You are on page 1of 2

CHIEF ENGINE DAO QUANG HUNG

34 An Da,St.,Lach Tray War, Ngo Quyen Dist., Haiphong, Vietnam Tel: (84) 31 3 734968 - Fax: (84) 31 3 734986; Email: anduong@anduongmarine.com.vn

nh 3x4 ging nh nh h chiu

CREW CARD
CODE NUMBER: / SURNAME MIDDLE NAME GIVEN NAME DATE OF BIRTH DAY: REGISTERED ADDRESS : MONTH: YEAR:

HOME TEL: LIST OF FAMILY DEPENDENTS: NAME RELATION DOB

HAND PHONE: NAME RELATION DOB

1/ EDUCATION: NAME OF COURSE OR SCHOOL GRADUATION YEAR

2/ LICENSE: COUNTRY GRADE VIETNAM PANAMA 3/ PASSPORT: TYPE COUNTRY INTL PASSPORT VIET NAM SEAMANS PASSPORT VIET NAM SEAMANS BOOK VIET NAM 4/ CERTIFICATE: NO TYPE 1 BASIC TRAINING CERTIFICATE 2 COMPETENCE CERT.STCW78/95 3 SURVIVAL CRAFT & RESCUE BOAT 4 ADVANCED FIRE FIGHTING 5 MEDICAL FIRST AID & MEDICAL CARE 6 MEDICAL CARE (FOR MASTER) 7 GOC - ENDORSEMENT 8 GENERAL OPERATOR CERT-GOC 9 RADAR OBSERVER CERT. 10 ARPA CERT. 11 OIL TANKER FAMILIARIZATION 12 OIL TANKER AVANCE 13 CHEMICAL TANKER FAMILIARIZATION 14 CHEMICAL TANKER AVANCE 15 ELECTRONIC NAVIGATION SYSTEMS 16 BRIDGE TEAM MANAGEMENT-BTM 17 ENGINE TEAM MANAGEMENT-ETM 18 SHIP SAFETY OFFICER CERTIFICATE 5/ MEDICAL : ADM-009

NUMBER

EXPIRY DATE

REMARKS

NUMBER

EXPIRE DATE

NUMBER

ISSUED DATE

EXPIRE DATE

HEIGHT:

(cm)

WEIGHT:

(kg) ISSUE DATE

BLOOD GROUP: EXPIRY DATE REMARKS

HEALTH CERTIFICATE VACCINATION CERTIFICATE 6/ BRIEFING FOR SAFETY MANAGEMENT SYSTEM : A. CONFIRMED 7/ ENGLISH: CONTENTS READ & WRITE SPEAK & LISTEN OTHER LANGUAGES

B.

NOT CONFIRMED

EVALUATION A/ EXCELLENT B/ GOOD C/ ACCEPTABLE D/ POOR E/ UNSUITABLE A/ EXCELLENT B/ GOOD C/ ACCEPTABLE D/ POOR E/ UNSUITABLE

8/ CLOTHES SIZE : S M L 9/ SHOES SIZE : (JAPANESE/ VIETNAMESE STANDARD) 22/36 23/37 24/38 25/39 25.5/40 10/ SEA SERVICE RECORDS: VESSEL NAME FLAG TYPE RANK

LL 26/41 26.5/42

EL 27/43

DEAD WEIGHT TONNAGE TRADING

ENGINE TYPE POWER KW

SIGN ON SIGN OFF

REMARKS

CREW MANNING DEPT

ADM-009