7/23/2019 A.L.M.a. Application for Ratings

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 Atlanta Ltd.

(A.L.M.A.) 

The supplement to the Quality manual.

Procedure: “Reception of the seamen/specialists on the

account in a database of the agency.”

№: AT/!."/#

$ersion №: %&

Page: '! of (!

)*A+A,-) *+P0+*,T APP12AT1, 3R+

 Position applied for : Second choice (if any): 44  _ Available from: _ Photo

 Family name: First name:Personal particulars

Date of birth: Place of birth:  Nationality:Marital status : olor of hair: olor of eyes:!ei"ht (cm): #ei"ht ($"): %verall: Shoes:hildren under &' (namedate of birth):!ome address:elephones (stationarymobile): *+mail:

 Ne,t of $in: Surname Name -elationship 444444444444444 

  Addresselephones 44444444444444444444444 

5ocuments and certificates

5ocuments № Place of issue 5ate of issue $alid until

Seaman.s passport

ivil travel passport

2ertificates of

competency

6rade № Place of issue 5ate of issue *ndorsement

7alid until

 National

%ther 

  Name of Marine School (Academy): ____________________________________/raduated on: _______________________ $isa 8)A 44444444444444444444444444444444444444444444444444444444 

)T29 2ertificates № 5ate of issue $alid until

0asic safetysurvival at sea

Medical carefirst aid

/MDSS

-%PS

A-PA

Advanced fire+fi"htin"

Proficiency in survival craft

Personal survival at sea

Dan"erous car"o (!a1mat)

an$er safety

hemical endorsement

Ship !andlin" Arran"ements

Ship.s security officer 

ertificate 2SPS ode

)ea ser7ice during last fi7e years start from last 7essel;

Ran< $essel-sname

type 59T +ain enginetype/=P;

)hip>o?ner+anager/cre?

comp.

3rommonth/

year;

Tomonth/

year;

3ast 4a"es5 6: _  444444 #a"es e,pected5 6: ______ )pecial remar<s to be filled by office only;

*n"lish:__________  ests: Marlins _____ es 78' _____ %ther _____Date of intervie4:____________________ 

311,6 5*) ,T 68ARA,T** *+P0+*,T@@@1& undersigned& confirm the all abo7e information is true and correct to the best of my <no?ledge

Si"nature __________ Date ____________