Ser application form offshore

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Information about Ser application form offshore
Career

Published on February 25, 2014

Author: PeterSmithRobinson

Source: slideshare.net

Description

Want to work offshore with SER? Fill in the attached form and send to peter@serlimited.com

Peter Smith-Robinson SER Limited, Time Tech Pk, Blackburn Road, Simonstone, Lancashire, BB12 7TW (T) 01282 777 414 (W) www.serlimited.com (E) info@serlimited.com Surname: First Name: Middle Name: PHOTO Section 1 Position Position Applied for Lowest Position Acceptable Expected Wages in $ per day Date of Availability $ Section 2 Personal Details Family name / Surname First Name / Given Name Date & Place of Birth Nationality Permanent Address Present Address SAFETY SHOES SIZE PPE information COVERALL SIZE Present Contact Number Fax Number Mobile Number Email Address Nearest Airport (and Distance) Section 3Passport and VISA details Country of Issue Date Issued Place Issued Passport Number Passport –Expires Secondary passport or Dual nationality USA Visa - Type USA VISA Expires USA Visa - Type USA VISA Expires Other Visa Visa Expiry Section 4 ( highlight as required ) Seaman book / Discharge book / Seaman Record Book / CDC Issuing Country & Place Number Date Issued Expiry Date Section 5Next of Kin – this is an important information we require- Don’t ignore it Full Name / Relationship Dependents / Children (inc age) Address Contact Numbers For further details on this applicant or to discuss terms please contact: SER Limited (agy) (T) 01282 777 414 (E) info@serlimited.com Registered in England & Wales 6281400

Peter Smith-Robinson SER Limited, Time Tech Pk, Blackburn Road, Simonstone, Lancashire, BB12 7TW (T) 01282 777 414 (W) www.serlimited.com (E) info@serlimited.com Section 6 STCW95 - Highest Certificate of Competency / Licence Held ( also list Flag State Endorsements) Class / Grade/Capacity Issuing Country Certificate No. Date Issued Expiry Details of Limitations ALSO ENTER ABOVE DETAILS OF ANY OTHER FLAG STATE CERTIFICATES HELD Section 7 STCW95 - Dangerous Cargo Endorsements Certificate No. Date Issued Expires Details of Limitations/ Grade Petroleum……………. Liquefied Gas………… Liquid Chemicals…… Section 8 STCW95 - related Courses Attended and Certificates Obtained Name of Course / Certificate STCW Code Place Issue Date Cert No For further details on this applicant or to discuss terms please contact: SER Limited (agy) (T) 01282 777 414 (E) info@serlimited.com Registered in England & Wales 6281400 Expiry Date

Peter Smith-Robinson SER Limited, Time Tech Pk, Blackburn Road, Simonstone, Lancashire, BB12 7TW (T) 01282 777 414 (W) www.serlimited.com (E) info@serlimited.com Section 9 OFFSHORE INDUSTRY COURSES Please enter below any other certificates held or courses done, ie offshore, DP certs etc or Any other not already mentioned Name of Course / Certificate APPROVALS Place Issue Date Cert No Expiry BOSIET HUET H2S HLO DANGEROUS GOODS MARLIN’s English Test SCORE: IELTS-English TEST http://www.ielts.org/test_centre_search/search_results.aspx SCORE: PMS maintenance system – Confirm that you are Familiar with its use ( YES / NO ) Yes/No: DEEP WATER ANCHOR HANDLING EXPERIENCE ENTER DEPTTH IN METERS: DP Maintenance Courses DP Maintenance Courses HIGH VOLTAGE COURSE Dynamic Positioning Induction Course Dynamic Positioning Simulator Course Dynamic Positioning Operators CERTIFICATE Dynamic Positioning Log book Details Section 10 Hours done with various DP system SYSTEM DETAILS Approx Hours as SDPO / Approx Days in case of Senior ETO / Senior Engineer SAT DIVING AIR DIVING ROV WELL STIMULATION / INTERVENTION / ACTIVATION AHTS Approx Hours as DPO / Approx Days in case of Junior ETO / Junior Engineer APPROXIMATE Total DP Hours in Various Operations CABLE LAYING SURVEY PIPE LAYING DRILL SHIP / SEMI SUB PSV For further details on this applicant or to discuss terms please contact: SER Limited (agy) (T) 01282 777 414 (E) info@serlimited.com Registered in England & Wales 6281400

