Application for Employment

Marine Personnel Position: Completed? Please send form to: crew.management@hlag.com

Personal Details
General
Surname: First Name: Nationality: Birthday: Civil Status: Middle Name: Sex: Birthplace: No.of Children / Dependent: Picture

Address
Street: City/ZIP Code: Country: Airport: or: Tel.: + Mobile: + Fax: + Email: / / /

Next of Kin
Name: Relation: Street: City/Country: Tel.: + Mobile: + Fax: + Email: / / /

Travel Documents
Passport No: Seamansbook No: German SB.No: U.S.VISA No: Other Visa No: Other Visa No: Issued: Issued: Issued: Issued: Issued: Issued: Expired: Expired: Expired: Expired: Expired: Expired: Place: Place: Place: Place: Place: Place:

Languages
Mother Language: Level of English (written): Other Language: Other Language: Level of English (spoken):

Medical Fitness
National (Place): German (Place): Issued: Issued: Expired: Expired:

Vaccination
Cholera: Yellow Fever: Other: Other: Issued: Issued: Issued: Issued: Expired: Expired: Expired: Expired:

Marine Personnel

hlag.com

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Application for Employment

Marine Personnel Position: Completed? Please send form to: crew.management@hlag.com

Qualification
1. Certificate of Competency (Nautical or Technical)
1.1. National Competence: 1.2. German Competence: Cert.No: Cert.No: Issued: Issued: Expired: Expired:

1.3. Watchkeeping (Deck/Engine) Cert.No: Issued:

2. GOC (General Operator's Certificate )

2.1. National Cert.No: 2.2. German Cert.No: Issued: Issued: Expired: Expired: Place: Place:

3. BASIC SAFETY TRAINING STCW

3.1. Basic Safety Bundle Cert.No: Issued: Expired: Place: Place: Place: Expired: Place: Place: Place: Place: Expired: Place:

3.2. Certificate of Proficiency in Survival Craft Cert.No: Issued: 3.3. Certificate of Proficiency in Fast Rescue Boat Cert.No: Issued: 3.4. Medical Care Cert.No: 3.5. Medical First Aid Cert.No: 3.6. Advanced Fire Fighting Cert.No: 3.7. ISPS Ships Security Officer Cert.No: Issued: Issued: Issued: Issued:

3.8. Dangerous, hazardous & harmful cargoes (HAZMAT) Cert.No: Issued:

4. Other Certificates/ Courses

4.1. High Voltage Cert.No: Issued:

4.2. Automatic Radar Plotting (ARPA) Cert.No: Issued: 4.3. ME Electronic Engine Cert.No: Issued:

5. Any Other Additional Qualification

Application for Employment

Marine Personnel Position: Completed? Please send form to: crew.management@hlag.com

Experience
1. Training Courses
Training Course / Seminar Location Duration Date

2. Graduated From:

3. Form of Education:

4. Sea Service (For last five years or last 10 ships served)

Name of vessel Type Gross tonnage Engine kW Company Rank from to

5. Availability for Serivce:

Date: Remarks:

6. Notes and Remarks: