Lerus Crew Management// Recruiting services in Oil and Gas ...



Position applied for:

|Family Name: |Name: |Father's name: |

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|Date of birth: |Place of birth: |Marital status: |E-mail: |

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|Address: |Tel (including city code): |Mobile: |

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|Next of kin and relationship: |Children (name & DOB): |

|Next of kin’s address: |Next of kin tel: |

|Inter. P’port No: |Issued: |Valid: |Place of issue: |

|Seaman's book No: |Issued: |Valid: |Place of issue: |

SEA GOING EXPERIENCE FOR THE LAST 5 YEARS

( MOST RECENT VESSEL LAST )

|Name of vessel |Type of vessel |DP system/ |Flag |Company Owner |

| | |Type of DP system | | |

|Drug & alcohol test |Issued: |Valid: |Eyes: |Hair: |

|Yellow fever |Issued: |Valid: |Overall size: |Safety shoes: |

VISAS:

|Visa |Type |Issue |Expire |Visa |Type |Issue |Expire |

|Schengen visa | | | |UK visa | | | |

|USA visa | | | |Nigeria visa | | | |

FLAG STATE DOCUMENTS:

|UK CEC | |CYPRUS | |ITALIA | |NORWAY | |

|PANAMA | |A&B | |MADEIRA | |SINGAPORE | |

Pevious employers for references

|Company name | |Company name | |

|Contact person | |Contact person | |

|Email | |Email | |

|Phone number | |Phone number | |

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