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[{"$nulls":5},"WALLEM SHIPMANAGEMENT LIMITED",{"$nulls":21},"Kindly affix a regular & \nrecent passport size \nPHOTOGRAPH .",{"$nulls":10},"Application form not verified, will be rejected",{"$nulls":105},193]
[{"$nulls":143},"X"]
{"$rows_empty":7}
[{"$nulls":37},"<<< click on desired tab/ button to view "]
["A P P L I C A T I O N     F O R M ",{"$nulls":16},"Date :",{"$nulls":3},"00:00:00"]
[]
[1,"Rank Applied For :",{"$nulls":16},"Date Of Availability:",{"$nulls":10},0,2006,4,1,{"$nulls":4}," [ select from dropdown menu ]",{"$nulls":70},"D"]
["PERSONAL DESCRIPTION AND INFORMATION"]
[2,"Name",{"$nulls":3},"Last:",{"$nulls":9},"First:",{"$nulls":10},"Middle:",{"$nulls":11},"[ Please fill as in your passport ]",{"$nulls":69},"D"]
[3,"Birth",{"$nulls":3},"Date:",{"$nulls":6},"Place & Country:",{"$nulls":13},"Nationality:",{"$nulls":81},"D"]
[null,"INDOS Number",{"$nulls":106},"D"]
[4,"Passport ",{"$nulls":3},"No:",{"$nulls":5},"Place of Issue",{"$nulls":7},"Date of Issue",{"$nulls":8},"Date of Expiry",{"$nulls":8}," [ date format - dd/mmm/yy ]",{"$nulls":70},"D"]
[5,"U.S. Visa",{"$nulls":3},"Type:",{"$nulls":5},"Place of Issue",{"$nulls":7},"Date of Issue",{"$nulls":8},"Date of Expiry",{"$nulls":79},"D"]
[null,"U.S Visa",{"$nulls":3},"Sec.",{"$nulls":5},"Place of Issue",{"$nulls":7},"Date of Issue",{"$nulls":8},"Date of Expiry",{"$nulls":79},"D"]
[]
[6,"Permanent  Address  &  Contact Details",{"$nulls":106},"D"]
[{"$nulls":10},"City",{"$nulls":5},"State",{"$nulls":7},"Country",{"$nulls":6},"ZipCode",{"$nulls":76},"D"]
[null,"STD Code ",{"$nulls":6},"Res.",{"$nulls":5},"Fax:",{"$nulls":5},"Mobile:",{"$nulls":6},"Email",{"$nulls":80},"D"]
[]
[7,"Correspondence  Address & Contact Details : ",{"$nulls":106},"D"]
[{"$nulls":10},"City",{"$nulls":5},"State",{"$nulls":7},"Country",{"$nulls":6},"Zip Code",{"$nulls":76},"D"]
[null,"STD Code ",{"$nulls":6},"Res.",{"$nulls":5},"Fax:",{"$nulls":5},"Mobile:",{"$nulls":6},"Email",{"$nulls":80},"D"]
[{"$nulls":37}," [ select from dropdown menu ]"]
[8,"Marital  Status",{"$nulls":11}," No. of Children",{"$nulls":8},"Nearest Airport / Station",{"$nulls":85},"D"]
[]
[9,"Family/NOK/Emergency Contact",{"$nulls":8},"Rela-tion",null,"Date of Birth",null,null,"Place of Birth",{"$nulls":4},"Passport No.",{"$nulls":3},"Date of Issue",null,null,"Date of Expiry",null,null,"Place of Issue",{"$nulls":4},"ECNR"]
[{"$nulls":37}," [ date format - dd/mmm/yy]"]
[{"$nulls":37}," [ if yes put 'X' ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[]
[10,"Next of Kin - [ Name , Address & Contact Details]",{"$nulls":8},"Name",{"$nulls":16},"Relationship",{"$nulls":80},"D"]
[]
[{"$nulls":23},"City",{"$nulls":84},"D"]
[{"$nulls":10},"State",{"$nulls":7},"Country",{"$nulls":10},"Zip Code",{"$nulls":78},"D"]
