Sea Position Application Form Doc No: FM1400G

Version: 2
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This form is to be completed by job applicant.

Complete this form by hand or electronically.

Send the completed form to one of the following email addresses.

 LNGrecruitment.glasgow@teekay.com
 LNGrecruitment.manila@teekay.com
 LNGrecruitment.mumbai@teekay.com
DATE AVAILABLE FOR APPOINTMENT: _________________________________________

Present rank:       Rank applied for:       Date:      

Name in full (First, Middle, Last) Nationality Photo
           
Date of birth       Age            
Place of birth       Next of kin
Permanent / Contact address Name      
      Relationship      
Address      

(include international dialing code)

Telephone number Mobile number Email address
                 
Nearest Airport:      
If accepted, date available for service: U.S. Visa Type Valid until
                       
Medical certificate expiry date: Other Visa Type Valid until
                       
Yellow fever vaccination expiry date: Other Visa Type Valid until
                       
Professional Qualifications
Licenses Grade of License Number Date Place Expiry
license Type issued issued / Date
(Steam Revalidated
or Motor)
National                                    
(please state)
     
                                         

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Sea Position Application Form Doc FM1400G
No:
Version 2
:

Seaman’s book Place & Expiry date Passport Place & Expiry
number / date nationality date issued date
Nationality issued / Number
                                   
Referees: 1)       2)      
Name, company
and contact
telephone number

Other professional qualifications / Certificates / Endorsements held

Course / Certificate Place held Date held Date of expiry
                       
                       
                       
                       
                       
                       
                       
                       
                       

Signature:

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Sea Position Application Form (Gas) Doc No: FM1400
Version: 1

Past Sea Experience

Vessel Containment Type e.g. Deck: Trading area / Vessel Type Steam or Full Company Rank Period Months
name (No.96; MKIII; IHI SPB; Moss) Deadweight Motor name From – /Days
e.g. LNG / To
Engine: Type & BHP OIL / LPG (S or M)
Please state
one only

Last                                                             /
     
     
nd
2                                                             /
Last      
     
rd
3                                                             /
Last      
     
th
4                                                             /
Last      
     
th
5                                                             /
Last      
     
th
6                                                             /
Last      
     
th
7                                                             /
Last      
     
th
8                                                             /
Last      
     
                                                     

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Sea Position Application Form (Gas) Doc No: FM1400
Version: 1

9th             /

Last      
10th                                                             /
Last      
     
11th                                                             /
Last      
     
12th                                                             /
Last      
     
13th                                                             /
Last      
     
14th                                                             /
Last      
     
15th                                                             /
Last      
     
Other experiences (New buildings / Dry docks / Repair yards / Office secondments, etc.      

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Sea Position Application Form (Gas) Doc No: FM1400
Version: 1

Marine Course Attended Date Attended Expiry (if any) Remarks

Basic Gas Tanker Training                  
Advanced Tanker Training (Liquid Gas)                  
Tanker Fire Fighting                  
Advanced Fire Fighting                  
Medical Care                  
Medical First Aid                  
Proficiency in Survival Craft                  
Proficiency in Fast rescue boat                  
Proficiency in security duties                  
Ship Security Officer                  
Bridge Resource Management                  
Engine Resource Management                  
High Voltage                  
Ship handling                  
LICOS                  
Kongsberg Step 1                  
Kongsberg Step 2                  
Furuno FMD 3200                  
Furuno FEA 2107                  
Kongsberg Bridge ECDIS                  
SAM Platinum ECDIS                  
Transas ECDIS- Navigation Sailor 4000                  
MFD
DFDE Wartsila W50 / W34                  
ABB Propulsion systems                  
MAN Engine 51/60                  
MAN DFDE 51/60                  
Wartsila gas reliquification course                  
MAN ME                  
MAN MEGI                  
Burckhardt (compressor)                  
LNG STS                  
Azipod Safety Space (H850)                  
Azipod V technical training (H881)                  
ABB technical training (H862, H864,                  

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Sea Position Application Form (Gas) Doc No: FM1400
Version: 1

H869, H874)
ABB Azipod training (H883, H886)                  
Ice navigation basic                  
Ice navigation advanced                  
Artic survival training                  
Honeywell instrumentation & control                  
Transas sigma ice radar                  

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