HANSEATIC

Seafarer Employment Application Form

Instructions: Please fill out all required fields marked with *. Ensure all information is accurate and up-to-date.

Position Applied For

Rank Applied for*

Willing to accept lower rank if rank applied for is not offered

Date of Availability

Personal Details

Surname*

Given Name*

Date of Birth

Place of Birth

Nationality*

Religion

Height (cm)

Weight (kg)

Home Address*

Overalls Size*

Safety Shoes Size*

Photo* Images will be automatically compressed to under 1MB (high quality) Large photos (>10MB) may take 10–30 seconds. Please wait for the progress bar

Documents

Passport No

Date of Issue

Date of Expiry

Seaman Book No

Date of Issue

Date of Expiry

SID No (Seafarer's Identity Document)

Date of Issue

Date of Expiry

Schengen Visa

US Visa

Contact Details

Telephone*

E-Mail*

Marital Status

Number of Children

Next of Kin Details

Name*

Relationship*

Telephone*

E-Mail

Home Address*

Vaccination

Yellow Fever Card No

Place of Issue

Date of Issue

1ST COVID Vaccine Name

1ST COVID - Place of Issue

Date of Issue

2ND COVID Vaccine Name

2ND COVID - Place of Issue

Date of Issue

COVID Booster Vaccine Name

Booster - Place of Issue

Date of Issue

Education / Pre Sea Training & Licenses

Qualification	Maritime College / University	From	To	COC No	Issuing Authority (COC)	Date of Issue (COC)	Date of Expiry (COC)	Action

Other Certificates

Certificate Name	Issuing Authority	Certificate Number	IDate of Issue	Date of Expiry	Upload Copy	Action

ECDIS

ECDIS Types Known

Sperry

Furuno

JRC

Transas

Konsberg

Raytheon

Other

Employment History (Last 12 Vessels in descending order)

Rank	From	To	Sea Time (Months)	Manager/Owner	Manning Agent in Sri Lanka	Vessel Name	Vessel Type	Flag	GRT	kW/HP	Main Engine Type	Sign Off Reason	Action

Questionnaire

1. Reason for leaving previous employer

2. Please give reason if not sailed in the last six months

3. Last Earned Wages

USD

4. Expected Wages

USD

5. English Proficiency

I hereby confirm that all the information provided by me in this form are True and Correct to the best of my knowledge.

Seafarer's Signature

Date

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