Peter Smith-Robinson SER Limited, Time Tech Pk, Blackburn Road, Simonstone, Lancashire, BB12 7TW (T) 01282 777 414 (W) www.serlimited.com (E) info@serlimited.com FPSO CONSTRUCTION CORING HEAVY LIFT SHUTTLE TANKER ROCK DUMPING / MATTRESSING TRENCHING ACCOMMODATION / GANGWAY Section 11 Medical History YES NO Have you ever signed off a ship due medical reason ? Have you undergone any medical operations in past? Have you consulted a doctor during the past 12 months for an illness / Accident Do you have any health or disability problem now? If answer to any of above is YES then give further details below or on a separate sheet NOTE : All our clients have STRICT Alcohol and Drug Policy, Which means ZERO TOLERENCE for alcohol and drugs Section 12 General Yes 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 convicted of any criminal offence? Have you ever been dismissed If yes to any of above then please full details below or on separate sheet of paper Section 13 References (Last Two Recent Employers) Name of company Name Person to be contacted Address Tel No Email Name of company Name Person to be contacted Address Tel No Email Section 14 Any other information, you wish to add in support of your application For further details on this applicant or to discuss terms please contact: SER Limited (agy) (T) 01282 777 414 (E) info@serlimited.com Registered in England & Wales 6281400 No

Peter Smith-Robinson SER Limited, Time Tech Pk, Blackburn Road, Simonstone, Lancashire, BB12 7TW (T) 01282 777 414 (W) www.serlimited.com (E) info@serlimited.com Section 15 Declaration I hereby declare that the above particulars are true and I authorize you to contact the referees listed above And confirm that All my certificates / Licences are Authentic / SEASERVICE RECORD is ACCURATE Signed Date ADDITIONAL INFORMATION SHEET VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority) 1. 2. 3. 4. MAXIMUM ACCEPTABLE CONTRACT PERIOD (Please indicate below in days) Languages Spoken / Written / Understood (1-poor/5-Fluent) Spoken Written Understood FOLLOWING DOCUMENTS COPIES MUST BE SENT TO US- send to us In separate Email Licence or Certificate of competency, Any endorsements, GMDSS of Deck Officers, Medical Fitness / Examination Certificate, Passport Main page, Seaman book or Discharge book Main pages, In case of DPO – DPO Cert, DP LOG Pages, certificates ( STCW95 ), SSO certificate, CoC, flag endorsement For further details on this applicant or to discuss terms please contact: SER Limited (agy) (T) 01282 777 414 (E) info@serlimited.com Registered in England & Wales 6281400

Peter Smith-Robinson SER Limited, Time Tech Pk, Blackburn Road, Simonstone, Lancashire, BB12 7TW (T) 01282 777 414 (W) www.serlimited.com (E) info@serlimited.com Section 16 Record of Sea Service VESSEL COMPANY (All Dates to be entered as dd/mm/yy) Type of Vessel And Type of operation in case of DP vessels GRT STARTING FROM LAST VESSEL FIRST Type of Engines BHP Or DP System Flag For further details on this applicant or to discuss terms please contact: SER Limited (agy) (T) 01282 777 414 (E) info@serlimited.com Registered in England & Wales 6281400 RANK Sign on DATE Sign off DATE

Peter Smith-Robinson SER Limited, Time Tech Pk, Blackburn Road, Simonstone, Lancashire, BB12 7TW (T) 01282 777 414 (W) www.serlimited.com (E) info@serlimited.com Section 16 Record of Sea Service VESSEL COMPANY (All Dates to be entered as dd/mm/yy) Type of Vessel And Type of operation in case of DP vessels GRT STARTING FROM LAST VESSEL FIRST Type of Engines BHP Or DP System Flag For further details on this applicant or to discuss terms please contact: SER Limited (agy) (T) 01282 777 414 (E) info@serlimited.com Registered in England & Wales 6281400 RANK Sign on DATE Sign off DATE

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