Application Forms – G&L SHIPMANAGEMENT, INC.

Please Answer accordingly

Put NA if not applicable

POSITION APPLIED FOR *

Name *

First

Middle

Last

Gender *

Male/Female/Bisexual

Mobile No# *

Address *

Date of Birth *

MM/DD/YYYY

Age *

Email *

Confirm Email

Civil Status *

Single/Married/Widow/Separated etc..

SKYPE ID *

Nationality *

Religion *

First

Last

First

Middle

Last

Philhealth No# *

First

Middle

Last

First

Middle

Last

PASSPORT *

First

Middle

Last

SEAMAN'S BOOK *

First

Middle

Last

EREG No# *

SRN *

First

Middle

Last

U.S VISA *

First

Middle

Last

PANAMA ENDORSMENT *

First

Middle

Last

MARSHALL ISLAND *

First

Middle

Last

LIBERIA BOOKLET *

First

Middle

Last

ANTIGUA & BARBUDA *

First

Middle

Last

CHOLERA / TYPHOID *

First

Middle

Last

LICENSE *

DOCUMENTS No#

License *

First

Middle

Last

CERTIFICATE OF COMPETENCY *

DOCUMENTS No#

Certificate of Competency *

First

Middle

Last

ENDORSMENT *

DOCUMENTS No#

Endorsement *

First

Middle

Last

GOC/GMDSS *

DOCUMENTS No#

GOC/GMDSS *

First

Middle

Last

BASIC TRAINING *

First

Middle

Last

COP BT *

First

Middle

Last

PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOAT (PSCRB) *

First

Middle

Last

COP (PSCRB) *

First

Middle

Last

PROFICIENCY IN FAST RESCUE BOAT (PFRB) *

First

Middle

Last

COP (PFRB) *

First

Middle

Last

SEAFARERS WITH DESIGNATED SECURITY DUTY (SDSD) *

First

Middle

Last

COP (SDSD) *

First

Middle

Last

ADVANCE TRAINING IN FIRE FIGHTING (ATFF) *

First

Middle

Last

COP AFF *

First

Middle

Last

MEDICAL CARE (MECA) *

First

Middle

Last

COP MECA *

First

Middle

Last

MEDICAL FIRST AID (MEFA) *

First

Middle

Last

COP MEFA *

First

Middle

Last

CONSOLIDATED MARPOL (I-VI) *

First

Middle

Last

ISM MANAGEMENT *

First

Middle

Last

YELLOW FEVER *

First

Middle

Last

MLC-DF1 *

First

Middle

Last

MLC-DF2 *

First

Middle

Last

MLC-DF3 *

First

Middle

Last

Bridge Resource Management (BRM) *

First

Middle

Last

Bridge Team Management (BTM) *

First

Middle

Last

Cargo Handling and Care of Cargo *

First

Middle

Last

Deck watchkeeping *

First

Middle

Last

Crane Operator *

First

Middle

Last

ECDIS *

First

Middle

Last

Radar Navigation, Radar Plotting& use of ARPA (ROPA) *

First

Middle

Last

Ship handling and Maneuvering *

First

Middle

Last

Ship Security Officer (SSO) *

First

Middle

Last

Ship Simulator & Bridge Teamwork (SSBT) *

First

Middle

Last

SSBT with BRM *

First

Middle

Last

HAZMAT *

First

Middle

Last

Advance Training for Chemical Tanker Cargo Operations (ATCT) *

First

Middle

Last

COP (ATCT) *

First

Middle

Last

Advance Training for liquefied Gas tanker Cargo Operations (ATLGT) *

First

Middle

Last

COP (ATLGT) *

First

Middle

Last

Advance Training for Oil tanker Cargo Operations (ATOT) *

First

Middle

Last

COP (ATOT) *

First

Middle

Last

Basic Training for Liquefied Gas tanker Cargo Operations (BTLGT) *

First

Middle

Last

COP (BTLGT) *

First

Middle

Last

Basic Training for Oil and Chemical Cargo Operations (BTOC) *

First

Middle

Last

COP (BTOC) *

First

Middle

Last

BOSIET (Basic Offshore Safety Induction and Emergency Training) *

First

Middle

Last

FOET (Further Offshore Emergency Training) *

First

Middle

Last

HUET (Helicopter Underwater Escape Training) *

First

Middle

Last

H2S (Hydrogen Sulfide-Alive) *

First

Middle

Last

MLC-EF1 *

First

Middle

Last

MLC-EF2 *

First

Middle

Last

MLC-EF3 *

First

Middle

Last

Advance Marine Electro Technology with simulator *

First

Middle

Last

Auxiliary Machinery System *

First

Middle

Last

Basic Electricity/Introduction to Marie Electro Technology *

First

Middle

Last

Control Engineering *

First

Middle

Last

Engine Watchkeeping *

First

Middle

Last

Engine Resource Management (ERM) *

First

Middle

Last

Engine Room Simulator (ERS) *

First

Middle

Last

Hydraulics and Pneumatics *

First

Middle

Last

Marine Refrigeration & Air Conditioning Simulator *

First

Middle

Last

Basic Shipboard Food Service Management Course *

First

Middle

Last

Catering Management *

First

Middle

Last

Food Hygiene Standard with HACCP *

First

Middle

Last

Shipboard Culinary Course (NCII) *

First

Middle

Last

Ships Catering Management Course Package (NCI, II, III) *

First

Middle

Last

NEXT OF KIN *

Mother’s Name

Contact No# *

Father's Name *

Contact No# *

NAME OF LEGAL DEPENDENTS/BENIFICIARIES *

RELATIONSHIP *

DATE OF BIRTH *

REFERENCES FROM PREVIOUS EMPLOYMENT *

Company name

Contact Person *

Contact Details *

REFERENCES FROM PREVIOUS EMPLOYMENT *

Company name

Contact Person *

Contact Details *

REFERENCES FROM PREVIOUS EMPLOYMENT *

Company name

Contact Person *

Contact Details *

Upon clicking the submit button,

I hereby certify that the information given by me are true and correct to my best of my knowledge and belief. That I have both withheld any information that would affect my application unfavorably. Any false declaration I supplied herein, may constitute ground for disqualification or non acceptance.