RYAN GROUP

RYAN OFFSHORE LTD / RYAN SHIP MANAGEMENT LTD Paste Latest

POSTAL ADDRESS:-RYANSHIP P O Box – 1282 - SUNDERLAND Photo In White
TYNE and WEAR SR5 9HX UNITED KINGDOM
Tel: +44 191 54 888 59 Fax: +44 191 54 88 425 Background
Email : hrmanager@ryan-shipmanagement.com
Web Site: www.ryan-shipmanagement.com

Application Form Deck & Engineering Officers

Section 1 Position
Position Applied for
Lowest Position Acceptable
Date of Availability / / MUST Enter a date and in dd/mm/yyyy
Section 2 Personal Details
Family name / Surname
First Name / Given Name
Date & Place of Birth Date - Place-
Nationality
Permanent Address

Present Address

PPE information SAFETY SHOES SIZE COVERALL SIZE

Blood Group Type RH
Physical Information HEIGHT WEIGHT
Present Contact Number
Mobile Number
SKYPE ADDRESS
Email Address
Nearest Airport (and Distance)
Section 3 Passport and VISA details
Country of Issue USA Visa - Type B1/OCS
Date Issued USA VISA Expires
Place Issued USA Visa - Type C1/D
Passport Number USA VISA Expires
Passport –Expires Other Country Visa
Secondary passport or Dual Visa Expiry
nationality

Section 4 ( hi-light as required ) Seaman book / Discharge book / Seaman Record Book / CDC
Issuing Country & Place Date Issued
Number Expiry Date (if any)
Section 5 Next of Kin – this is important information we require- Don’t ignore it
Full Name / Relationship
Any dependents / Children (incl age )
Address

Contact Numbers

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 Page 1 of 7
Section 6 STCW2010 (STCW78, as amended) Highest Certificate of Competency / Licence Held
Class / Issuing Certificate No. Date Issued Expiry Details of Limitations
Grade/Capacity Country

Also Enter Above Details of any Other Flag State Certificates (Also List Flag State Endorsements)

Section 7 STCW2010 (STCW78, as amended) Dangerous Cargo Endorsements

Petroleum……………. Certificate No. Date Issued Expires Details of Limitations/ Grade

Liquefied Gas…………..
Liquid Chemicals……....

Section 8 STCW2010 (STCW78, as amended) related Courses Attended and Certificates Obtained

Name of Course / Certificate STCW Code Place Issue Date Cert No Expiry Date

Basic Safety Training A-VI/1

Basic Sea Survival / Personal Survival A- VI/1-1
Techniques
Fire Prevention & Fire Fighting A-VI/1-2
Elementary First Aid A-VI/1-3
Personal Safety & Social Responsibility A-VI/ 1-4
Proficiency in Survival Craft & Rescue A-VI/ 2-1
Boats
Proficiency in RESCUE CRAFTS
Proficiency in FAST RESCUE BOATS A-VI/ 2-2
Advanced Fire Fighting A-VI/ 3
Medical & First Aid A-VI/ 4-1
Medical Care A-VI/4-2
( Ship Captains Medical Course )
Radar & ARPA Simulator Trg- A-II/ 1-2
Management level
Electronic chart Display and A-II / 1
Information System course Model 1.27
(ECDIS)
GMDSS + ENDORSEMENT A-IV/ 2
SAFETY OFFICERS COURSE (SO)
Ship Security Officers Course (SSO) A-VI/ 5
Issued under STCW 2010
Proficiency in Security Awareness A-VI/6-1
Proficiency in Designated Security A-VI/6-2
Duties
Medical Certificate / HEALTH STCW 2010/
Certificate MLC Compliant
Drug and Alcohol test certificate

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 YELLOW FEVER
Bridge Team Management A-II/2
Bridge Resources Management B-VIII/2
ISM Code A.1441 (18)
Engine Room Resources Management A-III/1, A-III/2,
( Operational Level / Management level ) A-III/3,A-VIII/2
HELM (leadership and management skills ) A-II/2, A-III/2

TANKERS FAMILIARISATION A-V/1

Advanced Tanker Operations (Chem.) A-V/1-2
Advanced Tanker Operations (Oil) A-V/1
Advanced Tanker Operations (LPG) A-V/1
REFRESHER & UPDATING I/II & III/2

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L Section 9 OFFSHORE INDUSTRY COURSES
I Please enter below any other certificates held or courses done, ie offshore, DP certs etc or Any other not already mentioned
S Name of Course / Certificate APPROVAL Place Issue Date Cert No Expiry
T S

A BOSIET / FOET
L HUET
L
OFFSHORE MEDICALS
( UK, NORWAY or NETHERLAND )
O Re-Breather training
T
Initial Standby vessel crews training ( ITSO )
H
E CAA (Civil Aviation Authorities – Helicopter)
R Advanced Medical Aider ( AMA )
HLO
C
O HLA
U Hydrogen Sulphide (H2S)
R MARLIN’s English Test Score:
S %
E IELTS-English TEST http://www.ielts.org/test_centre_search/search_results.aspx SCORE
S
PMS maintenance system – Confirm that you are Familiar with its use ( YES / NO )

DEEP WATER ANCHOR HANDLING EXPERIENCE ENTER DEPTH IN METERS ???????

DP Maintenance Courses
DP Maintenance Courses
HIGH VOLTAGE COURSE
Dynamic Positioning Induction Course
Dynamic Positioning Simulator Course
Dynamic Positioning Operators Full or
CERTIFICATE Limited
(Details of Old Certificate- Before Renewal )
Dynamic Positioning Operators Full or
st
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 CERTIFICATE Limited
(Details of New Certificate- After Renewal )
Dynamic Positioning Log book Details

Section 10 Hours done with various DP system

SYSTEM DETAILS Approx Hours as SDPO / Approx Days Approx Hours as DPO / Approx Days in
in case of Senior ETO / Senior Engineer case of Junior ETO / Junior Engineer

APPROXIMATE Total DP Hours in Various Operations

SAT DIVING CABLE LAYING
AIR DIVING SURVEY
ROV PIPE LAYING
WELL STIMULATION / INTERVENTION / DRILL SHIP / SEMI SUB
ACTIVATION
AHTS PSV
FPSO SHUTTLE TANKER
CONSTRUCTION ROCK DUMPING / MATTRESSING
CORING TRENCHING
HEAVY LIFT ACCOMMODATION / GANGWAY

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Section 11 Medical History

YES NO
1. Have you ever signed off a ship due medical reason and been hospitalised?
2. Have you ever been signed off the vessel and repatriated due illness?
3. Have you undergone any medical operations in past?
4. Have you consulted a doctor during the past 12 months for an illness / Accident
5. Do you have any health or disability problem now??
6. Any Past Medical Condition – Which May Affect Your Work :- (If Yes Than Please Specify Below)
7. Do you feel healthy and fit to perform the duties of your designated
Position/occupation?

8. Are you allergic to any medications?- If Yes, then please identify below
Allergic to Medications :
9. Are you taking any non-prescription or prescription medications at present?
If yes, please list the medications taken, and the purpose(s) and dosage(s):

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 PRESCRIPTION MEDICATION:

NON-PRESCRIPTION MEDICATION:

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 No
Have you ever been involved in a maritime accident, ie grounding, fire, Explosion, Collision.etc
Have you been Rejected by Aramco / Shell or by any other Charter
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 due any reason

If yes to any of above then please full details below or on separate sheet of paper

Section 13 PROVIDE DETAILS OF YOUR LAST TWO EMPLOYERS, IN

ORDER TO OBTAIN CONFIRMATION ON YOUR SEA SERVICES

Name of company
Name Person to be contacted
Address
Tel No Fax
Email

Name of company
Name Person to be contacted
Address
Tel No Fax
EMAIL

Section 14 Any other information, you wish to add in support of your application

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Section 15 Record of Sea Service (All Dates to be entered as dd/mm/yyyy)
Please give full detail record of sea service as per SEAMAN BOOK STARTING FROM LAST VESSEL FIRST
VESSEL COMPANY Area Type of DWT or Type of BHP RANK Sign on Sign off
Vessel Engines DATE DATE
of And Type of
GRT Or DP System
(please delete as
Operation operation in reqd)
case of DP
vessels
dd / mm /yyyy dd /mm/yyyy

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Type of Engines :: for engineers only, DPOs to Mark DP System BHP : for Engineers and AHTS / TUG Masters & Officers Page 5 + 6 of 7

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 ADDITIONAL INFORMATION SHEET
VESSEL TYPE YOU ARE INTERESTED IN (please list in order of priority)
1.
2.
3.
4.
5.
Enter Flag state Seaman Book with validity (if any)

MAXIMUM ACCEPTABLE CONTRACT PERIOD (Please indicate below)

Please Quote –Consolidated MINIMUM MONTHLY SALARY ( no leave pay ) payable for
time onboard only or Working DAY RATE EXPECTATION ( no leave pay)
( please quote below in US$ -preferred or Euro or GBP£ )

Languages Spoken / Written / Understood (1-poor 5-Fluent)

Spoken Written Understood
ENGLISH

DRUG & ALCOHOL POLICY

ALL Our Clients have very strict NO DRUG and ALCOHOL POLICY, Which is required to be
complied with at all times, which means “””ZERO TOLERENCE on ALCOHOL & DRUG”””
Your body must NOT have any ALCOHOL or DRUG substances from the time you board your flight
or commence your travel to join vessel, and Must remain so Until you have completed full contract
and returned to your home Airport / Town
If during the said period you are found under the influence of DRUG or ALCOHOL then ALL
EXPENCES incurred which will include all your travel and recruiting costs, And your relief’s Travel
and recruiting costs, And Any other costs whatsoever incurred due to your NON-COMPLIANCE will
be deducted from your salary, Which will include but not limited to “damage to vessel her
equipments and machineries, loss of charter, and any other costs Directly or indirectly connected
with your NON-COMPLIANCE
FOLLOWING DOCUMENTS COPIES MUST BE SENT TO US- send to us In separate Email –
NOT MORE THAN 5 MB
All Certificates / Courses Listed in this form + Licence or Certificate of competency, GMDSS showing expiry
date + Endorsement in case of Deck Officers, Medical Fitness / Examination Certificate, Passport Main
page / Address page in case of Indians, Seaman book or Discharge book Main pages, In case of DPO – DPO
Cert, DP LOG Pages, Any tanker endorsements
FOLLOWING ADDITIONAL DOCUMENTS will ALSO BE REQUIRED – Send to us in separate email –
NOT MORE THAN 5 MB
All short courses certificates ( STCW2010, 78 as amended ), SSO certificate, Last 3-5 years ships entries in
Discharge book or Seaman book, Last 5 years Passport immigration stamp pages, Certificate of Equivalent
Competency from other flag states
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