[null,"Std. Code ",{"$nulls":6},"Res.",{"$nulls":5},"Fax:",{"$nulls":5},"Mobile:",{"$nulls":6},"Email",{"$nulls":80},"D"]
[]
[11,"Emergency Address            [If family onboard]",{"$nulls":8},"Name",{"$nulls":97},"D"]
[]
[{"$nulls":23},"City"]
[{"$nulls":10},"State",{"$nulls":7},"Country",{"$nulls":10},"Zip Code",{"$nulls":78},"D"]
[null,"STD Code ",{"$nulls":6},"Res.",{"$nulls":5},"Fax:",{"$nulls":5},"Mobile:",{"$nulls":6},"Email",{"$nulls":80},"D"]
[]
[12,"Licence  Grade -  [Description]",{"$nulls":13},"Number",{"$nulls":6},"Date of Issue ",{"$nulls":3},"Date of Expiry",{"$nulls":3},"Country",{"$nulls":4},"Nat-  ional"]
[]
[{"$nulls":37},"[date format - dd/mmm/yy ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[]
[13,"Seaman Book  [ C.D.C ]",{"$nulls":13},"Number",{"$nulls":6},"Date of Issue",{"$nulls":3},"Date of Expiry",{"$nulls":3},"Place of Issue",{"$nulls":4},"Nat-  ional"]
[]
[{"$nulls":37}," [ date format - dd/mmm/yy ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[14,"Other visa"]
[null,"Name",{"$nulls":13},"Place of Issue",{"$nulls":12},"Date of Issue",{"$nulls":3},"Date of Expiry"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[]
["COURSES AND CERTIFICATES"]
[15,"Description",{"$nulls":9},"Issuing Authority",{"$nulls":5},"Number",{"$nulls":4},"Date of Issue",{"$nulls":3},"Date of  Expiry",{"$nulls":3},"Nationality"]
[]
[{"$nulls":37}," [ date format - dd/mmm/yy ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
["Note: Details of any more courses / certificates other than the above may be included  below in box No. 18 - [SUMMARY]"]
["PREVIOUS SEA EXP.  [ Datewise upto 10 previous vessels in ascending order ] ie : End with your last vessel served"]
[16,"Vessel Name",{"$nulls":5},"Flag",null,"Type",null,"Dwt",null,"GRT",null,"Engine",null,"Bhp",null,"Manning Agts /",{"$nulls":4},"Rank",null,null,"From",null,null,"To",null,null,"UMS",null,"TEUs"]
[{"$nulls":15},"Type",{"$nulls":3},"Owners Name"]
[{"$nulls":37}," [ date format - dd/mmm/yy ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[null,"Note : Eng. Officers and Elec.Officers to indicate UMS experience"]
[]
[17,"SUMMARY OF KNOWLEDGE AND EXPERIENCE ACQUIRED [Give a brief resume of your Career and Experience at Sea, e.g. Type of Ships, Engines, Specific Trades (E.G. ICE / Lighterage etc.), reactivation, New Buildings, Shore Experience, Computer Knowledge etc.]  \n"]
[]
[]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[]
["EDUCATIONAL BACKGROUND  [ please include pre-sea training ]"]
[18,"Name of Schools / Colleges Attended",{"$nulls":13},"City / Country",{"$nulls":6},"From",null,null,"To",null,null,"Type of Degree / Diploma / Qualification Received"]
[]
[{"$nulls":37}," [ date format - mmm/yyyy ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[]
["REFERENCES:"]
[19,"Title",null,"Name",{"$nulls":17},"Company Name",{"$nulls":6},"Phone Number"]
