TSM SHIPPING (PHILS.), INC.

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Recent
CREW PERSONNEL FORM
Picture
Application Promotion Position Applied for Date of Application

Amendment Nomination

A. PERSONAL DETAILS
Family Name Given Name Middle Name

Sex Date of Birth (dd-mm-yy) Place of Birth Nationality Religion

Civil Status Height (in meters) Weight(in kilograms) Color of Hair Color of Eyes

Distinguishing Marks National Registration No. (for NON-CBA officers only) Nearest Airport

Permanent Address

Other Contact Address you can be reached

Contact Number Email address

SSS No. Tin No. PhilHealth No. Pag-ibig No.

B. NATIONAL, VISA & VACCINATION DOCUMENTS
Issue Date Validity
Document Document Number Rank
(dd-mm-yy) (dd-mm-yy)
Passport
Seamans Book
Seafarers Registration Certificate (SRC)
Certificate of Competency (COC) /

COP on Rank / NCI/NCII/NCIII
STCW Endorsement Certificate
Oil Chemical Gas Others

General Operator Certificate (GOC)

US Visa
Yellow Fever
Cholera
C. FOREIGN DOCUMENTS
Issue Date Validity
Document Document Number
(dd-mm-yy) (dd-mm-yy)





D. TRAINING CERTIFICATES
Issue Date Validity
Course STCW Certificate No.
(dd-mm-yy) (dd-mm-yy)
Basic Safety Course (BSC) Reg V/1 & a-

(W/PSSR - Yes No) VII/1
Personal Safety and Social Responsibility Reg VI/1 & A-

(PSSR) VI/1
Basic Training (STCW 2010) Reg VI/1
Reg VI/2-4 & A-
Advance Safety Course (ASC)
VI/2-4
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REC-F006/Rev.2/20 February 2014

 Reg VI/2-4 & A-
a) Advance Fire Fighting (AFF)
VI/2-4

REC-F006/Rev.2/20 February 2014

 Reg VI/2-4 & A-
b) Medical Emergency First Aid (MEFA)
VI/2-4
Reg VI/2-4 & A-
c) Proficiency in Survival Craft (PSC)
VI/2-4
Reg VI/I & A-
General Tanker Familiarization (GTF)
VII/1
Reg V/1 & A-
Shore Based Fire Fighting (SBFF)
V/1
Basic Training Oil & Chemical Tanker Cargo Reg V/1.1 & A-

Operation(STCW 2010) V/1-1.1
Reg V/1-2 & A-
Basic Gas Tanker(STCW 2010)
V/1-2
Specialized Training in Oil Tanker (STOT) or
Reg V/1.2 & A-
Advance Training for Oil Tanker Cargo
V/1
Operation (STCW 2010)
Specialized Training in Chemical Tankers
Reg V/1.2 & A-
(STCT) or Advance Training for Chemical
V/1
Tanker Cargo Operation (STCW 2010)
Specialized Training in Liq Gas Tankers
Reg VI/1.2 & A-
(STLGT) or Advance Training for Gas Tanker
V/1
Cargo Operation (STCW 2010)
Security Training with Designated Security
Reg VI/6 & A-
Duties with Security Awareness Training
VI/6,6.1,6.2
(STSDSD)
The Operational Use of ARPA Sec A-II/1
Radar Observer Course (ROC) Sec B-IV/2
Radar Simulator Course (RSC) Sec B-1/12
GMDSS/INMARSAT Reg IV/1-2
Ships Restricted Radio Operator Course
Reg A-702
(SRROC)
Bridge Resource Management (BRM) Sec B-VIII/2
Bridge Team Management (BTM) Sec B-VIII/2
Ship Handling and Maneuvering Sec A-II/1 & 2
ECDIS
Trim and Stability Sec A-II/2
Medical Care (MECA) Reg A-VI/4-4
Deck/Engine Watchkeeping Certificate Reg II/4-III/4
NIS
Maritime Administration (MARAD)
Requirement
Reg V/I-1 &
Inert Gas System / Crude Oil Washing
V/1-2
Ship Security Officers Course
MARPOL 73 /78 Annex I
MARPOL 73 /78 Annex II
Hazardous Material (HazMat)
Welding Course
Lathe Machine
Culinary Course (C/CK AND 2nd COOK)
Messman Course






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REC-F006/Rev.2/20 February 2014

 E. SEA SERVICE RECORDS (from latest to backward) Note: Sea service must be in one decimal point e.g 1.2 yrs = one yr and 2 mos.
Sea
Cargo Pumps Bulk
Service Manning
Engineers Only (Deck Offices Carriers PERIOD
(in Agency/Company
Vessel Only) Only
Rank Vessel Name Flag GRT Years)*
Type with
Engine Centri- FROM TO
BHP Framo Ship
Type fugal (dd/mm/yy) (dd/mm/yy
Cranes?
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Yes

None
Note: Sea Service in Years = number of months multiply by 30 add number of days divided by 365e.g. 5 months and 12 days 5 x 30+ 12/365 = .44 years
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REC-F006/Rev.2/20 February 2014

 F. EDUCATION

REC-F006/Rev.2/20 February 2014

 Highest Educational Attainment (Course) School Year Graduated

G. COMPUTER LITERACY
Software/Systems Used
Computer Literate? Yes No
MSWord MSExcel Email Web Others
H. NEXT OF KIN
Name Date of Birth (DD/MM/YY) Relationship Is he/she is your beneficiary

Yes No
Contact Address Contact Number

Name of Dependents Date of Birth
Relationship
(for children & siblings must below 21 years of age) (DD-MM-YY)

I. MEDICAL HISTORY (if yes, describe briefly)
Has any previous surgery? Yes None

Has previous illness? Yes None

Has any physical handicap? Yes None

J. LEGAL CASES (if yes, describe briefly)

Do you have any Detailed of legal case/s
previous/existing/pending
administrative/criminal case
filed against you in any
government agency/court?

Yes None
K. REFERENCES FROM PREVIOUS EMPLOYMENT
Name Contact Number Company

REC-F006/Rev.2/20 February 2014


L. DECLARATION & SIGNATURE

I hereby certify that the information given above are true and correct to the best of my knowledge and belief. That I have
not withheld any information that would affect my application unfavourably.

Any false declaration I supplied herein may constitute ground for disqualification and non-acceptance to the company and
can be further subjected to applicable penalties in accordance to existing laws governing the recruitment and employment
of overseas seafarers.

Signature Date

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REC-F006/Rev.2/20 February 2014