctor during the past 12 months for an illness / Accident?

Have you undergone any medical operations in the past?

Have you ever signed off a ship due to medical reason?

If the answer to any of the above is in affirmative (YES), please enter details below:-

Issuing Institute/Place


Expires on

SECTION 8 - Passport / Seaman Book and Travel DetailsFull Name (as in Passport)

Date Expires onDate Issued

Place IssuedPassport Number


Place Issued

Full Name (as in Passport)

Passport Number


Place IssuedSeaman Book Number

SEAMAN BOOK DETAILS:


Place IssuedSeaman Book Number

LEAVE DESTINATION DETAILS:

Nearest AirportCountryLeave Destination

What is your prefered airline for travel?

CountryLeave Destination

Note: Where possible preferences will be taken intoconsideration with no assurance whatsoever.

VISA DETAILS:

Country Issued at Issued on Remarks

OTHER DETAILS:

Have you ever been the subject of a court of enquiry or involved in a maritime accident?

Have you ever had a professional licence suspended or revoked?

Have you ever been denied a visa by the United States of America?

Have you ever been denied a visa by any country?

Do you have any previous criminal convictions?(FOR US VISA APPLICATION)

If the answer to any of the above is in affirmative (YES), please enter details below:-

Do you have dual nationality or hold a second passport? (If yes, please fill in details of the second passport below.)

Type

Do you have a second seamans book? (If yes, please fill in details of the second passport below)

Expires onIssued at Issued on RemarksType




SECTION 9 - Experience DetailsCumulative Experience - Enter highest to lowest

Date ToDate FromLast Company ServedTotal Period in monthsRank / Position

Last Contract

SECTION 10 - Hours done with various DP systemsHours as JDPOHours as SDPODP System Details Model

SECTION 11 - Record of Sea ServiceVessel Company

Type ofVessel

DWT/GRT/BHP

Type ofEngine/DP

RankSigned

OnSigned

Off

Type of Engines :: for engineers only, DPOs to Mark DP System BHP : for Engineers and AHTS / TUG Masters & Officers

OperationInvolved





Understood

Why did you quit previous employer? (Give brief explanation)

SECTION 12 - References

Person

Reference One

SECTION 13 - Additional Information

Position

Company

Full Address

Telephone

Reference Two

Fax Number

What is the Maximum acceptable trip length for you?

Minimum salary/day rate expectation (please quote in GBP£ (UK personnel) or in US$ (for NON-UK personnel) Note: Leave pay inclusive

How did you hear about us? (Give brief explanation)

Languages spoken/written/understood 1-Poor, 2- Fair, 3-Good, 4-Very Good, 5-Excellent

WrittenSpokenLanguage

ENGLISH

Thank you for your time in filling this form. Once you submit this form, our DP vessel crew co-ordinator will get in touch with you ifyou are eligible and as soon as a suitable vacancy arises.

How to submit this form?You can submit this form in three ways:1. Click "Submit by Email" and all the data will be extracted without the form itself being sent and you will be prompted to email it to the correct email addresses. This isthe preferred way.2. You can save the file with your entries, and send the full file back to [email protected]. You can print the form and mail the printout to "James Thomson, DP vessel crew co-ordinator, Al Saffar House, Fourth Floor, Building No.1042, Road no.3621, Block436, Seef District, Manama, Kingdom of Bahrain."

Company

Person Position

Full Address

Telephone Fax Number

Note: To fill this form you will require Adobe Acrobat Reader 7 or Professional 7 (or later versions)

Note: Some drop down fields are editable

Email

Email

adams offshore limitedadams offshore limited section 1 - position applied for date of availability...

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