["A",{"$nulls":107},"D"]
[{"$nulls":108},"D"]
["B",{"$nulls":107},"D"]
[{"$nulls":108},"D"]
[null,"Address"]
["A",{"$nulls":107},"D"]
["B",{"$nulls":107},"D"]
[]
["LANGUAGES"]
[20,"LANGUAGE",{"$nulls":5},"Spoken",{"$nulls":3},"Written",{"$nulls":3},"Read",{"$nulls":4},"OTHER [specify]",{"$nulls":4},"Spoken",{"$nulls":3},"Written",{"$nulls":3},"Read"]
[null,"ENGLISH",{"$nulls":35},"[ Type 'X' to tick ]",{"$nulls":70},"D"]
[{"$nulls":37},"[ Type 'X' to tick ]",{"$nulls":70},"D"]
[]
["PHYSICAL DECLARATION "]
[21,"VISION",{"$nulls":5},"Excellent",{"$nulls":3},"Good",{"$nulls":3},"Poor",{"$nulls":4},"HEARING",{"$nulls":4},"Normal",{"$nulls":3},"Poor",{"$nulls":3},"Nil"]
[null,"With Glasses",{"$nulls":18},"Right Ear",{"$nulls":16}," [ Type 'X' to tick ]",{"$nulls":70},"D"]
[null,"Without  Glasses",{"$nulls":18},"Left Ear",{"$nulls":16}," [ Type 'X' to tick ]",{"$nulls":70},"D"]
[]
[null,"Height (cms)",{"$nulls":6},"Hair  [colour]",{"$nulls":8},"Identification Mark on body  [if any]",{"$nulls":90},"D"]
[null,"Weight (kgs)",{"$nulls":6},"Eyes [colour]",{"$nulls":28},174,{"$nulls":70},"D"]
[]
["a","Are you involved in any marine accident/investigations? [Collision/Grounding/Fire/Pollution]?  If yes please give details",{"$nulls":35},"[ select from dropdown menu ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":37},178,{"$nulls":70},"D"]
[]
["b","Did you suffer any accident which rendered you temporarily and / or partially disabled ? If yes please give details.",{"$nulls":35},"[ select from dropdown menu ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[]
["c","Are you currently under medical treatment or taking medication for existing conditions?  If yes please give details",{"$nulls":35},"[ select from dropdown menu ]",{"$nulls":70},"D"]
[{"$nulls":108},"D"]
[{"$nulls":108},"D"]
[]
["d","Did you suffer , or do you presently suffer from any diseases likely to render you unfit for sea service or likely to endager the health of other persons onboard ?",{"$nulls":35},"[ select from dropdown menu ]"]
[]
[]
["e","Did you ever undergo psychiatric treatment ?",{"$nulls":35},"[ select from dropdown menu ]"]
[]
["f","Are you addicted to alcohol or drugs of any kind ?",{"$nulls":35},"[ select from dropdown menu ]"]
[]
["UNION MEMBERSHIP DETAILS "]
{"$rows_empty":9}
[null,"Membership No. [ For Officers]",{"$nulls":23},"Date",{"$nulls":11},"[ date format - dd-mmm-yy ]",{"$nulls":70},"D"]
[22,"Seaman Registration No. [ For Ratings]",{"$nulls":23},"Date",{"$nulls":82},"D"]
{"$rows_empty":20}
[23,"ADDITIONAL INFORMATION"]
[null,"a.","CARGO'S CARRIED"]
[null,"b.","TRADING PATTERN"]
[null,"c.","NATIONALITIES SAILED WITH"]
[null,"d.","CARGO GEAR'S"]
[null,"e.","COMPUTER SKILL"]
[null,"f.","CARGO GEAR'S"]
[null,"g.","MISCELLANEOUS"]
[]
[24,"REASON FOR LEAVING LAST EMPLOYER"]
[null,"a."]
[null,"b."]
