adams offshore limitedadams offshore limited section 1 - position applied for date of availability...
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Copyright @ Adams Offshore Limited Page 1 of 6
First/ Given Name
Al Saffar House, Fourth FloorBuilding No.1042
Road no.3621, Block 436Seef District, Manama
Kingdom of Bahrain
ADAMS OFFSHORE LIMITED
SECTION 1 - Position applied for
Date of availability
Position applied for
SECTION 2 - Personal Details
Date of Birth
Nationality
Place of Birth
Family / Surname
Sex
Present address is same as permanent address
Zip CodeState
Country
City
Address2
Address1
PERMANENT ADDRESS:
Zip CodeStateCity
Address2
Address1
PRESENT ADDRESS:
CONTACT DETAILS:
Telephone 1 Telephone 2 Mobile
Fax Number How do prefer to be contacted?
NEXT OF KIN:
Zip CodeStateCity
Address1
Full Name Relationship
Tel 1 Tel 2
Mobile
Are you married? Enter wedding anniversary (wedding date)
Note: Adams is an equal opportunity employer .
Lowest Position acceptable
Note: Drop down fields are editable
Last Position held
Note: If present address is same as permanent address, after filling in permanent address, check the checkbox above
Note: Drop down fields are editable
Note: Drop down fields are editable
DP FLEET - ONLINE APPLICATION FORM
Email1 Email2
Country
Country
NOK Email
Copyright @ Adams Offshore Limited Page 2 of 6
SECTION 3 - Certificate of Competency / Licenses heldClass/Grade Issuing Country Certificate No.: Date Issued Expires on
Expires onDate IssuedCertificate No.:Text
Basic Sea Survival
Proficiency in Survival Craft
Personal safety & Social Responsibility
Fire Fighting
Advanced Fire Fighting
Medical & First Aid
Ship Captains Medical Course
GMDSS
Ship Security Officer Course (SSO)
Personal Survival Techniques
Medical Fitness Certificate
Medical Care
Radar Observer
Radar Simulator
ARPA
Bridge Team Management
Bridge Resources Management
ISM Code
Class/Grade Issuing Country Certificate No.: Date Issued Expires onClass/Grade Details of Limitations
Certificate No.: Expires onDate IssuedIssuing Institute/Place
SECTION 4 - Details of STCW certificatesName of Course/Certificate
Note: Drop down fields are editable
Copyright @ Adams Offshore Limited Page 3 of 6
SECTION 5 - Details of Offshore Training Courses and certificates obtained
Initial Standby vessel crews training
Offshore Survival
H2S Course
Re-Breather training
Civil Aviation Authorities - Helicopter
Medical & First Aid
Proficiency in RESCUE CRAFTS
Proficiency in RESCUE BOATS
Advanced Medical Aid
Helicopter Underwater Escape Training
H2S/BA Certificate
Dynamic Positioning Induction Course
Dynamic Positioning Simulator Course
DP Operators Certificate
DP Maintenance Course
DP Log book Details
Expires onDate IssuedCertificate No.:Issuing Institute/PlaceName of Course/Certificate
SECTION 6 - Details of Other Educational Qualification or TrainingExpires onDate IssuedCertificate No.:Name of Course/Certificate
SECTION 7 - Medical History
Do you have any health or disability problem now?
Have you consulted a doctor during the past 12 months for an illness / Accident?
Have you undergone any medical operations in the past?
Have you ever signed off a ship due to medical reason?
If the answer to any of the above is in affirmative (YES), please enter details below:-
Issuing Institute/Place
Copyright @ Adams Offshore Limited Page 4 of 6
Expires on
SECTION 8 - Passport / Seaman Book and Travel DetailsFull Name (as in Passport)
Date Expires onDate Issued
Place IssuedPassport Number
Date Expires onDate Issued
Place Issued
Full Name (as in Passport)
Passport Number
Date Expires onDate Issued
Place IssuedSeaman Book Number
SEAMAN BOOK DETAILS:
Date Expires onDate Issued
Place IssuedSeaman Book Number
LEAVE DESTINATION DETAILS:
Nearest AirportCountryLeave Destination
What is your prefered airline for travel?
CountryLeave Destination
Note: Where possible preferences will be taken intoconsideration with no assurance whatsoever.
VISA DETAILS:
Country Issued at Issued on Remarks
OTHER DETAILS:
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 denied a visa by the United States of America?
Have you ever been denied a visa by any country?
Do you have any previous criminal convictions?(FOR US VISA APPLICATION)
If the answer to any of the above is in affirmative (YES), please enter details below:-
Do you have dual nationality or hold a second passport? (If yes, please fill in details of the second passport below.)
Type
Do you have a second seamans book? (If yes, please fill in details of the second passport below)
Expires onIssued at Issued on RemarksType
Note: Drop down fields are editable
Note: Drop down fields are editable
Copyright @ Adams Offshore Limited Page 5 of 6
SECTION 9 - Experience DetailsCumulative Experience - Enter highest to lowest
Date ToDate FromLast Company ServedTotal Period in monthsRank / Position
Last Contract
SECTION 10 - Hours done with various DP systemsHours as JDPOHours as SDPODP System Details Model
SECTION 11 - Record of Sea ServiceVessel Company
Type ofVessel
DWT/GRT/BHP
Type ofEngine/DP
RankSigned
OnSigned
Off
Type of Engines :: for engineers only, DPOs to Mark DP System BHP : for Engineers and AHTS / TUG Masters & Officers
OperationInvolved
Note: Drop down fields are editable
Note: Drop down fields are editable
Note: Drop down fields are editable
Copyright @ Adams Offshore Limited Page 6 of 6
Understood
Why did you quit previous employer? (Give brief explanation)
SECTION 12 - References
Person
Reference One
SECTION 13 - Additional Information
Position
Company
Full Address
Telephone
Reference Two
Fax Number
What is the Maximum acceptable trip length for you?
Minimum salary/day rate expectation (please quote in GBP£ (UK personnel) or in US$ (for NON-UK personnel) Note: Leave pay inclusive
How did you hear about us? (Give brief explanation)
Languages spoken/written/understood 1-Poor, 2- Fair, 3-Good, 4-Very Good, 5-Excellent
WrittenSpokenLanguage
ENGLISH
Thank you for your time in filling this form. Once you submit this form, our DP vessel crew co-ordinator will get in touch with you ifyou are eligible and as soon as a suitable vacancy arises.
How to submit this form?You can submit this form in three ways:1. Click "Submit by Email" and all the data will be extracted without the form itself being sent and you will be prompted to email it to the correct email addresses. This isthe preferred way.2. You can save the file with your entries, and send the full file back to [email protected]. You can print the form and mail the printout to "James Thomson, DP vessel crew co-ordinator, Al Saffar House, Fourth Floor, Building No.1042, Road no.3621, Block436, Seef District, Manama, Kingdom of Bahrain."
Company
Person Position
Full Address
Telephone Fax Number
Note: To fill this form you will require Adobe Acrobat Reader 7 or Professional 7 (or later versions)
Note: Some drop down fields are editable