[]
[25,"CONTACTS OF SENIOR OFFICERS SAILED WITH FOR REFERENCE CHECK (NAME & PHONE  NUMBER)"]
[null,null,"Name",{"$nulls":22},"Phone Number"]
[null,1]
[null,2]
[null,3]
[]
[26,"HOW DID YOU COME TO KNOW ABOUT US? (Please tick the appropriate medium)       "]
[null,"A","Company presentation/seminar",{"$nulls":11},"B","Marine Club notice-board",{"$nulls":9},"C","Marine magazine advertisement"]
[null,"D","Newspaper advertisement",{"$nulls":11},"E","Told by seagoing friend(s)",{"$nulls":9},"F","Direct Mail from Company"]
[null,"G","Others (Please specify)"]
[]
[27,"DECLARATION"]
[null,"I certify that the details given by me in filling up this form are true, complete, and correct to best of my knowledge and belief. I understand that any misrepresentation or material omission made in this application     form or other    documents submitted to Wallem Shipmagement  may renders me liable for termination or dismissal."]
[]
[]
[null,"Date:",{"$nulls":6},"SIGNATURE OF APPLICANT"]
[]
[null,"An acknowledgement of this application is received."]
[null,"Date:",{"$nulls":6},"SIGNATURE OF RECRUITING AGENT"]
[]
[null,"Please hand in, mail or e-mail your application to:"]
[null,"Eurasia.:-   License No.RPSL-MUM-026  Valid till 06.07.2011"]
[null,"401, Olympia, Hiranandani Gardens, Powai",{"$nulls":16},"208, Oriental House, Gulmohar Enclave Commercial Complex"]
[null,"Mumbai - 400 076 ",{"$nulls":16},"New Delhi –110 049"]
[null,"Telephone: (022) 5704224         Fax: 91-11- 5704226  ",{"$nulls":16},"Telephone: (011) 6510111, 6510222       Fax: 91-11-6960222"]
[null,"E-mail: psm.mumbai@eurasiagroup.com ",{"$nulls":16},"E-mail: psm.delhi@eurasiagroup.com "]
[]
[null,"6-A, EGA Trade Centre"]
[null,"809, Poonamalle High Road"]
[null,"Kilpauk, Chennai 600 010"]
[null,"Tel: 91-44-26616007/6407"]
[null,"Fax: 91-44-52178054"]
[null,"Email : eurasia.chennai@eurasiagroup.com"]
[]
[28,"INITIAL INTERVIEW",{"$nulls":9},"SIGHTED",{"$nulls":3},"CHECKED",{"$nulls":3},"Experience confrmd by interview"]
[null,"Original Licences/Passport/CDC ",{"$nulls":17},"Details confirmed by Interview."]
[null,"STCW and Training Certificates ",{"$nulls":17},"References Checked"]
[]
[null,"GRADING",{"$nulls":4},"EDUCATION",{"$nulls":4},"EXPERIENCE",{"$nulls":4},"PERSONALITY",{"$nulls":4},"COMMUNICATION",{"$nulls":5},"POTENTIAL",{"$nulls":4},"OVERALL ASSESMENT"]
[null,"Excellent",{"$nulls":36}," [ date format - dd-mmm-yy ]"]
[null,"Good"]
[null,"Satisfactory"]
[null,"Poor"]
[]
[null,"Interviewed by:",{"$nulls":28},"Date:"]
[]
[null,"Additional Comments:"]
{"$rows_empty":77}
[{"$nulls":106},"DROPDOWN BOX",{"$nulls":15},"SEATIME CALCULATION"]
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[]
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["CANDIDATES SUMMARY OF KNOWLEDGE AND EXPERIENCE  CONTD."]
["SUMMARY OF KNOWLEDGE AND EXPERIENCE ACQUIRED [Give a brief resume of your Career and Experience at Sea, e.g. Type of Ships, Engines, Specific Trades (E.G. ICE / Lighterage etc.), reactivation, New Buildings, Shore Experience, Computer Knowledge etc.]  \n"]

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